A CROSS-SECTIONAL STUDY OF PARKINSONISM AND TARDIVE-DYSKINESIA IN LITHIUM-TREATED AFFECTIVE DISORDERED PATIENTS

Background: The purpose of this study was to investigate the prevalenc e of extrapyramidal symptoms (EPS) and tardive dyskinesia (TD) in affe ctive disordered patients treated with lithium and to study the associ ation of these symptoms with medication and other factors. Method: Thi s cross-sectional study was carried out in all consenting outpatients attending an affective disorders clinic in a psychiatric hospital. The study sample consisted of 130 stable ontpatients: 110 with bipolar di sorder, 18 with unipolar (major) depression, and 2 with atypical affec tive disorder. At the time of evaluation, 110 patients were receiving lithium, 37 in combination with antidepressants and 19 with neurolepti cs, and 40 had a history of neurolept ic treatment during the previous 6 months. The patients were assessed with the Extrapyramidal Symptom Rating Scale (ESRS) for parkinsonism, akathisia, dystonia, and TD. The prevalence of these symptoms was calculated for all patients and by c urrent lithium and neuroleptic intake. Multiple linear regression anal ysis was used to investigate the relationship between the ESRS subscal e scores and gender, age, diagnosis, and medication type. Results: The prevalence of tremor was 20.8%; hypokinetic parkinsonism, 7.7%; akath isia, 4.6%; dystonia, 3.8%; and TD, 9.2%. Tremor was associated with l ithium and neuroleptic intake; hypokinesia was associated with neurole ptic treatment and age; and TD was associated with neuroleptic, lithiu m, and tricyclic intake and age. Seven of 51 patients taking lithium b ut without a history of neuroleptic treatment during the previous 6 mo nths presented symptoms of TD. Conclusion: The combination of lithium and neuroleptics was associated with a high prevalence of EPS. The pre sence of TD in lithium-treated patients not treated with neuroleptics for at least 6 months is consistent with the hypothesis that lithium m ay exacerbate the vulnerability of affective disordered patients to dy skinesias.