title: Extrapyramidal side effects with atypical neuroleptics in bipolar disorder.
abstract: OBJECTIVE
  To examine, in a real-world clinical setting, the risk of extrapyramidal symptoms (EPS) with atypical neuroleptics in bipolar patients.
  
  
  METHODS
  The authors assessed 51 individual patient trials of atypical neuroleptic agents (17 risperidone, 13 olanzapine, 11 quetiapine, 8 ziprasidone, and 2 aripiprazole) in 37 bipolar patients (type I or type II). Risk of EPS was assessed using the Abnormal Involuntary Movement Scale, Barnes Akathisia Rating Scale, and the Simpson-Angus Scale. Mean duration of treatment was 25.5 weeks (range 3-107 weeks) and 60.8% of patients were female.
  
  
  RESULTS
  62.7% of trials resulted in moderate to severe EPS. EPS and discontinuation frequencies were similar between specific neuroleptic agents or between high potency (risperidone/ziprasidone/aripiprazole; 52.9%, 27/51 trials) and low potency (quetiapine/olanzapine; 47.1%, 24/51 trials) agents. In a multiple regression model adjusted for confounders, akathisia was less common with low potency agents. Younger age was associated with more akathisia. 31.4% (11/35) of trials discontinued due to side effects. 7.8% (4/51) of trials led to mild de novo tardive dyskinesia.
  
  
  CONCLUSIONS
  Over one-half of bipolar patients experienced EPS in this real world clinical setting. This rate is much higher than the 5-15% range reported in clinical trials, suggesting potential problems with clinical trial generalizability.
authors.affiliation: Bipolar Disorder Research Program, Department of Psychiatry, Emory University, 1365 Clifton Road, Building B, Suite 6100, Atlanta, GA 30322, USA.
authors.forename: S Nassir
authors.initials: SN
authors.lastname: Ghaemi
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Hsu
authors.forename: Klara J
authors.initials: KJ
authors.lastname: Rosenquist
authors.forename: Tamara B
authors.initials: TB
authors.lastname: Pardo
authors.forename: Frederick K
authors.initials: FK
authors.lastname: Goodwin
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D001480:Basal Ganglia Diseases / Q000139:chemically induced* / Q000145:classification; D001714:Bipolar Disorder / Q000188:drug therapy*; D003710:Demography; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index
chemical_list: D014150:Antipsychotic Agents