The patient suffers from akathisia, an unbearable feeling of inner restlessness that manifests in movement. Whether the person shuffles the feet back and forth, or repeatedly rises and sits from the chair or paces in place, remaining immobile is nearly impossible. The symptoms may arise as a side effect of medications. Neuroleptic antipsychotics (the major tranquilizers) especially the phenothiazines, thioxanthenes, butyrophenones, piperazines, antiemetics and stimulants are known to bring about the problem. People with Parkinson’s disease, and Huntington’s disease may suffer with the condition.

The patient describes rage, feeling like he must fight against the world. He doesn’t want to meet people for lunch, go for a walk, leave the house or exercise. He feels he constantly maintains equilibrium by practicing anger management. He gets no relief, and he states he’s worn down by the constant agitation, anxiety and feeling of coldness. Whatever the physician has tried is not working. He needs a new solution as fast as possible.

The doctor recommends Seroquel at night to calm him down and to improve sleep and to maintain it for at least six hours, straight. When the patient finds he is sleeping six hours, then he is taking the correct amount, until then he should gradually increase the medication. He also recommends taking it in smaller doses, during the day, working up to taking it four times, spread throughout daylight hours.

After changing the state of the patient’s akathisia, he would like the patient to schedule his days with an assortment of activities. Getting out of the house, getting exercise and meeting others should be included in a weekly agenda. Until the patient reaps some benefit from Seroquel, he is likely to be at risk of suicide. The nurse coordinator speaks separately with the spouse of the patient, encouraging her to be the one who controls access to medications. The patient stands heads above the physician and his spouse. Northern European, perhaps Norwegian Viking genes have endowed the patient with the height and strength to inflict serious bodily injury on someone, should he become upset. His teary wife is not the only one hoping for a quick change in circumstances.

The muscles of your jawbone go berserk, so that you bite the inside of your mouth and your jaw locks and the pain throbs. For hours every day this will occur. Your spinal column stiffens so that you can hardly move your head or your neck and sometimes your back bends like a bow and you cannot stand up. The pain grinds into your fiber … You ache with restlessness, so you feel you have to walk, to pace. And then as soon as you start pacing, the opposite occurs to you; you must sit and rest. Back and forth, up and down you go in pain you cannot locate, in such wretched anxiety you are overwhelmed, because you cannot get relief even in breathing. Jack Henry Abbot, In the Belly of the Beast (1981/1991).


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