Gastrointestinal and liver disease in patients with schizophrenia: A narrative review

Abstract

Schizophrenia is a severe mental illness which can have a devastating impact on an individual’s quality of life. Comorbidities are high amongst patients and life expectancy is approximately 15 years less than the general population. Despite the well-known increased mortality, little is known about the impact of gastrointestinal and liver disease on patients with schizophrenia. We aimed to review the literature and to make recommendations regarding future care. Literature searches were performed on PubMed to identify studies related to gastrointestinal and liver disease in patients with schizophrenia. High rates of chronic liver disease were reported, with Non-Alcoholic Fatty Liver Disease being of particular concern; antipsychotics and metabolic syndrome were contributing factors. Rates of acute liver failure were low but have been associated with antipsychotic use and paracetamol overdose. Coeliac disease has historically been linked to schizophrenia; however, recent research suggests that a causal link is yet to be proven. Evidence is emerging regarding the relationships between schizophrenia and peptic ulcer disease, inflammatory bowel disease and irritable bowel syndrome; clinical vigilance regarding these conditions should be high. Patients with schizophrenia poorly engage with bowel cancer screening programmes, leading to late diagnosis and increased mortality. Clozapine induced constipation is a significant issue for many patients and requires close monitoring. There is a significant burden of gastrointestinal and liver disease amongst patients with schizophrenia. Better levels of support from all members of the medical team are essential to ensure that appropriate, timely care is provided.

Psychiatric and Neurological Manifestations of Celiac Disease in Adults

“…People with schizophrenia have a two-to fourfold increased risk of dying prematurely compared to the general population. The vulnerability to developing schizophrenia is influenced by both genetic and environmental variables, with drug abuse disorders (especially those involving cannabis) possibly having the strongest link [65]. Past studies have found an association between schizophrenia and CD, but current evidence suggests a causal link has yet to be established [66].…”

“…A treatment-resistant schizophrenia patient with immunological gluten sensitivity benefited from a gluten-restricted diet, showing improvement in both mental and physical symptoms and a reduction in the plasma quantitative level of AGA-IgG [69]. Gluten intolerance is thought to increase chronic inflammation, which, in turn, may worsen the symptoms of schizophrenia and make it more difficult for patients to respond to treatment and absorb medications [65,69].…”

The Hypothalamic-Pituitary-Gonadal Axis in Men with Schizophrenia

“…Frequent alcohol abuse among patients suffering from mental disorders, including schizophrenia, increases the risk of alcohol-related liver diseases—i.e., alcoholic fatty liver, acute alcoholic hepatitis, or alcoholic cirrhosis. Other possible causes of liver damage include, among others, non-alcoholic fatty liver disease, chronic viral hepatitis, and antipsychotic use [ 206 ].…”

Nanosystems for Brain Targeting of Antipsychotic Drugs: An Update on the Most Promising Nanocarriers for Increased Bioavailability and Therapeutic Efficacy

“…Nevertheless, there are numerous disadvantages associated with antipsychotic drug administration, such as the occurrence of frequent, severe and sometimes fatal adverse effects, leading to decreased quality of life and life expectancy for the patient, thus reducing adherence to therapy and, consequently, disease control. Clinically significant antipsychotic adverse effects include the following: extrapyramidal symptoms, such as akathisia, Parkinsonism, catalepsy and tardive dyskinesia; anticholinergic effects, such as dry eyes and mouth, constipation, urinary retention, cognitive impairment and memory deficits; hematological effects, such as neutropenia, leucopenia and agranulocytosis; neuroleptic malignant syndrome, which comprises symptoms such as altered mental status, stiffness, hyperthermia, autonomic overactivity, excessive sweating and urinary incontinence; metabolic syndrome, comprising symptoms such as weight gain, hyperglycemia, diabetes mellitus and altered lipid metabolism; cardiovascular effects, such as QT interval prolongation and orthostatic hypotension; endocrine effects, such as hyperprolactinemia; and respiratory diseases, such as asthma and chronic obstructive pulmonary disease [ 31 , 32 , 33 , 34 ].…”