Disorders of swallowing are poorly characterized but quite common in schizophrenia. They are a source of considerable morbidity and mortality in this population, generally as a result of either acute asphyxia from airway obstruction or more insidious aspiration and pneumonia. The death rate from acute asphyxia may be as high as one hundred times that of the general population. Most swallowing disorders in schizophrenia seem to fall into one of two categories, changes in eating and swallowing due to the illness itself and changes related to psychotropic medications. Behavioral changes related to the illness are poorly understood and often involve eating too quickly or taking inappropriately large boluses of food. Iatrogenic problems are mostly related to drug-induced extrapyramidal side effects, including drug-induced parkinsonism, dystonia, and tardive dyskinesia, but may also include xerostomia, sialorrhea, and changes related to sedation. This paper will provide an overview of common swallowing problems encountered in patients with schizophrenia, their pathophysiology, and management. While there is a scarcity of quality evidence in the literature, a thorough history and examination will generally elucidate the predominant problem or problems, often leading to effective management strategies.

Speech and language difficulties have been reported in people with schizophrenia since the early 19th century, but they have been relatively poorly characterized. Research has mostly focused on pragmatics and the social aspects of communication, but changes in voice quality are common and can also interfere with intelligibility of speech, thus adding to the patient's disability. These changes in voice quality are not entirely related to effects of neuroleptics. A few common vocal characteristics have been identified; indeed, the most consistent vocal characteristic in people with schizophrenia may be the lack of consistent characteristics between patients. There has been little speculation about the etiology of vocal changes; they have been regarded as “neurological soft signs” indicative of mild central nervous system dysfunction but may be related to longstanding insensitivity to comprehension cues from the listener. Response to speech therapy in people with schizophrenia has been disappointing overall. We present three patients with schizophrenia and representative vocal changes, and we also discuss the sparse available literature available through the PubMed database. This may be a fruitful and relatively unexplored area of investigation with potential to substantially improve social interactions and quality of life for some patients with schizophrenia. [ Psychiatr Ann . 2020;50(1):33–37.]

Chronic microaspiration and diffuse aspiration bronchiolitis may account for some otherwise unexplained frailty in nursing home patients.