Comments on Lucire and Crotty, 2011.

Abstract

Dear editor In a recent article, Yolande Lucire and Christopher Crotty presented their findings in an ongoing naturalistic study concerning a possible relationship between variant alleles in three CYP450 genes and a variety of behavioral problems.1 Unfortunately, the tested population of 129 persons was very heterogeneous and poorly characterized from a phenomenological perspective. In the results section of their article, the authors use the term “akathisia” to describe the adversity, but without defining this phenomenon. They also use this term in the title of their paper. Since they state that the majority of the persons who experienced adverse clinical events had akathisia, which is not expected considering their clinical characteristics, it is possible that the term has been used to describe other types of problems rather than this well-defined extrapyramidal motor disorder.2,3 In our opinion, this is unfortunate as it may lead to false interpretation of the mechanistic background of these putative side effects. As a matter of fact, such a false interpretation of the relationship between aggression and akathisia has probably led to misunderstandings during a number of court trials in the Netherlands. On one occasion, an accused person was sentenced to 24 years in prison because of an erroneous interpretation of the message of Lucire and Crotty’s paper.4 Because the motor symptoms of akathisia were not confirmed by a small number of layman observers prior to his committing the felony, the judges rejected akathisia as a possible explanation for this aggressive behavior. It is important, therefore, not to use the term “akathisia” as being synonymous with drug-induced aggression. There are many other possible mechanisms which could cause selective serotonin reuptake inhibitors to lead to this type of adversity5 and, in addition, it should be noted that adverse clinical events are only very rarely monocausally related to the intake of a drug.