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Open Access Highly Accessed Open Badges Research article

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

Inge van Rossum1, Diederik Tenback23 and Jim van Os45*

Author Affiliations

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

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

Published: 28 April 2009



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).


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.


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.


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.