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Diagnosis and treatment of akathisia in a cancer patient who cannot stand up or sit down, because of poor performance status: Factors that make the diagnosis of akathisia difficult, and diagnosis clues

Published online by Cambridge University Press:  28 September 2010

Hideki Onishi*
Department of Psycho-Oncology, Saitama Medical University, Japan
Makoto Wada
Department of Psycho-Oncology, Saitama Medical University, Japan
Tomomi Wada
Department of Psycho-Oncology, Saitama Medical University, Japan
Mei Wada
Department of Psycho-Oncology, Saitama Medical University, Japan
Mayumi Ishida
Graduate School of Human Sciences, Waseda University, Japan
Chiaki Kawanishi
Department of Psychiatry, Yokohama City University, Japan
Keiko Mizuno
Department of Clinical Oncology, Saitama Medical University, Japan
Hiroshi Ito
Department of Clinical Oncology, Saitama Medical University, Japan
Masaru Narabayashi
Department of Clinical Oncology, Saitama Medical University, Japan
Yasutsuna Sasaki
Department of Clinical Oncology, Saitama Medical University, Japan
Address correspondence and reprint requests to: Hideki Onishi, Department of Psycho-Oncology, Saitama Medical University, 1397-1 Yamane, Hidaka-City, Saitama, 350-1298, Japan. E-mail:



Akathisia is a common adverse effect of antipsychotics and, less commonly, antidepressants. Akathisia can cause great discomfort and is often described by the patient as a most distressing sensation; however, the condition is often underdiagnosed or misdiagnosed. In oncological settings, neuroleptics and antidepressants that induce akathisia are also administered. However, reports of akathisia in oncology settings are few and a case of akathisia in a bedridden patient has not been reported as far as we know.

Case report:

A 72-year-old man with esophageal cancer who could not sit down or stand up was administered 5 mg/day haloperidol to relieve agitation as a symptom of major depressive disorder. Three days after the administration of haloperidol, the agitation had become worse. Careful observation revealed that the patient sometimes showed slight rubbing movement of the lower extremities and slight twisting movements of the body, which were not observed before the administration of haloperidol. The patient moved his body and lower extremities to relieve restlessness, which had developed after the administration of haloperidol. Although symptoms were atypical, akathisia was suspected and discontinuation of haloperidol resolved the symptoms.

Results and significance of results:

In patients with poor performance status, clues leading to the correct diagnosis of akathisia might be absent, which would not be the case in patients who were able to walk, stand up, or sit down. Careful observations of patients before and after the administration of drugs that may cause akathisia may be required to ensure correct diagnosis.

Case Report
Copyright © Cambridge University Press 2010

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