Management of constipation in patients with schizophrenia—a case study and review of literature

Abstract

Background Schizophrenia is a disorder that affects about 1% of the US population, with an extensive impact on patients’ health and their risk of later developing comorbidities from treatment. While literature on the side effect profile of antipsychotics is abundant, there are few studies on identification of anticholinergic effects on gut motility and prophylaxis development. The aim of this review is to consider antipsychotic-associated constipation in patients with schizophrenia and to discuss management of antipsychotic-induced constipation as documented in the literature. Main body We present a case of antipsychotic-induced constipation and conducted a literature review assessing the prevalence of this issue in this population. The search was done on Embase, MEDLINE, Cochrane Library, and PubMed databases. Key word searches included constipation with concurrent antipsychotic use, antipsychotics and anticholinergic effects, factors causing constipation in schizophrenia, social disparities involved with constipation, and colorectal cancer screenings. Main findings included high complication rates that may be explained by clozapine-specific side effects, negative health habits, disease, and treatment-related metabolic disorders. Co-existing negative symptoms could also be associated with health outcomes and was found to have adverse consequences on schizophrenia progression. Comorbidities of diabetes and cardiovascular complications contributed to gut hypomotility. Caregiver burden was a factor in delayed recognition of constipation as a side effect. Routine surveillance for symptoms and optimization of medications facilitates early recognition of constipation. Conclusion Overall, there is insufficient trial-based evidence to compare the effectiveness and safety of common pharmacological interventions for constipation, such as lactulose, polyethylene glycol, stool softeners, and lubricant laxatives.

Perceptions of Family Caregivers of Patients with Schizophrenia Towards Antipsychotics Associated Side-Effects in China:A Qualitative Study

“…We found that family caregivers considered the side effect of antipsychotics as the nightmare, such as sleep disturbances, obesity, drooling, irregular menstruation, and impaired liver function and constipation, which were reported in previous studies. 9 , 15 , 16 , 21 , 24 Most Chinese have high expectations for their children, and it is their duty as parents to raise a competitive child and bring honor to the family. 12 However, the side effects of antipsychotic drugs impair the physical and social functioning of patients with SZ, as well as their learning and employment.…”

“…For caregivers, limited knowledge and heavy care burdens prevent them from effectively identifying and responding to drug side effects. 24 , 25 Hence, Health professionals should evaluate the patient’s medical history and medication interactions before recommending medication regimens, and family caregivers should be provided with information about side effects of antipsychotics and coping skills. Health professionals also can mitigate the effects of drug side effects on patients by building a strong support system and implementing health strategies, such as dietary modifications, stress relief, and exercise regimes.…”

“…Health professionals also can mitigate the effects of drug side effects on patients by building a strong support system and implementing health strategies, such as dietary modifications, stress relief, and exercise regimes. 24 …”

Quotation Accuracy of Systematic Review and Meta-Analysis Protocols on Acupuncture

“…Anyway, although the title clearly indicates that what is being read is an SR protocol and meta-analysis [ 31 ], and that there is no evidence at this time, it is quoted as a published meta-analysis whose results are favorable to the effect of acupuncture on knee osteoarthritis: “A recent meta-analysis has reported the beneficial effect of acupuncture in the management of knee osteoarthritis” [ 32 ]. Even the protocol [ 33 ] quotation can be as inaccurate as providing quantitative results: “They found that eight weeks of EA increases CSBMs to 3 or more mean weekly CSBMs in the electro acupuncture group, 37.7% compared with 14.1% in the placebo group” [ 34 ]. The problem can be further complicated by inaccurate quotations included in literature reviews; an example is the quotation of this protocol on auricular acupuncture for premature ovarian insufficiency [ 35 ]: “Luo et al (...) conducted a systematic review and meta-analysis of the efficacy and safety of ear acupuncture in the treatment of POI by searching multiple databases before August 2020.…”

Lubiprostone for the Treatment of Clozapine-Induced Constipation: A Case Series

“…Shirazi et al estimated the prevalence of clozapine-associated constipation at 31.2% of patients taking clozapine [3]. There is insufficient trial-based evidence to compare the effectiveness and safety of common laxatives for clozapine-induced constipation [4]. The risk of serious morbidity/mortality from clozapine-associated constipation is substantial, and there is a need for active monitoring of bowel function [5].…”