Research article

Bipolar disorder and dopamine dysfunction: an indirect approach focusing on tardive movement syndromes in a naturalistic setting

Inge van Rossum¹ , Diederik Tenback^2,3 and Jim van Os^4,5

¹  Eli Lilly Nederland, Medical Department, Houten, the Netherlands

²  Symfora Group Psychiatric Center, Utrechtseweg 266, 3818 EW Amersfoort, the Netherlands

³  Department of Psychiatry, University Medical Center Utrecht, Heidelberglaan 100, 3584 GX Utrecht, the Netherlands

⁴  Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands

⁵  Division of Psychological Medicine, Institute of Psychiatry, London SE5 8AF, UK

author email corresponding author email

BMC Psychiatry 2009, 9:16doi:10.1186/1471-244X-9-16

Published:	28 April 2009

Abstract

Background

It has been suggested that dopamine dysfunction may play a role in bipolar disorder (BD). An indirect approach to examine this issue was developed, focusing on associations between dopamine proxy measures observed in BD (dopamine-related clinical traits using tardive movement syndromes as dopamine proxy measure of reference).

Methods

3459 eligible bipolar patients were enrolled in an observational study. Incidence rates of tardive movement syndromes (tardive dyskinesia and tardive dystonia; TDD) were examined. A priori hypothesized associations between incident TDD and other dopamine proxies (e.g. prolactin-related adverse effects, bipolar symptoms) were tested over a 2 year follow-up period.

Results

The incidence rate of tardive syndromes was 4.1 %. Incident TDD was independently associated not only with use of antipsychotics, but also with more severe bipolar symptoms, other extrapyramidal symptoms and prolactin-related adverse effects of medication.

Conclusion

Apart from the well-known association with antipsychotics, development of TDD was associated with various other dopamine proxy measures, indirectly supporting the notion of generalised dopamine dysregulation in BD.