PURPOSE: Recognizing the negative impact that antipsychotic-induced movement disorders have on the quality of life and treatment outcomes in bipolar disorder (BD), this study aimed to assess clinical correlates and antipsychotic use patterns of tardive dyskinesia (TD+) in BD. MATERIALS AND METHODS: Participants with and without TD were included. Clinical variables were compared using t-test and χ2 test. Antipsychotic use patterns in TD+, including number of trials, mean doses, and estimated cumulative exposure, were assessed in a case-only analysis. RESULTS: The prevalence rate of TD was 5.1%. In comparison to the TD- group (n = 1074), TD+ participants (n = 58) were older, more likely to be female and have type I bipolar illness. There were 60.3% of the TD+ group that continued using antipsychotics at study entry and had a mean cumulative exposure to antipsychotics of 18.2 ± 15.6 years. Average dose, in haloperidol equivalents, was 5.9 ± 3.5 mg and 77.7% of the trials were second-generation antipsychotics. CONCLUSIONS: This study confirms previously identified TD risk factors, such as age, sex, and bipolar subtype in a large BD cohort. Limitations included a cross-sectional design and the lack of tardive illness severity assessment. As atypical antipsychotics continue to be primary mood stabilization treatment, attempting to harmonize large data sets to identify additional biomarkers of tardive risk will optimize individualized care for patients with BD.
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This study was supported, in part, by the Marriott Family Foundation and the Mayo Clinic Center for Individualized Medicine; none had a role in the design, conduct, analysis, or submission of the study. M.G.R. reports receiving support from the Marriot Family Foundation during the conduct of the study. M.A.F. reports receiving grants from the Marriott Family Foundation during the conduct of the study; receiving grants from the National Institute of Alcohol Abuse and Alcoholism and National Institute of Mental Health, National Institutes of Health, Assurex Health, Myriad, and Pfizer; being a consultant to Janssen Global Services LLC; receiving travel and hotel honoraria from CME Outfitters to give a lecture for continuing medical education credit and receiving support for a presentation from Sunovion. F.R.-N reports support fromthe Brain&Behavior Research Foundation NARSADYoung Investigator Award and having patent 62 581 968 pending. S.L.M. reports receiving personal fees for advisory boards and/or consultation from Allergan, Avanir, Idorsia, Mitsubishi Tanabe Pharma America, Myriad, Novo Nordisk, Opiant, Shire, Sunovion, and Takeda (Shire); receiving grant support from Azevan, Brainsway, Marriott Foundation, Medibio, Neurocrine, Novo Nordisk, Otsuka, and Sunovian; and receiving payments from Johnson & Johnson for being an inventor on US Patent 6 323 236 B2. B.S. has received research time support from Medibio. No other disclosures are reported. These data have not been previously presented at a meeting.
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