Prevalence and severity of antipsychotic related constipation in patients with schizophrenia: a retrospective descriptive study

Abstract

BackgroundAntipsychotic are the cornerstone in the treatment of schizophrenia. They also have a number of side-effects. Constipation is thought to be common, and a potential serious side-effect, which has received little attention in recent literature.MethodWe performed a retrospective study in consecutively admitted patients, between 2007 and 2009 and treated with antipsychotic medication, linking different electronic patient data to evaluate the prevalence and severity of constipation in patients with schizophrenia under routine treatment conditions.ResultsOver a period of 22 months 36.3% of patients (99) received at least once a pharmacological treatment for constipation. On average medication for constipation was prescribed for 273 days. Severe cases (N = 50), non-responsive to initial treatment, got a plain x-ray of the abdomen. In 68.4% fecal impaction was found.ConclusionA high prevalence of constipation, often severe and needing medical interventions, was confirmed during the study period. Early detection, monitoring over treatment and early intervention of constipation could prevent serious consequences such as ileus.

Factors predicting use of laxatives in outpatients stabilized on clozapine

“…A Dutch study reviewing hospital admissions due to GI hypomotility associated with antipsychotic treatment found 65% of admissions to be male patients [De Hert et al 2011]. Only 29% of our male sample had laxatives prescribed.…”

Drug-induced gastrointestinal disorders

“…In a nursing home-based study of 5622 elderly individuals, polypharmacy was associated with diarrhoea, and the medications that were implicated were antibiotics, psychotropics, allopurinol and angiotensin-2 inhibitors. Psychotropic medications that affect cholinergic and serotonergic pathways are known to cause GI symptoms (see discussion) 25 26. Cardiovascular medications used in the treatment of hypertension may also cause constipation (such as the calcium channel blocker, verapamil) and diarrhoea (such as β blockers), presumably related to their pharmacodynamic actions 27 28.…”

Gastroenterology issues in schizophrenia: Why the gut matters

“…As such, its use can lead to constipation, bowel obstruction, colitis, paralytic ileus and death. The prevalence of antipsychotic-related constipation has been reported to range from 1.5% to 60% in patients with schizophrenia [41][42][43][44]. Other antipsychotics with cholinergic effects, including both agonists and antagonists, and the use of specific cholinergic compounds to counter extrapyramidal side effects of medications prescribed to people with schizophrenia can produce a variety of adverse effects on the gut including anorexia, nausea, vomiting, diarrhea and abdominal pain [45].…”