Choking Incidents among Psychiatric Patients: Retrospective Analysis of Thirty-one Cases from the West Bologna Psychiatric Wards

Abstract

Various simple, effective preventive measures emerge from the study.

Bedside assessment of swallowing in elderly subjects using psychotropic drugs

“…Table 3 shows how each clinical sign was distributed among subjects in both groups. study and other published papers are due both to the methods for evaluating swallowing and to observing carefully the relationship between food consistency and clinical signs [5][6][7][8][9][10][11]19,21,[23][24][25] . Therefore, while one of those studies found changes in 30% of subjects, and another found changes in 90% of subjects, we encountered no significant effect of neuroleptic drugs on swallowing 7,11 .…”

“…Two studies applied specific swallowing evaluation methods in subjects taking neuroleptics and found disorders in a significant number of their sample 7,11 . These studies, however, were not controlled and patients belonged to several age groups, including elderly subject; the latter have specific physical features and systemic diseases that may lead to dysphagia [8][9][10] . Furthermore, the authors did not describe the clinical signs in those patients, and used only a watery consistency without informing the volume 7,11 .…”

“…Studies on the relationships among neuroleptics, nutrition, dysphagia, and asphyxia have all been clinica 5,6,[8][9][10] . Two studies applied specific swallowing evaluation methods in subjects taking neuroleptics and found disorders in a significant number of their sample 7,11 .…”

“…Anxiolytic, antidepressant, antiepileptic, and antipsychotic drugs may affect cognition and alertness or act upon the brainstem, thereby causing or facilitating oral and/or pharyngeal phase swallowing disorders [3][4][5] . Neuroleptic antipsychotic drugs in particular have been implicated as causing asphyxia and silent dysphagia in psychiatric patients, particularly hospitalized elderly patients diagnosed with schizophrenia, bipolar or schizoaffective disorders, and depression with psychotic symptoms [6][7][8][9][10] . The term asphyxia has been used to describe respiratory disorders during meals in patients given neuroleptic antipsychotic drugs 5,[8][9][10] .…”

“…Neuroleptic antipsychotic drugs in particular have been implicated as causing asphyxia and silent dysphagia in psychiatric patients, particularly hospitalized elderly patients diagnosed with schizophrenia, bipolar or schizoaffective disorders, and depression with psychotic symptoms [6][7][8][9][10] . The term asphyxia has been used to describe respiratory disorders during meals in patients given neuroleptic antipsychotic drugs 5,[8][9][10] . Although the word asphyxia denotes respiratory pathway obstruction, it does not clarify its mechanism, which may be other than a false route taken by the food bolus during swallowing.…”