Abstract
Mr. CK, a 40-year-old Chinese gentleman is a Bipolar I Disorder patient with no history of depressive episodes. He had never achieved full remission and had 3 previous admissions for manic episodes due to poor insight to his illness. Patient experienced his first manifestation of unexpected tardive dyskinesia in the hypomanic phase after more than 15 years. The movement persisted and was exacerbated by his recent manic episode and almost disappeared when the manic symptoms resolved. There were case reports of the appearance of tardive dyskinesia in manic phase associated with dopamine-receptor supersensitivity, while in others the movement occurred in the depressive phase only. In this case, the risk of tardive dyskinesia increased with patient’s advancing age, with past history of multiple manic relapses and no depressive episode and with the prolonged inadequate treatment with lithium. Mr. CK attained optimum level of functioning and further recurrence of tardive dyskinesia was prevented with the remission of his recent manic episode.

Key words: bipolar disorder, mania, depression, persistent tardive dyskinesia