title: Neuroleptic-induced deficit syndrome in bipolar disorder with psychosis.
abstract: Neuroleptics can induce not only physical adverse effects but also mental effects that produce deficit status in thought, affect, cognition, and behavior. This condition is known as neuroleptic-induced deficit syndrome (NIDS), which includes apathy, lack of initiative, anhedonia, indifference, blunted affect, and reduced insight into disease. Although this old concept now appears almost forgotten, neuroleptics, whether typical or atypical, can make depression or bipolar disorder resemble other more refractory conditions, readily leading to mistaken diagnosis and inappropriate treatment. The authors describe three cases of NIDS superimposed on depressive phase in bipolar disorder with psychosis, where the attending psychiatrist's failure to recognize NIDS prevented patients from receiving effective treatment and achieving remission. All cases achieved remission after reduction of neuroleptics and intensive therapy, including electroconvulsive therapy, for bipolar depression. The concept of NIDS was originally introduced for schizophrenia, and it has rarely been highlighted in other diseases. In recent years, however, atypical antipsychotics are being more often administered to patients with bipolar disorder. Psychiatrists, therefore, should also remember and exercise caution regarding NIDS in the pharmacotherapy of bipolar disorder with and without psychosis. The authors believe that the concept of NIDS needs to be reappraised in current psychiatry.
authors.affiliation: Department of Neuropsychiatry, Nippon Medical School, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ueda
authors.affiliation: Department of Neuropsychiatry, Nippon Medical School, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sakayori
authors.affiliation: Tamachuo Hospital, Tokyo, Japan.
authors.forename: Ataru
authors.initials: A
authors.lastname: Omori
authors.affiliation: Kurumegaoka Hospital, Tokyo, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Fukuta
authors.affiliation: Kurumegaoka Hospital, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kobayashi
authors.affiliation: Department of Neuropsychiatry, Nippon Medical School, Tokyo, Japan.
authors.forename: Kousuke
authors.initials: K
authors.lastname: Ishizaka
authors.affiliation: Saijo Clinic, Tokyo, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Saijo
authors.affiliation: Department of Neuropsychiatry, Nippon Medical School, Tokyo, Japan.
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Okubo
keywords: atypical antipsychotics; bipolar disorder; electroconvulsive therapy; neuroleptic-induced deficit syndrome (NIDS); psychosis