The incidence of akathisia in bipolar affective disorder treated with neuroleptics - a preliminary report

Background: Akathisia is a common side effect of neuroleptic therapy. Preva lence and incidence studies of akathisia have been predominantly undertaken in patients with schizophrenia and schizoaffective disorder. Investigation s of akathisia in neuroleptic treated patients suffering from bipolar disor der are lacking. Method: In the present study, 23 patients with bipolar aff ective disorder who were treated with neuroleptics were assessed for akathi sia and parkinsonism, using the Barnes Akathisia Rating Scale and DSM-IV cr iteria, respectively. Results: 15 patients (65.2%) developed akathisia. Eig hteen patients (78.3%) had parkinsonism, including all of the akathisia-gro up. In six patients (40%) of the akathisia-group the onset of akathisia was after neuroleptic dose reduction or after additional administration of moo d stabilizers. Conclusions: Neuroleptic-induced side effects may occur freq uently in patients with bipolar affective disorder and should therefore be monitored thoroughly. Demasking effects due to diminishing parkinsonian sym ptoms may contribute to akathisia-onset after neuroleptic dose reduction. E arly application of alternative treatment regimens, e.g. monotherapy with m ood stabilizers in combination with benzodiazepines should be considered. F uture directions: The preliminary findings require further investigation re garding dose dependency, incidence of akathisia in untreated patients with bipolar affective disorder, akathisia in patients with depressed episodes o n SSRI, and possible differences between various mood stabilizers in their propensity to enhance akathisia, as well as possible sex differences. (C) 1 999 Elsevier Science B.V. All rights reserved.