Article

Clozapine-induced intestinal occlusion: a serious side effect.

Casalmaggiore Psychiatric Operative Unit n. 25 - "Oglio Po" General Hospital, Cremona Hospital Institutes, Italy.
Acta bio-medica: Atenei Parmensis 09/2007; 78(2):144-8.
Source: PubMed

ABSTRACT Aim of this article is to describe the first italian case reported in literature of a clozapine-induced intestinal occlusion with previous severe constipation in a 45-year-old male patient who had been treated with daily clozapine for 5 months because of treatment-resistant residual schizophrenia. When conservative treatment (intravenous fluids, fleet enema and rectal washout) was used and clozapine therapy was decreased, gastrointestinal symptoms rapidly improved and the patient had regular bowel motions within a week. Preventive measures (high-fiber diet, adequate fluid intake, stool softeners and exercise) was also used to ensure that clozapine therapy could be safely continued. Although constipation is a common and usually benign side effect of treatment with clozapine, this case-report highlights the consequences of undertreated and unrecognized marked constipation progressing to severe bowel obstruction (a complication which deserves more attention because it can lead to hospitalization and might be potentially fatal).

0 Followers
 · 
251 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Cardiac autonomic dysfunction has been reported in patients suffering from schizophrenia. The aim of the present study was to evaluate gastric electrical activity in unmedicated patients suffering from acute schizophrenia in relation to their symptoms. Electrogastrography was performed before and after test meal ingestion in 26 patients suffering from schizophrenia and 26 matched controls. The non-linear measure approximate entropy (ApEn) was calculated for the first time from the obtained signal in addition to standardized measures. Results were correlated with the scales for the assessment of positive symptoms and negative symptoms. In addition, autonomic and abdominal symptoms were assessed by the autonomic symptom score. We found a significantly increased amount of tachygastria and arrhythmia within the signal of the activity of the gastric pacemaker before and after test meal digestion in patients compared to controls, indicating increased sympathetic modulation within the enteric nervous system. A significant difference was observed for slow wave, which represents the dominant frequency of gastric pacemaker activity, indicating gastric dysmotility in our patients. The elevated ApEn measure points to increased complexity and dysregulation. In addition, we have observed a correlation between delusions and tachygastria. Sympathetic function seems to be altered in the enteric nervous system of patients suffering from schizophrenia. Future studies need to explore the influence of the disease on different branches of the autonomic nervous system and clinical consequences of enteric dysfunction. Our findings point to a possible systemic autonomic imbalance that needs to be studied in respect to the neurobiology of schizophrenia.
    Progress in Neuro-Psychopharmacology and Biological Psychiatry 08/2009; 33(7):1236-40. DOI:10.1016/j.pnpbp.2009.07.007 · 4.03 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Although there have been reported fatalities associated with clozapine-induced bowel infarction, in all of these cases, the patients had taken clozapine for months to years. We present here the case of a 47-year-old single man who died suddenly due to bowel infarction and sepsis 1 week after taking clozapine.
    General hospital psychiatry 11/2013; 35(6):679.e5-6. DOI:10.1016/j.genhosppsych.2013.03.002 · 2.90 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Antipsychotics are the cornerstone in the management of psychotic disorders and schizophrenia. They are effective agents but also have a wide range of side effects. In the recent literature constipation as possible side effect has received little attention. A review of the literature concerning constipation associated with antipsychotics was performed. Overall constipation is a rarely studied or reported side effect of antipsychotic medication. Nevertheless constipation is a common side effect. Antipsychotic agents differ in their liability to induce constipation. Constipation can be severe and can lead to serious consequences such as paralytic ileus, bowel occlusion and death. Active screening, monitoring and treatment are recommended. Further research on incidence, prevalence, underlying mechanisms and preventive measures is required.
    European Psychiatry 01/2011; 26(1):34-44. DOI:10.1016/j.eurpsy.2010.03.003 · 3.21 Impact Factor

Preview

Download
9 Downloads
Available from