Restlessness of Respiration as a Manifestation of Akathisia: Five Case Reports of Respiratory Akathisia

Background: Akathisia is a feeling of subjectiveor inner restlessness, which causes excessive, semipurposefulmovements, commonly in the legs. However, restlessness inrespiration, which presents as dyspnea but is best characterizedas the sensation of being unable to breathe in a relaxed manner,has never been reported.

Case Reports: Five cases are reported in whichdyspnea as a sign of akathisia followed the administration ofantipsychotic medications. The clinical features of dyspnea wereexamined, and all patients manifested both subjective andobjective restlessness. The dyspnea was characterizedsubjectively by the patients’ inner feeling of restlessness inrespiration, which was perceived as an inability to breathe in aleisurely, relaxed manner, and objectively as restless movementsof respiration such as gasping or sighing. The dyspnea wasmomentarily suppressed when a patient took a quick, full breathto relieve the perceived restlessness and was exacerbated whenthe patient kept the respiration still. Response to medicationscommonly used in the treatment of akathisia was also examined inan open, uncontrolled therapeutic trial for each patient. Theadministration of such medications completely alleviated therespiratory restlessness.

Conclusion: Restlessness in respiration, whichclinically presents as dyspnea, may be a manifestation ofakathisia. This type of akathisia could be referred to as respiratoryakathisia.