What are the potential complications of a patient with a thick disorder, such as hyperactivity, Akathisia (restlessness), or aphasia (speech disorder)?

From the Guidelines

Patients with thick disorders, such as hyperactivity, akathisia, or aphasia, are most likely to experience complications related to aphasia, which can result in significant communication barriers, social isolation, depression, and reduced independence, as evidenced by the high prevalence of aphasia in stroke patients and its association with decreased response to rehabilitation interventions and increased risk for mortality 1.

Potential Complications

The potential complications of these disorders can be broken down as follows:

• Hyperactivity: impaired concentration, academic or occupational difficulties, relationship problems, and increased risk of accidents
• Akathisia: severe distress, sleep disturbances, and medication non-compliance
• Aphasia: communication barriers, social isolation, depression, and reduced independence

Management and Treatment

Management of these conditions typically involves:

• Hyperactivity: medications like methylphenidate (Ritalin) at 18-72 mg daily or amphetamine salts (Adderall) at 5-40 mg daily, alongside behavioral therapy
• Akathisia: reducing the causative agent (often antipsychotics), adding beta-blockers like propranolol (20-120 mg daily), or anticholinergics like benztropine (1-4 mg daily)
• Aphasia: speech therapy, focusing on language rehabilitation exercises tailored to the specific type of aphasia, as aggressive management of aphasia through therapy helps to improve both language and broader recovery 1

Importance of Early Intervention

Early intervention is crucial for all these conditions to prevent long-term complications, and a multidisciplinary approach involving specialists, therapists, and family support often yields the best outcomes. In the context of real-life clinical medicine, it is essential to prioritize the management of aphasia, given its significant impact on quality of life and mortality, as highlighted in the most recent and highest quality study 1.

From the Research

Potential Complications of Thick Disorder

The potential complications of a patient with a thick disorder, such as hyperactivity, Akathisia (restlessness), or aphasia (speech disorder), can be understood through the lens of Attention Deficit Hyperactivity Disorder (ADHD) and its treatment with methylphenidate.

• Hyperactivity: Studies have shown that methylphenidate, a common treatment for ADHD, may improve teacher-rated ADHD symptoms, including hyperactivity, in children and adolescents 2. However, the certainty of the evidence for this outcome is very low.
• Akathisia (Restlessness): Methylphenidate may cause more adverse events considered non-serious, such as restlessness, versus placebo or no intervention 2, 3. The proportion of participants on methylphenidate with any non-serious adverse events, including restlessness, was found to be 51.2% in non-comparative cohort studies 3.
• Aphasia (Speech Disorder): There is no direct evidence in the provided studies to suggest that methylphenidate or ADHD is associated with aphasia. However, it is essential to note that the studies primarily focus on the effects of methylphenidate on ADHD symptoms and adverse events, rather than its impact on speech disorders.

Adverse Events Associated with Methylphenidate

The use of methylphenidate in patients with ADHD, including those with thick disorder, may be associated with various adverse events, including:

• Serious adverse events, such as psychotic disorders and arrhythmia 3
• Non-serious adverse events, such as insomnia, sleep problems, decreased appetite, headache, abdominal pain, and restlessness 2, 3
• Withdrawal from methylphenidate due to adverse events, which occurred in 6.20% of participants for non-serious adverse events and 1.20% for serious adverse events 3

Considerations for Treatment

When considering the treatment of patients with thick disorder, including those with hyperactivity, Akathisia, or other ADHD symptoms, it is crucial to weigh the potential benefits of methylphenidate against its potential risks and adverse events. The choice of formulation, such as sustained-release methylphenidate, and monitoring of cardiovascular parameters during long-term use are essential considerations 4, 5.