Tardive dyskinesia in bipolar patients

Abstract

Although it is recognized that tardive dyskinesia (TD) occurs also in bipolar patients who receive long-term neuroleptic treatment, there has been limited research on the clinical and biological correlates of TD in this population. We examined the prevalence of TD and its relations to select clinical and biological measures in 50 bipolar patients admitted to a research unit at a state psychiatric center. Diagnosis of TD was based on the criteria proposed by Schooler and Kane (1982). Twenty-two (44%) of the 50 bipolar patients fulfilled criteria for TD, a prevalence rate that is slightly higher than the 35% noted in bipolar patients in an outpatient clinic (Mukherjee et al, 1986), but not significantly different from the 43% rate in 90 research schizophrenic patients. Limb dyskinesia scores were significantly higher in schizophrenic patients (.83 + .95) than in the bipolar patients (.38 + .78) [p < .02], while orofacial ratings did not differ between the groups. The presence of TD was associated with a greater number of past episodes of depression but not mania. None of the five unipolar manic patients was noted to have TD. TD was not related to measures of ventricular enlargement or cortical atrophy on CT scan. Our findings indicate that TD in bipolar patients may be related to a past history of depressive episodes, but not to morphological brain abnormalities such as ventricular enlargement and cortical atrophy. The different topographic distributions of abnormal involuntary movements in bipolar and schizophrenic patients suggest that pathological processes contributing to the development of TD may vary across the diagnostic groups.