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Beta-adrenergic antagonists in psychosis: is improvement due to treatment of neuroleptic-induced akathisia?

Van Putten and colleagues have reported an association between akathisia and exacerbations of psychosis in schizophrenic patients treated with neuroleptic drugs. They noted that treatment with an anticholinergic drug, biperiden, led to prompt improvement in both conditions. Recent reports suggest that beta-adrenergic antagonists may be effective in the treatment of akathisia. Based on these observations, we surveyed studies in which beta-adrenergic antagonists were administered as putative antipsychotic agents in order to determine whether reports of improvement may actually have reflected successful treatment of underlying neuroleptic-induced akathisia. Though inferential, the results of this review support this hypothesis. It is possible that the mechanism of action for the anti-akathisia and antipsychotic effects of beta-adrenergic antagonists may be due to enhancement of the firing rate of dopamine neurons in the ventral tegmental area, with subsequent increased release of dopamine and decreased interference with dopaminergic neurotransmission.