Comprehensive exams for Mental Health Q 81
A client is receiving haloperidol (Haldol) to reduce psychotic symptoms. As he watches television with other clients, the nurse notes that he has trouble sitting still. He seems restless, constantly moving his hands and feet and changing position. When the nurse asks what is wrong, he says he feels jittery. How should the nurse manage this situation?
A. Ask the client to sit still or leave the room because he is distracting the other clients.
B. Ask the client if he is nervous or anxious about something.
C. Give an as needed dose of a prescribed anticholinergic agent to control akathisia.
D. Administer an as needed dose of haloperidol to decrease agitation.
Correct Answer: C. Give an as needed dose of a prescribed anticholinergic agent to control akathisia.
Akathisia, characterized by restlessness, is a common but often overlooked adverse reaction to haloperidol and other antipsychotic agents; it may be confused with psychotic agitation. To control akathisia, the nurse should give an as needed dose of a prescribed anticholinergic agent. Anticholinergic agents such as benztropine may be utilized if concomitant pseudoparkinsonism is present.
Option A: The client can’t control the movements, so asking him to sit still would be pointless. Patient’s presenting with akathisia typically have recently started an antipsychotic agent, or their dose has been increased. Akathisia usually develops within the first 2 weeks of antipsychotic therapy. There are subjective and objective components to akathisia. Patients will typically describe a feeling of restlessness with a desire to move. Additionally, patients will be objectively seen manifesting that restlessness by pacing, rocking, and shifting position. Patients with akathisia often feel distressed and uncomfortable.
Option B: Asking him to leave the room wouldn’t address the underlying cause of the problem. Encouraging him to talk about the symptoms wouldn’t stop them from occurring. Providers should be aware that the inner restlessness often causes extreme anxiety and dysphoria in the individual. In chronic cases, akathisia has also been associated with a high risk of self-harm or suicidal behavior; therefore, the clinician should obtain a history of depression, anxiety, and suicidal ideations.
Option D: Giving more antipsychotic medication would worsen akathisia. The exact etiology of akathisia is unknown, but it is thought to be due to antipsychotic agents blocking dopamine type-2 receptors in the brain. The general belief is that there is an imbalance between cholinergic/dopaminergic or serotonergic/dopaminergic systems. The organ where this imbalance occurs is most likely the shell of the nucleus accumbens.