It is often used in tardive dyskinesia. Combination Therapy for Treatment Resistant Schizophrenia Schizophrenia is a mental disorder that affects how a person acts, thinks, and feels. 2023 eHealthMe.com. Depending on your symptoms, they could give you a mood stabilizer or antidepressant. It is important to take this medicine together with other medicines for Parkinson's disease. Cogentin and Schizophrenia - a phase IV clinical study of FDA data Haldol Decanoate (haloperidol decanoate) is an antipsychotic used to treat schizophrenia. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. 1Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, AB, Canada, 2Department of Psychiatry and Pharmacy, Dalhousie University, Halifax, NS, Canada, 3Department of Psychiatry, University of Calgary, Calgary, AB, Canada, 4Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada, 5Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy, 6Institute of Molecular and Clinical Sciences, St Georges University of London, London, UK, 7Institute of Cardiovascular and Cell Sciences, St Georges University of London, London, UK, 8Department of Philosophy, Kings College London, London, UK, 9Departments of Psychiatry and Psychological Clinical Science, Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, ON, Canada, 10Department of Neurology, St Georges University of London, London, UK, 11Division of Psychiatry, University of Edinburgh, Edinburgh, UK, 12Department of Psychiatry, Imperial College London, London, UK, Supplemental Material, Appendix_1_Search_Strategy for The Assessment and Treatment of Antipsychotic-Induced Akathisia by Tamara Pringsheim, David Gardner, Donald Addington, Davide Martino, Francesca Morgante, Lucia Ricciardi, Norman Poole, Gary Remington, Mark Edwards, Alan Carson, and Thomas R. E. Barnes in The Canadian Journal of Psychiatry, Supplemental Material, Appendix_2_Akathisia_Table_of_Included_Studies for The Assessment and Treatment of Antipsychotic-Induced Akathisia by Tamara Pringsheim, David Gardner, Donald Addington, Davide Martino, Francesca Morgante, Lucia Ricciardi, Norman Poole, Gary Remington, Mark Edwards, Alan Carson, and Thomas R. E. Barnes in The Canadian Journal of Psychiatry. Two trials have compared benztropine to other drugs for the treatment of antipsychotic-induced akathisia.65,66 Both trials had a high risk of bias (class III and IV), and neither employed a non-inferiority design. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. benztropine - UpToDate This double-blind, randomized, multicenter study investigated the use of divalproex with an antipsychotic agent in patients hospitalized for acute exacerbation of schizophrenia. Both trials reported significant improvement with vitamin B6 relative to placebo on the Barnes Akathisia Rating Scale subjective and global subscales, but not on the objective subscale. Antipsychotics come with other side effects as well. With medical big data and AI algorithms, eHealthMe is running millions of phase IV trials and makes the results available to the public. Le but de ce guide est d'offrir aux cliniciens des recommandations sur l'valuation et le traitement de l'acathisie. Akathisia is a common and distressing neuropsychiatric syndrome associated with antipsychotic medication, characterised by subjective and objective psychomotor restlessness. Adverse effects of treatment were not formally studied or reported in either study. We need more research about how effective these treatments are for schizophrenia, but many doctors try them. Do no harm: Benztropine revisited | MDedge Psychiatry Our analysis results are available to researchers, health care professionals, patients (testimonials), and software developers (open API). The Assessment and Treatment of Antipsychotic-Induced Akathisia Successful clonazepam treatment of neuroleptic-induced akathisia in older adolescents and young adults: a double-blind, placebo-controlled study, A double-blind comparison of clonazepam and placebo in the treatment of neuroleptic-induced akathisia, Vitamin B6 treatment in acute neuroleptic-induced akathisia: a randomized, double-blind, placebo-controlled study. Maintenance dose: 2 to 8 mg orally per day Maximum dose: 16 mg orally per day Oral Formulation Comments: They may be less effective on "negative" symptoms like withdrawal and lack of emotion. Both studies had a high risk of bias (Class III) and included a small number of participants. Usual Adult Dose for Psychosis Oral Haloperidol Formulations: Moderate symptomology: 0.5 to 2 mg orally 2 to 3 times a day Severe symptomology: 3 to 5 mg orally 2 to 3 times a day Initial doses of up to 100 mg/day have been necessary in some severely resistant cases. Medications assessed include amantadine (one Class III trial v. benztropine),66 apomorphine (one Class III trial v. placebo),81 zolmitriptan (one Class III trial v. propranolol),61 clonidine (2 class IV studies),62,82 gabapentin (one Class IV study),83 and pregabalin (one Class IV study).84 The results of these trials are described in the Supplemental Appendix. Pyridoxine-induced neurotoxicity in rats: a stereological quantification of the sensory neuropathy, Low-dose apomorphine challenge in tardive akathisia. But it can be, and often is, a persistent problem when not addressed; chronic akathisia is usually defined as the continuation of the signs and symptoms for more than 3 months. The treating team reviews Ms. P's medication regimen, and notes that she is receiving benztropine 1 mg twice daily for prophylaxis of extrapyramidal symptoms (EPS). The doses used exceed those currently recommended, and the adverse effects of anticholinergic medications, including memory impairment, are of great concern in patients with schizophrenia. What Are Side Effects of Haldol Decanoate? 8600 Rockville Pike Studies were rated for methodological quality using the American Academy of Neurology Risk of Bias Classification system. These drugs work on chemicals in thebrainsuch as dopamine and serotonin. Overall ratings: 3.4/5 Poyurovsky M, Pashinian A, Weizman R, et al. A controlled trial of amantadine in drug-induced extrapyramidal disorders. generic drugs) are not considered. Benztropine (Oral Route) Proper Use - Mayo Clinic Our analysis results are available to researchers, health care professionals, patients (testimonials), and software developers (open API). L'acathisie est un syndrome neuropsychiatrique commun et prouvant associ aux mdicaments antipsychotiques, caractris par une agitation psychomotrice subjective et objective. fever. Limitations in the evidence should be acknowledged and prompt cautious prescribing, particularly with respect to the duration of use of adjuvant medications, is warranted. Side Effects EPS Sedation TD Anticholinergic BP Sexual Dysfunction Weight Gain clozapine (Clozaril) haloperidol (Haldol) olanzapine (Zyprexa) risperidone (Risperdal) quetiapine (Seroquel) ziprasidone (Geodon)++ + + + + + + Side Effects/Co-existing Symptoms Anti-EPS Starting Dose Range (daily dose) Each recommendation required agreement by 80% of the panel for inclusion in the guideline. We included any type of therapeutic study, including case reports, case series, and controlled trials. Although recognised soon after the introduction of antipsychotic medication,2,3 it was largely overlooked for 30 years4,5 until the clinical presentation was delineated in the 1980s.68 The core of the condition is a subjective experience of mental unease and dysphoria, characterised by a sense of restlessness that may sometimes drive impulsive behaviour.9,10 When the condition is severe, there is an irresistible urge to move around, partly to achieve some respite. The evidence to support the use of clonazepam for the treatment of antipsychotic-induced akathisia is limited and with a high risk of bias. Three trials comparing haloperidol with olanzapine, and 2 trials comparing haloperidol with olanzapine and risperidone demonstrated a significantly higher risk of treatment-emergent akathisia with haloperidol. Warnings Use only as directed. Tamara Pringsheim, MD, Mathison Centre for Mental Health Research and Education, 3280 Hospital Drive NW, Calgary AB, Canada T2 N 4Z2. A randomised controlled trial addressed the risks and benefits of staying on antipsychotic polypharmacy or switching to monotherapy in adults with schizophrenia.47 Outpatients taking 2 antipsychotics were randomised to stay on polypharmacy or switch to monotherapy by discontinuing one antipsychotic. Treatment of Agitation With Lorazepam in Clinical Practice: A Pharmacogenomics and Personalized Medicine: "Treatment-resistant schizophrenia: current insights on the pharmacogenomics of antipsychotics. If your dose is different, do not change it unless your doctor tells you to do so. Keep from freezing. There are 7 published trials comparing propranolol with placebo for the treatment of akathisia. Some common ones are: The newer ones are called second-generation or atypical antipsychotics. Patients (n=249 . Some data suggest that anticholinergic medications may be preferentially helpful in patients with akathisia and co-existing parkinsonism. The overall level of evidence classifications were made using the Scottish Intercollegiate Guidelines Network framework (see Table 2). Recommendation statements were formulated based on the evidence obtained from the systematic review, the magnitude of benefit associated with the intervention, and the risk of harm, cost, availability, and variation in patient preference. Significant improvement in the Barnes Akathisia Rating Scale subjective, distress, and global subscales with mianserin relative to placebo was seen in both studies, whereas improvement in the objective subscale was only demonstrated in 1 of the 2 studies. Each study was given a class rating of I, II, III, or IV based on the fulfilment of these criteria (see Table 1). DISCLAIMER: All material available on eHealthMe.com is for informational purposes only, and is not a substitute for medical advice, diagnosis, or treatment provided by a qualified healthcare provider. We performed a systematic review of therapeutic studies assessing the treatment of antipsychotic-induced extrapyramidal symptoms. Your doctor may start you at a low dose and. Cogentin. Many people who have schizophrenia also have symptoms of depression. All rights reserved. Winkelman JW, Armstrong MJ, Allen RP, et al. For patients requiring higher doses, a sustained release formulation is available (60 mg capsules or higher), which may reduce dosing frequency to daily or twice daily. Children below 3 years of ageUse is not recommended. COMMON BRAND NAMES Cogentin HOW SUPPLIED DESCRIPTION Synthetic muscarinic-receptor antagonist; structurally similar to atropine and diphenhydramine; has a longer duration of action and may require less frequent dosing than diphenhydramine; produces less CNS stimulation than does trihexyphenidyl and, thus, may be useful in geriatric patients. Those switching to monotherapy lost weight, and had no worsening of symptom control or increase in hospitalization compared with those on polypharmacy. Both studies reported significant improvement in the global subscale of the Barnes Akathisia Rating Scale with mirtazapine relative to placebo. Nevertheless, the choice of intervention should probably favour the more established treatments, with careful consideration of any contraindications to use and potential side effects. Schizophrenia (a mental disorder characterized by a breakdown of thought processes) is found to be associated with 1,182 drugs and 711 conditions by eHealthMe. The withdrawal of benztropine mesylate in chronic - PubMed There are 2 class II studies (low risk of bias) comparing mianserin to placebo for the treatment of antipsychotic-induced akathisia in individuals with schizophrenia or schizoaffective disorder.72,73 Both trials evaluated mianserin at a dose of 15 mg, for a treatment period of 5 days in 90 individuals. This content does not have an Arabic version. The following dosing guidelines were written in reference to both benztropine mesylate tablets and COGENTIN Injection. Our Medline and CENTRAL search found 5,053 abstracts, which were reviewed independently by 2 researchers, and of which 250 were chosen for full-text review. Generally, older patients, and thin patients cannot tolerate large doses. Drug information provided by: Merative, Micromedex. Dosage for Benztropine Mesylate To treat Parkinson's disease, the usual daily dose of benztropine mesylate is 1 to 2 mg, with a range of 0.5 to 6 mg orally or parenterally. The evidence suggests that the risk of akathisia is greater in patients prescribed antipsychotic medication for the first timei.e., antipsychotic-nave, or for whom antipsychotic drug dosage is rapidly escalated6,44and that akathisia tends to improve following dose reduction. You could have any of the following: Be sure you see your doctor regularly while taking antipsychotic medication. So to treat it, a doctor will prescribe medications that can ease symptoms and prevent them from coming back. Quarante tudes sur l'acathisie et quatre revues systmatiques valuant les effets indsirables des antipsychotiques ont t utilises pour formuler les recommandations. Movement problems: The typical dose ranges from 1 mg to 4 mg by mouth once or twice daily. Risperidone was associated with more akathisia than sertindole and ziprasidone. For those receiving second-generation antipsychotic monotherapy, the prevalence was 11%, whereas polypharmacy with 2 second-generation antipsychotics was associated with a prevalence of 34%. The .gov means its official. They ease symptoms such as delusions and hallucinations. Clonazepam may be considered as a short-term therapy option for the treatment of antipsychotic-induced akathisia. A significantly greater proportion of vitamin B6-treated individuals had a reduction of at least 2 points on the global subscale in both studies. They include:. 7,198 people reported to have side effects when taking Cogentin. Cogentin has active ingredients of benztropine mesylate. Haldol (haloperidol) is an antipsychotic drug that decreases excitement in the brain. Do not double doses. We study millions of patients and 5,000 more each day. In total, 194 individuals participated in these 7 trials. Every effort has been made to ensure that all information is accurate, up-to-date, and complete, but no guarantee is made to that effect. An official website of the United States government. Usual dose: 1 to 2 mg orally per day. Make your tax-deductible gift and be a part of the cutting-edge research and care that's changing medicine. Careers, Unable to load your collection due to an error. Among them, 166 people (2.31%) have Schizophrenia. Use of this site constitutes acceptance of eHealthMe.com's terms of service and privacy policy. One trial68 compared up to 18 mg per day of oral biperiden to placebo for 4 weeks in 15 psychiatric in-patients with antipsychotic-induced akathisia. With medical big data and proven AI algorithms, eHealthMe provides a platform for everyone to run phase IV clinical trials. Efficacy of low-dose mirtazapine in neuroleptic-induced akathisia: a double-blind randomized placebo-controlled pilot study, Trazodone for the treatment of neuroleptic-induced acute akathisia: a placebo-controlled, double-blind, crossover study. Propranolol in the treatment of neuroleptic-induced akathisia (NIA) in schizophrenics: a double-blind, placebo-controlled study. It is possible to overdose on this drug. The initial approach to treatment should be to consider antipsychotic dose reduction, cessation of antipsychotic polypharmacy, and switching to an antipsychotic with a perceived lower liability for akathisia, before the use of any additional medication. Both trials had a high risk of bias (Class III). Surrounding yourself with people who care about your well-being is also key. Haldol Decanoate may cause serious side effects including: hives, difficulty breathing, swelling of your face, lips, tongue, or throat, All rights reserved. It is created by eHealthMe based on reports of 7,198 people who have side effects when taking Cogentin from the FDA, and is updated regularly. The therapeutic options for akathisia are limited.10,70 The evidence supporting the most commonly used pharmacological interventions, such as switching to an antipsychotic with a perceived lower liability for the condition, or prescribing a beta-adrenergic blocker or antihistaminic/anticholinergic agent, remains limited. Significant worsening in tests of recent memory were associated with benztropine use. Les limitations des donnes probantes doivent tre reconnues et inciter une prescription prudente, surtout l'gard de la dure d'utilisation des mdicaments adjuvants. Prescribing more than one antipsychotic drug for patients is also a risk factor. Allow your loved ones to be part of the decision-making process with your doctor. All rights reserved. Atypical antipsychotics such as quetiapine, aripiprazole, olanzapine, and risperidone have been shown to be helpful in addressing a range of anxiety and depressive symptoms in individuals with . Poyurovsky M, Epshtein S, Fuchs C, et al. All rights reserved. Akathisia may also arise following reduction of dosage or cessation of antipsychotic medication,1113 referred to as withdrawal akathisia; although, it is generally considered to be indistinguishable phenomenologically from acute akathisia.7 The term tardive akathisia has been inconsistently applied in the literature to refer to akathisia that occurs late in the course of treatment, is exacerbated or provoked by antipsychotic dose reduction or withdrawal, and improves at least temporarily when the dose is increased; these are pharmacological characteristics shared with tardive dyskinesia.7,11 However, it has also been used to refer to late-onset akathisia occurring in the absence of any change in drug dose or type, or provoked by stopping anti-akathisia medication14 as well as persistent akathisia that is particularly disabling and often refractory to treatment.15, Where a patient exhibits the objective signs of akathisia in the absence of awareness of the typical subjective experience, this is sometimes called pseudoakathisia. Some of the more common side effects of antidepressants are: Schizophrenia can make it hard to stick to a medication plan. Un bon point de la pratique serait pour les cliniciens de systmatiquement valuer l'acathisie avec une chelle valide avant de commencer les antipsychotiques et durant l'ajustement posologique de l'antipsychotique. Anticholinergic drugs (eg, trihexyphenidyl and benztropine) or antidepressants with anticholinergic properties may unmask or activate TD by virtue of their Treatment of dystonia in children and adults limiting and can interfere with school and other activities. Long term ratings: 3.5/5. The overall level of evidence classifications and grades of recommendation were made using the Scottish Intercollegiate Guidelines Network framework. WARNING: Please DO NOT STOP MEDICATIONS without first consulting a physician since doing so could be hazardous to your health. We study millions of patients and 5,000 more each day. Improvements were very similar between the 2 active medications. Advertising revenue supports our not-for-profit mission. Effectiveness of switching from antipsychotic polypharmacy to monotherapy. There are 2 trials comparing mirtazapine to placebo (and also to propranolol in one trial) for the treatment of antipsychotic-induced akathisia in individuals with schizophrenia.53,74 Both trials used mirtazapine at a dose of 15 mg, and evaluated the response after 5 or 7 days. Miodownik C, Lerner V, Statsenko N, et al. Typical dosing for benztropine (Cogentin) Parkinson's disease: The typical starting dose ranges from 0.5 mg to 1 mg by mouth daily. As with any agent used in parkinsonism, dosage must be individualized according to age and weight, and the type of parkinsonism being treated. AdultsAt first, 0.5 to 2 milligrams (mg) at bedtime. Benztropine: MedlinePlus Drug Information Quetiapine (Oral Route) Precautions - Mayo Clinic When standing, there is a tendency for the body weight to shift from one foot to the other (marching on the spot) or for the person to pace back and forth. Compared to placebo, treatment with biperiden resulted in a significant decrease in akathisia scores. Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article. All trials reported benefit with propranolol from baseline to endpoint, as well as with the other agents studied (metoprolol, zolmitriptan, cyproheptadine), except for benztropine, which showed no change in objective ratings of akathisia. The site is secure. A double-blind cross-over study with placebo, Intravenous biperiden in akathisia: an open pilot study, Managing antipsychotic-induced acute and chronic akathisia, Treatment of antipsychotic-related akathisia revisited: the role of serotonin 2a receptor antagonists. You can start a phase IV clinical trial to monitor Cogentin safety and effectiveness. Forty studies on akathisia and 4 systematic reviews evaluating the adverse effects of antipsychotics were used in the formulation of recommendations. You may also have trouble keeping yourblood sugarandcholesterol levelsunder control. Every effort has been made to ensure that all information is accurate, up-to-date, and complete, but no guarantee is made to that effect. Although some results are promising, the current evidence available on the potential risks and benefits for these agents as treatments for akathisia is insufficient to allow for clear practice recommendations. Cogentin (Benztropine) - Indications and Dosage - Druglib.com Akathisia is a common and distressing neuropsychiatric syndrome associated with antipsychotic medication, characterised by subjective and objective psychomotor restlessness. Further large scale, randomised controlled trials are needed to test potential treatments for antipsychotic-induced akathisia and thus improve the evidence base and expand the therapeutic options. Cogentin Dosage Guide - Drugs.com Download PDF Abstract The pharmacological management of treatment resistant schizophrenia provides clinicians with a broad range of clinical challenges. *Numbers iiii in Class Ie are required for Class II in equivalence trials. This content does not have an English version. It works just as well as taking a daily pill. Scottish Intercollegiate Guidelines Network Framework. Havaki-Kontaxaki BJ, Kontaxakis VP, Christodoulou GN. It is among the most disabling and economically catastrophic medical disorders, ranked by the World Health Organization as among the top 10 causes of years lost to disability worldwide for both males and females [ 2 ]. The dose is usually not more than 6 mg. Children 3 years of age and aboveUse and dose must be determined by your doctor. Avital A, Gross-Isseroff R, Stryjer R, et al. For example, given the success of both gabapentin and pregabalin in the treatment of restless legs syndrome85 and similarities between restless legs syndrome and akathisia, trials with these agents may be worthwhile. With medical big data and AI algorithms, eHealthMe is running millions of phase IV trials and makes the results available to the public. Practice guideline summary: treatment of restless legs syndrome in adults: report of the guideline development, dissemination, and implementation subcommittee of the american academy of neurology, Canadian Journal of Psychiatry. Cogentin may also be used for purposes not listed in this medication guide. Benztropine is used with other medicines to treat Parkinson's disease. Propranolol, a nonselective beta-adrenergic antagonist, is the most studied treatment intervention for antipsychotic-induced akathisia. Your doctor may increase your dose as needed. I personally hunted around until I found a med that doesn't cause akithisia. Double-blind, placebo-controlled study. Several reviews have analysed akathisia risk in specific subsets of published studies. El-Sayeh HG, Lyra da Silva JP, Rathbone J, et al. eHealthMe is studying from 7,466 Cogentin users for its effectiveness, alternative drugs and more. Discrepancies were resolved by discussion. One of the common side effects of many of the newer antipsychotics isweight gain. Rummel-Kluge C, Komossa K, Schwarz S, et al. It is based on benztropine mesylate (the active ingredients of Cogentin) and Cogentin (the brand name). Cyproheptadine versus propranolol for the treatment of acute neuroleptic-induced akathisia: a comparative double-blind study. As a class, there is limited evidence to support the use of 5HT2A antagonists for the treatment of akathisia, with the 2 trials of mirtazapine including the greatest number of participants. But it may take up to 4 to 6 weeks before symptoms like hallucinations and delusions get better. Benefits and limits of anticholinergic use in schizophrenia: Focusing All trials were of short duration (longest trial 7 days). National Institute of Mental Health: Schizophrenia, Mental Health Medications., Medscape: Schizophrenia Treatment & Management., National Alliance on Mental Illness: Mental Health Medications.. If any one of the 3 is missing, the class is automatically downgraded to Class III. Initial recommendations were drafted by a team of researchers and then voted on by the entire panel for inclusion in the guideline. They might prescribe these extra drugs for what's known as treatment-resistant schizophrenia. This means antipsychotics don't address all your symptoms. The observable features include the inability to sit, stand or lie still. The other trial67 compared the intramuscular injection of 2.5 mg of biperiden (up to 3 times, every 2 hours) to placebo for 6 hours in 30 individuals. If propranolol is prescribed, clinicians should review its contraindications before starting treatment and monitor blood pressure and heart rate in the supine and standing position, as propranolol can cause hypotension and bradycardia, which can be exacerbated by antipsychotic medications. There are 2 trials of the anticholinergic benztropine v. placebo for the treatment of antipsychotic-induced akathisia.54,64 Both trials had a high risk of bias (class III). Reversal of aripiprazole induced tardive akathisia by addition of pregabalin. Use of this site constitutes acceptance of eHealthMe.com's terms of service and privacy policy. Email: Supplemental Material, Appendix_1_Search_Strategy - The Assessment and Treatment of Antipsychotic-Induced Akathisia, GUID:93F658AA-B546-4634-B769-81FDF39B5AF7, Supplemental Material, Appendix_2_Akathisia_Table_of_Included_Studies - The Assessment and Treatment of Antipsychotic-Induced Akathisia, GUID:6490CCF8-1B22-467B-96F6-AEA393CE06D5, No more than 2 primary outcomes specified, Exclusion and inclusion criteria clearly defined, Adequate accounting of dropouts (with at least 80% of participants completing the study) and crossovers, For non-inferiority or equivalence trials claiming to prove efficacy for one or both drugs, the following are also required, The authors explicitly state the clinically meaningful difference to be excluded by defining the threshold for equivalence or non-inferiority, The standard treatment used in the study is substantially similar to that used in previous studies establishing efficacy of the standard treatment (e.g., for a drug, the mode of administration, dose, and dosage adjustments are similar to those previously shown to be effective), The inclusion and exclusion criteria for participant selection and the outcomes of participants on the standard treatment are comparable with those of previous studies establishing efficacy of the standard treatment, The interpretation of the study results is based on a per-protocol analysis that accounts for dropouts or crossovers, For crossover trials, both period and carryover effects are examined and statistical adjustments performed, if appropriate, Baseline characteristics of treatment order groups presented, d. Presentation of baseline characteristics, antipsychotics, extrapyramidal syndromes, evidence-based medicine, Le traitement de la maladie de Parkinson et des manifestations extrapyramidalles par Ie diethylaminoethyl n-thiophyenylamine (2987 RP): resultats dune annre dapplication, Persistent muscular restlessness after phenothiazine treatment: report of 3 cases, Akathisia: a side effect to be remembered, Clinical characteristics of akathisia.
Logistics Committee In Events, Articles C