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Hu X, Ma YN, Karako K, Tang W, Song P, Xia Y. Comprehensive assessment and treatment strategies for dysphagia in the elderly population: Current status and prospects. Biosci Trends 2024; 18:116-126. [PMID: 38658363 DOI: 10.5582/bst.2024.01100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
As the population ages, the prevalence of dysphagia among older adults is a growing concern. Age-related declines in physiological function, coupled with neurological disorders and structural changes in the pharynx associated with aging, can result in weakened tongue propulsion, a prolonged reaction time of the submental muscles, delayed closure of the laryngeal vestibule, and delayed opening of the upper esophageal sphincter (UES), increasing the risk of dysphagia. Dysphagia impacts the physical health of the elderly, leading to serious complications such as dehydration, aspiration pneumonia, malnutrition, and even life-threatening conditions, and it also detrimentally affects their psychological and social well-being. There is a significant correlation between frailty, sarcopenia, and dysphagia in the elderly population. Therefore, older adults should be screened for dysphagia to identify both frailty and sarcopenia. A reasonable diagnostic approach for dysphagia involves screening, clinical assessment, and instrumental diagnosis. In terms of treatment, multidisciplinary collaboration, rehabilitation training, and the utilization of new technologies are essential. Future research will continue to concentrate on these areas to enhance the diagnosis and treatment of dysphagia, with the ultimate aim of enhancing the quality of life of the elderly population.
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Affiliation(s)
- Xiqi Hu
- Department of Neurosurgery, Central South University, Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, China
| | - Ya-Nan Ma
- Department of Gastroenterology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Kenji Karako
- Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Wei Tang
- Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Peipei Song
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Ying Xia
- Department of Neurosurgery, Central South University, Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, China
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Chane-Law E, Prum G, Mallart R, Verin E. Oropharyngeal dysphagia in children with multiple disabilities. J Laryngol Otol 2024:1-3. [PMID: 38576123 DOI: 10.1017/s0022215124000215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
OBJECTIVE This study aimed to investigate the prevalence of oropharyngeal dysphagia among institutionalised children with multiple disabilities, a topic with limited literature coverage. METHODS The study employed a questionnaire, specifically the F-PEDI-EAT-10, to screen for dysphagia in children. Trained nurses administered the questionnaire to the participants. RESULTS The study included 117 children with multiple disabilities (51.3 per cent boys and 48.7 per cent girls) with an average age of 14 ± 4.7 years. The questionnaire revealed that 53 per cent (n = 62) of the children had a positive score and, surprisingly, 29 per cent of them (n = 18) did not have a confirmed diagnosis of oropharyngeal dysphagia. Notably, children with a positive F-PEDI-EAT-10 score had a significantly higher prevalence of pneumopathy and undernutrition compared with those with a negative score. CONCLUSION This study underscores the high prevalence of oropharyngeal dysphagia among children with multiple disabilities, a condition that is often underdiagnosed.
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Affiliation(s)
- Emeline Chane-Law
- Pediatric Department, Rouen Normandy University Hospital, Rouen, France
| | - Grégoire Prum
- Pediatric Department, Rouen Normandy University Hospital, Rouen, France
- CHU Rouen Rehabilitation Department, Rouen Normandy University Hospital, Rouen, France
| | - Remi Mallart
- Pediatric Department, Rouen Normandy University Hospital, Rouen, France
| | - Eric Verin
- Pediatric Department, Rouen Normandy University Hospital, Rouen, France
- CHU Rouen Rehabilitation Department, Rouen Normandy University Hospital, Rouen, France
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Ohira M, Ohkubo M, Miura K, Yamashita S, Morimitsu T, Goto Y. Diagnostic Accuracy of Mann Assessment of Swallowing Ability for Predicting Dysphagia in Patients with Psychiatric Disorders. THE BULLETIN OF TOKYO DENTAL COLLEGE 2023; 64:79-87. [PMID: 37599089 DOI: 10.2209/tdcpublication.2022-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Dysphagia occurs in various diseases and constitutes a major concern in patients with psychiatric disorders. The Mann Assessment of Swallowing Ability (MASA) comprises 24 clinical parameters designed to identify swallowing disorders. One item in MASA, the "gag reflex", involves an unpleasant stimulus, which means that it is often omitted when the test is administered. The aims of this study were to determine the presence/absence of dysphagia in patients with psychiatric disorders using the MASA and determine its diagnostic accuracy when the gag reflex item was excluded in patients with psychiatric disorders. The study participants comprised patients admitted to a hospital psychiatric ward in whom dysphagia had been suspected based on oral intake status. The following items were determined: age, total MASA score (23 out of 24 items, giving a score out of 195 points), body mass index score, milligram equivalents of chlorpromazine, and the Food Intake Level Scale score. The patients were divided into two groups according to the presence or absence of swallowing problems as assessed by videoendoscopic or videofluoroscopic examination. The scores for each item investigated in the MASA, including the total score, were compared between the two groups. Receiver operating characteristic curve analysis was carried out to determine the optimum cut-off value. The total MASA score, which excluded the "gag reflex" item, was lower in the problematic swallowing group than in the non-problematic swallowing group. The MASA scores for cooperation, respiratory, dysphasia, tongue coordination, oral preparation, pharyngeal phase, and pharyngeal response tended to be lower in the problematic swallowing group. Furthermore, an optimum cut-off value of 169 points (sensitivity, 0.92; specificity, 0.68; likelihood ratio, 2.84) was identified. These results indicate that the cut-off MASA score is effective in screening for dysphagia, even when the "gag reflex" item is excluded.
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Affiliation(s)
- Mariko Ohira
- Department of Removable Partial Prosthodontics, Tokyo Dental College
| | - Mai Ohkubo
- Department of Oral Health and Clinical Science Division of Dysphagia Rehabilitation
| | - Keina Miura
- Department of Oral Health and Clinical Science Division of Dysphagia Rehabilitation
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Nakajima Y, Tsujimura T, Tsutsui Y, Chotirungsan T, Kawada S, Dewa N, Magara J, Inoue M. Atropine facilitates water-evoked swallows via central muscarinic receptors in anesthetized rats. Am J Physiol Gastrointest Liver Physiol 2023; 325:G109-G121. [PMID: 37219016 DOI: 10.1152/ajpgi.00039.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/01/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023]
Abstract
Anticholinergic medication causes impaired swallowing with hyposalivation. However, the underlying mechanisms by which these drugs modulate the swallowing reflex remain unclear. This study investigated the effects of the muscarinic acetylcholine receptor (mAChR) nonspecific antagonist atropine on the initiation of swallowing. Experiments were performed on 124 urethane-anesthetized rats. A swallow was evoked by either topical laryngeal application of a small amount of distilled water (DW), saline, citric acid, or capsaicin; upper airway distention with a continuous airflow; electrical stimulation of the superior laryngeal nerve (SLN); or focal microinjection of N-methyl-d-aspartate (NMDA) into the lateral region of the nucleus of the solitary tract (L-nTS). Swallows were identified by electromyographic bursts of the digastric and thyrohyoid muscles. Either atropine, the peripheral mAChR antagonist methylatropine, or antagonists of mAChR subtypes M1-M5 were intravenously delivered. Atropine at a dose of 1 mg/kg increased the number of DW-evoked swallows compared with baseline and did not affect the number of swallows evoked by saline, citric acid, capsaicin, or upper airway distention. Methylatropine and M1-M5 antagonists did not significantly change the number of DW-evoked swallows. Bilateral SLN transection completely abolished DW-evoked swallows, and atropine decreased the swallowing threshold of SLN electrical stimulation. Finally, microinjection of NMDA receptor antagonist AP-5 into the L-nTS inhibited DW-evoked swallows, and atropine facilitated the initiation of swallowing evoked by NMDA microinjection into this region. These results suggest that atropine facilitates DW-evoked swallows via central mAChR actions.NEW & NOTEWORTHY Atropine facilitated the distilled water (DW)-evoked swallows in anesthetized rats. Atropine decreased the swallowing threshold evoked by electrical stimulation of the superior laryngeal nerve, which is a primary sensory nerve for the initiation of DW-evoked swallows. Atropine facilitated the swallows evoked by N-methyl-d-aspartate microinjection into the lateral region of the nucleus of the solitary tract, which is involved in the DW-evoked swallows. We speculate that atropine facilitates the DW-evoked swallows via central muscarinic receptor actions.
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Affiliation(s)
- Yuta Nakajima
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takanori Tsujimura
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yuhei Tsutsui
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Titi Chotirungsan
- Department of Oral Diagnosis, Faculty of Dentistry, Naresuan University, Muang, Phitsanulok, Thailand
| | - Satomi Kawada
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Nozomi Dewa
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Jin Magara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Makoto Inoue
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Cheng I, Hamad A, Sasegbon A, Hamdy S. Advances in the Treatment of Dysphagia in Neurological Disorders: A Review of Current Evidence and Future Considerations. Neuropsychiatr Dis Treat 2022; 18:2251-2263. [PMID: 36268265 PMCID: PMC9578488 DOI: 10.2147/ndt.s371624] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/08/2022] [Indexed: 11/19/2022] Open
Abstract
Dysphagia, which refers to difficult and/or disordered swallowing, is a common problem associated with various neurological diseases such as stroke, motor neuron diseases and neurodegenerative diseases. Traditionally, dysphagia treatments are either compensatory, which includes modifications of bolus texture or feeding posture, or rehabilitative, which includes behavioral exercises and sensory stimulation. Despite being widely adopted in clinical practice, recent views have challenged the clinical efficacy of these treatments due to the low level of evidence supported by mainly non-controlled studies. As such, with advancements in technology and scientific research methods, recent times have seen a surge in the development of novel dysphagia treatments and an increasing number of robust randomized controlled clinical trials. In this review, we will review the clinical evidence of several newly introduced treatments for dysphagia in the last two decades, including rehabilitative exercises, biofeedback, pharmacological treatments, neuromodulation treatments and soft robotics. Despite the recent improvements in the quality of evidence for the efficacy of dysphagia treatments, several critical issues, including heterogeneity in treatment regimens, long-term treatment effects, underlying mechanisms of some neuromodulation treatments, and the effects of these techniques in non-stroke dysphagia, remain to be addressed in future clinical trials.
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Affiliation(s)
- Ivy Cheng
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Adeel Hamad
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Ayodele Sasegbon
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Shaheen Hamdy
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Bendsen BB, Jensen D, Westmark S, Krarup AL, Riis J, Melgaard D. The Quality of Life in Citizens with Oropharyngeal Dysphagia—A Cross-Sectional Study. J Clin Med 2022; 11:jcm11144212. [PMID: 35887975 PMCID: PMC9322035 DOI: 10.3390/jcm11144212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 02/04/2023] Open
Abstract
Dysphagia is a risk factor that impaires an individual’s experience of mealtimes. Few studies contribute to the knowledge on the health-related quality of life (HRQoL) of citizens with oropharyngeal dysphagia (OD) living independently. The aim of this study involves evaluating the HRQoL in citizens living independently and suffering from OD. This cross-sectional study was performed in seven municipalities in Denmark between March 2019 and December 2020. The 90 citizens included (54% female, mean age 76.6 years (SD 0.8)) were ≥18 years, as well as diagnosed with OD using the volume-viscosity swallow test and Minimal Eating Observation Form version II. The Dysphagia Handicap Index-DK, Barthel 20, and European Quality of Life-5 Dimensions were fulfilled. Of the participating citizens, 66% of them needed additional time to eat, 64% coughed while eating, and 58% coughed while drinking. Additionally, 60% reported having a dry mouth, 62% needed to drink to succeed with swallowing foods, and 57% had to swallow multiple times. About one-third felt embarrassed when eating with others. They could not enjoy eating in the same manner as they had previously, and/or felt handicapped or limited. OD was shown to have had a high impact on the QoL in citizens with OD living independently. Focus is needed on xerostomia, as well as on the psychological aspects pertainings to mealtimes for citizens with OD.
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Affiliation(s)
- Bettina Burgdorff Bendsen
- Department of Physiotherapy and Occupational Therapy, Municipality of Hjørring, Bistrupvej 3, 9800 Hjoerring, Denmark;
| | - Diana Jensen
- Center of Rehabilitation, Municipality of Tønder, Carstensgade 6-10, 6270 Toender, Denmark;
| | - Signe Westmark
- Center for Clinical Research, North Denmark Regional Hospital, Bispensgade 37, 9800 Hjoerring, Denmark; (S.W.); (J.R.)
| | - Anne Lund Krarup
- Department of Neuro-Gastroenterological Research, North Denmark Regional Hospital, Bispensgade 37, 9800 Hjoerring, Denmark;
- Department of Acute Medicine and Trauma Care, Aalborg University Hospital, Hobrovej, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
| | - Johannes Riis
- Center for Clinical Research, North Denmark Regional Hospital, Bispensgade 37, 9800 Hjoerring, Denmark; (S.W.); (J.R.)
| | - Dorte Melgaard
- Center for Clinical Research, North Denmark Regional Hospital, Bispensgade 37, 9800 Hjoerring, Denmark; (S.W.); (J.R.)
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
- Correspondence: ; Tel.: +45-2628-1086
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Guthrie S, Baker J, Cahill J, Hemsley B. Mealtime difficulties in adults with mental health conditions: an integrative review. J Ment Health 2022; 32:504-516. [PMID: 35037562 DOI: 10.1080/09638237.2021.2022633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Dysphagia and choking are highly prevalent in adults with mental health conditions. However, there is scant research considering the personal experience of dysphagia for this population. AIMS To understand the evidence-base for strategies to involve the patient in recognition, assessment and treatment of mealtime difficulties. METHODS This integrative review synthesised the literature on the experience of dysphagia in patients with mental health conditions. Patient consultation led to co-designed search terms and eligibility criteria for a systematic search of five scientific databases following Prisma guidance. Quality assessment of the eligible studies and reflexive thematic analysis were completed. RESULTS 31 studies were included for review. These included case reports, literature reviews and cross-sectional studies. Quality of evidence was weak and no intervention studies were identified. There was scant detail regarding the personal experience of dysphagia or choking. Themes identified related to biomedical perspectives, influencing factors presented without context, and decision-making led by clinicians. CONCLUSIONS Guidance on mental healthcare calls attention to under-diagnosis of physical co-morbidities and advocates patient inclusion. However, the patient voice in this population is rarely described regarding dysphagia. Further inclusive research is indicated to explore the impact of dysphagia and choking, and implications for interventions and outcome measures.
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Affiliation(s)
- Susan Guthrie
- School of Healthcare, University of Leeds, Leeds, UK.,Leeds and York Partnership Foundation Trust, Leeds, UK
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, UK.,Leeds and York Partnership Foundation Trust, Leeds, UK
| | - Jane Cahill
- School of Healthcare, University of Leeds, Leeds, UK
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Tani H, Tomita M, Suzuki T, Mimura M, Uchida H. Clinical Characteristics of Patients with Schizophrenia Maintained without Antipsychotics: A Cross-sectional Survey of a Case Series. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2021; 19:773-779. [PMID: 34690131 PMCID: PMC8553521 DOI: 10.9758/cpn.2021.19.4.773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/30/2021] [Accepted: 06/03/2021] [Indexed: 11/18/2022]
Abstract
Objective While antipsychotics are necessary for relapse prevention in the treatment of schizophrenia in general, some minority of patients may be maintained without continuous antipsychotic treatment. However, the characteristics of such patients are not well known and previous reports have not evaluated key elements such as physical comorbidities and functioning. Methods Among 635 patients with schizophrenia who participated in a 12-year follow-up, those who were maintained without antipsychotic treatment for at least one year after the study were investigated. The patients underwent comprehensive assessments, including Positive and Negative Syndrome Scale (PANSS) for psychopathology, Cumulative Illness Rating Scale for Geriatrics (CIRS-G) for physical comorbidities, and Functional Assessment for Comprehensive Treatment of Schizophrenia (FACT-Sz), Barthel Index, and EuroQoL five dimensions (EQ5D) for function. Results Six patients were included (mean ± standard deviation age, 66.8 ± 17.4 years; 4 inpatients). The four inpatients were old (77.8 ± 4.8 years) and chronically ill (duration of illness, 49.3 ± 12.5 years) with a high PANSS score (total score, 118.0 ± 9.8; negative syndrome subscale, 41.3 ± 6.9), low functioning (FACT-Sz, 9.8 ± 3.6; Barthel Index, 8.8 ± 9.6), and serious physical comorbidities (CIRS-G, 15.5 ± 1.1). By contrast, the two outpatients were relatively young (45.0 ± 12.0 years) and clinically in good condition (PANSS total score, 44.5 ± 0.5; Barthel Index, 100 for both; EQ5D, 0.85 ± 0.04). Conclusion Although the number is limited, two types of patients with schizophrenia were identified who were free from ongoing antipsychotic treatment; 1) older chronic inpatients with serious physical comorbidities, and 2) younger outpatients with milder impairments. Future explorations are needed to identify those who will be successfully withdrawn from continuous antipsychotic treatment.
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Affiliation(s)
- Hideaki Tani
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Kimel Family Translational Imaging-Genetics Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Takefumi Suzuki
- Department of Neuropsychiatry, University of Yamanashi, Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Prevalence of oropharyngeal dysphagia in geriatric patients and real-life associations with diseases and drugs. Sci Rep 2021; 11:21955. [PMID: 34754078 PMCID: PMC8578645 DOI: 10.1038/s41598-021-99858-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 09/27/2021] [Indexed: 12/19/2022] Open
Abstract
Risk factors for oropharyngeal dysphagia (OD) in elderly patients are mainly central nervous system (CNS) and structural organic diseases or presbyphagia. We analysed the OD prevalence and association of OD with multimorbidity and polypharmacy using real-life data to complete this spectrum, with a focus on further and iatrogenic risk. This was a cross-sectional retrospective study based on a random sample of 200 patients admitted to a geriatric hospital. Data analysis included diagnoses, the detailed list of drugs, and an intense clinical investigation of swallowing according to Stanschus to screen for OD in each patient. The mean patient age was 84 ± 6.5 years. The prevalence of OD was 29.0%, without an effect of age, but a higher rate was found in men and in nursing home residents and an elevated risk of pneumonia. OD risk was slight in diabetes mellitus and COPD, and pronounced in CNS diseases. A relevant OD association was found, even after adjusting for CNS diseases, with antipsychotics, benzodiazepines, anti-Parkinson drugs, antidepressants, and antiepileptics. Further risk of OD was found with beta-blockers, alpha-blockers, opioids, antiemetics, antivertiginosa or antihistamines, metoclopramide, domperidone, anticholinergics, loop diuretics, urologics, and ophthalmics. From real-life data in patients with and without CNS diseases, we identified drug groups associated with a risk of aggravating/inducing OD. Restrictive indications for these drugs may be a preventative contribution, requiring implementation in dysphagia guidelines and an integrative dysphagia risk scale that considers all associated and cumulative medication risks in addition to diseases.
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Dziewas R, Allescher HD, Aroyo I, Bartolome G, Beilenhoff U, Bohlender J, Breitbach-Snowdon H, Fheodoroff K, Glahn J, Heppner HJ, Hörmann K, Ledl C, Lücking C, Pokieser P, Schefold JC, Schröter-Morasch H, Schweikert K, Sparing R, Trapl-Grundschober M, Wallesch C, Warnecke T, Werner CJ, Weßling J, Wirth R, Pflug C. Diagnosis and treatment of neurogenic dysphagia - S1 guideline of the German Society of Neurology. Neurol Res Pract 2021; 3:23. [PMID: 33941289 PMCID: PMC8094546 DOI: 10.1186/s42466-021-00122-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction Neurogenic dysphagia defines swallowing disorders caused by diseases of the central and peripheral nervous system, neuromuscular transmission, or muscles. Neurogenic dysphagia is one of the most common and at the same time most dangerous symptoms of many neurological diseases. Its most important sequelae include aspiration pneumonia, malnutrition and dehydration, and affected patients more often require long-term care and are exposed to an increased mortality. Based on a systematic pubmed research of related original papers, review articles, international guidelines and surveys about the diagnostics and treatment of neurogenic dysphagia, a consensus process was initiated, which included dysphagia experts from 27 medical societies. Recommendations This guideline consists of 53 recommendations covering in its first part the whole diagnostic spectrum from the dysphagia specific medical history, initial dysphagia screening and clinical assessment, to more refined instrumental procedures, such as flexible endoscopic evaluation of swallowing, the videofluoroscopic swallowing study and high-resolution manometry. In addition, specific clinical scenarios are captured, among others the management of patients with nasogastric and tracheotomy tubes. The second part of this guideline is dedicated to the treatment of neurogenic dysphagia. Apart from dietary interventions and behavioral swallowing treatment, interventions to improve oral hygiene, pharmacological treatment options, different modalities of neurostimulation as well as minimally invasive and surgical therapies are dealt with. Conclusions The diagnosis and treatment of neurogenic dysphagia is challenging and requires a joined effort of different medical professions. While the evidence supporting the implementation of dysphagia screening is rather convincing, further trials are needed to improve the quality of evidence for more refined methods of dysphagia diagnostics and, in particular, the different treatment options of neurogenic dysphagia. The present article is an abridged and translated version of the guideline recently published online (https://www.awmf.org/uploads/tx_szleitlinien/030-111l_Neurogene-Dysphagie_2020-05.pdf).
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Affiliation(s)
- Rainer Dziewas
- Klinik für Neurologie, Universitätsklinik Münster, 48149 Münster, Germany. .,Klinik für Neurologie und Neurologische Frührehabilitation, Klinikum Osnabrück, Am Finkenhügel 1, 49076, Osnabrück, Germany.
| | - Hans-Dieter Allescher
- Zentrum für Innere Medizin, Klinikum Garmisch-Partenkirchen GmbH, Auenstraße 6, 82467, Garmisch-Partenkirchen, Germany
| | - Ilia Aroyo
- Klinik für Neurologie und Neurointensivmedizin, Klinikum Darmstadt, Grafenstr. 9, 64283, Darmstadt, Germany
| | | | | | - Jörg Bohlender
- Universitätsspital Zürich, ORL-Klinik, Abteilung für Phoniatrie und Klinische Logopädie, Frauenklinikstr. 24, 8091, Zürich, Schweiz
| | - Helga Breitbach-Snowdon
- Schule für Logopädie, Universitätsklinikum Münster, Kardinal-von-Galen-Ring 10, 48149, Münster, Germany
| | | | - Jörg Glahn
- Universitätsklinik für Neurologie und Neurogeriatrie, Johannes Wesling Klinikum Minden, Hans-Nolte Strasse 1, 32429, Minden, Germany
| | - Hans-Jürgen Heppner
- Private Universität Witten/Herdecke gGmbH, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Karl Hörmann
- University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christian Ledl
- Abteilung Sprach-, Sprech- und Schlucktherapie, Schön Klinik Bad Aibling SE & Co. KG, Kolbermoorer Str. 72, 83043, Bad Aibling, Germany
| | - Christoph Lücking
- Schön Klinik München Schwabing, Parzivalplatz 4, 80804, München, Germany
| | - Peter Pokieser
- Medizinische Universität Wien, Teaching Center / Unified Patient Program, AKH Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Joerg C Schefold
- Universitätsklinik für Intensivmedizin, Inselspital, Universitätsspital Bern, 3010, Bern, Schweiz
| | | | - Kathi Schweikert
- REHAB Basel, Klinik für Neurorehabilitation und Paraplegiologie, Im Burgfelderhof 40, 4012, Basel, Schweiz
| | - Roland Sparing
- VAMED Klinik Hattingen GmbH, Rehabilitationszentrum für Neurologie, Neurochirurgie, Neuropädiatrie, Am Hagen 20, 45527, Hattingen, Germany
| | - Michaela Trapl-Grundschober
- Klinische Abteilung für Neurologie, Therapeutischer Dienst, Universitätsklinikum Tulln, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Alter Ziegelweg 10, 3430, Tulln an der Donau, Österreich
| | - Claus Wallesch
- BDH-Klinik Elzach gGmbH, Am Tannwald 1, 79215, Elzach, Germany
| | - Tobias Warnecke
- Klinik für Neurologie, Universitätsklinik Münster, 48149 Münster, Germany
| | - Cornelius J Werner
- Sektion Interdisziplinäre Geriatrie, Klinik für Neurologie, Medizinische Fakultät, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Johannes Weßling
- Zentrum für Radiologie, Neuroradiologie und Nuklearmedizin, Clemenskrankenhaus Münster, Düesbergweg 124, 48153, Münster, Germany
| | - Rainer Wirth
- Klinik für Altersmedizin und Frührehabilitation, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Katholische Kliniken Rhein-Ruhr, Hölkeskampring 40, 44625, Herne, Germany
| | - Christina Pflug
- Klinik und Poliklinik für Hör-, Stimm- und Sprachheilkunde, Universitäres Dysphagiezentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Pu D, Wong MCH, Yiu EML, Chan KMK. Profiles of polypharmacy in older adults and medication associations with signs of aspiration. Expert Rev Clin Pharmacol 2021; 14:643-649. [PMID: 33764819 DOI: 10.1080/17512433.2021.1909474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Polypharmacy and specific medication classes are prevalent in older adults. Their relationships with swallowing disorders are not well explored, which would best be managed holistically, with consideration of medication profiles. This study aimed to establish profiles of polypharmacy in older adults and investigate the associations of polypharmacy and medication class with signs of aspiration during swallowing. METHODS This was a secondary retrospective analysis of data from 291 adults aged 60 years and older. Polypharmacy was profiled numerically and described. Multivariate logistic regression was used to identify associations between medication classes with signs of aspiration, while controlling for independent variables of demographics, functional status, and medical history. RESULTS Three distinct profiles of polypharmacy were described. Higher numbers of medications were associated with higher age, lower functional status, nursing home residency, multimorbidity, and showing signs of aspiration. Thirty-four classes of medications were found in this study, benzodiazepines were the only class independently associated with signs of aspiration. CONCLUSIONS Different profiles of polypharmacy can be observed in older adults, but none were independently associated with signs of aspiration. In addition to known demographic and functional status variables, benzodiazepine-use was found to be independently associated with signs of aspiration (p = .005, B = 7.94).
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Affiliation(s)
- Dai Pu
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Michael C H Wong
- Registered Pharmacist, Pharmacy & Poisons Board of Hong Kong, Hong Kong, China
| | - Edwin M L Yiu
- Swallowing Research Laboratory, Faculty of Education, the University of Hong Kong, Hong Kong, China
| | - Karen M K Chan
- Swallowing Research Laboratory, Faculty of Education, the University of Hong Kong, Hong Kong, China
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Al-Mahrouqi T, Al-Kindi A, Al-Harrasi A. Crippling Side Effects Induced by Paliperidone Palmitate Treatment: A Case Report. Cureus 2021; 13:e13588. [PMID: 33796427 PMCID: PMC8006656 DOI: 10.7759/cureus.13588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In this report, we present the case of a 20-year-old woman with schizophrenia, who had been treated with a once-monthly dosage of long-acting paliperidone palmitate due to poor adherence to oral antipsychotics. She presented to the emergency department of the Sultan Qaboos University Hospital (SQUH), Muscat, Oman, with tachycardia, difficulty in breathing, difficulty in swallowing, choking, excessive production of saliva, drooling, urinary incontinence, blurry vision, a shuffling gait, slowness of movement, stooped posture, muscle rigidity, tremor, and hyperprolactinemia. The paliperidone palmitate injections were discontinued and the patient underwent a treatment course with procyclidine, and she subsequently achieved full recovery within seven days. It appears that even though the long-acting paliperidone palmitate prescription had improved her psychotic symptoms, it also induced several potentially life-threatening conditions. This case report highlights the diagnostic challenge represented by the overlapping features of the neuroleptic malignant syndrome (NMS) and extrapyramidal side effects (EPS).
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Affiliation(s)
- Tamadhir Al-Mahrouqi
- Psychiatry, General Foundation Program, Oman Medical Specialty Board, Muscat, OMN
| | - Ameera Al-Kindi
- Psychiatry, Psychiatry Residency Training Program, Oman Medical Specialty Board, Muscat, OMN
| | - Ahmed Al-Harrasi
- Behavioural Medicine, Sultan Qaboos University Hospital, Muscat, OMN
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Fernandes MS, Castelo PM, Chaves GN, Fernandes JPS, Fonseca FLA, Zanato LE, Gavião MBD. Relationship between polypharmacy, xerostomia, gustatory sensitivity, and swallowing complaints in the elderly: A multidisciplinary approach. J Texture Stud 2020; 52:187-196. [PMID: 33191538 DOI: 10.1111/jtxs.12573] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 11/30/2022]
Abstract
Oral dysfunctions are common in the elderly but the literature lacks a multidisciplinary approach on the relationship between polypharmacy, saliva flow, xerostomia, taste, and swallowing complaints. This cross-sectional study included 204 non-institutionalized elderly (>60 years; 123 women/81 men), free of severe disabilities and non-alcohol/tobacco consumers, from whom specific pharmacological therapies were evaluated, as well xerostomia (Xerostomia Inventory-XI) and swallowing complaints (EAT-10 questionnaire), salivary flow rate and gustatory sensitivity. Statistical analysis included Chi-square, Mann-Whitney, Two-way ANCOVA, and linear multiple regression. Polypharmacy (≥5 drugs daily), hyposalivation, and severe taste dysfunction were found in 18, 46, and 10% of the participants, respectively. Polypharmacy was related with xerostomia (p = .041) and swallowing complaints (p < .001; power = 94%), but not with taste dysfunction. Dry mouth complaint and higher risk of swallowing disorders were found in 50 and 12% of the elderly, respectively, and angiotensin-converting enzyme (ACE) inhibitors users (n = 36) showed higher EAT-10 scores (p = .038). Regression models showed that stimulated salivary flow rate was dependent on gender and diuretic use, while xerostomia scores were dependent on the number of medications and unstimulated saliva flow (p < .001). In conclusion, the results draw attention to the high frequency of oral and maxillofacial dysfunctions found in non-institutionalized elderly, especially polypharmacy, xerostomia and swallowing complaints, and the side effects of drugs that can disturb the oral functions, the acceptance of food, and the adherence to oral therapies.
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Affiliation(s)
- Mariana S Fernandes
- Department of Pediatric Dentistry, University of Campinas, Piracicaba, Brazil
| | - Paula M Castelo
- Department of Pharmaceutical Sciences, Universidade Federal de São Paulo, Diadema, Brazil
| | - Giovanna N Chaves
- Department of Pharmaceutical Sciences, Universidade Federal de São Paulo, Diadema, Brazil
| | - João P S Fernandes
- Department of Pharmaceutical Sciences, Universidade Federal de São Paulo, Diadema, Brazil
| | - Fernando L A Fonseca
- Department of Pharmaceutical Sciences, Universidade Federal de São Paulo, Diadema, Brazil
| | - Luciana E Zanato
- Department of Speech Language Therapy, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Maria B D Gavião
- Department of Pediatric Dentistry, University of Campinas, Piracicaba, Brazil
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16
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Miarons M, Clavé P, Wijngaard R, Ortega O, Arreola V, Nascimento W, Rofes L. Pathophysiology of Oropharyngeal Dysphagia Assessed by Videofluoroscopy in Patients with Dementia Taking Antipsychotics. J Am Med Dir Assoc 2019; 19:812.e1-812.e10. [PMID: 30149844 DOI: 10.1016/j.jamda.2018.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/19/2018] [Accepted: 04/21/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The objective of this study was to assess the pathophysiology of oropharyngeal dysphagia (OD) in patients with dementia, specifically in those taking antipsychotics (APs). DESIGN A cross-sectional study was performed from January 2011 to May 2017 in a general hospital. SETTING AND PARTICIPANTS We included 114 patients with dementia, of which 39 (34.2%) were taking APs (82.5 ± 7.8 years, Barthel Index 52.28 ± 30.42) and 29 patients without dementia (82.4 ± 6.7 years, Barthel Index 77.71 ± 24.7) and OD confirmed by a videofluoroscopy. MEASURES Demographical and clinical factors as well as swallowing function of patients with dementia with OD were compared with older patients without dementia with OD. We also compared patients with dementia taking and not taking APs. Impaired efficacy during videofluoroscopy was defined as the presence of oral and/or pharyngeal residue, and impaired safety (unsafe swallow) was defined as aspiration or penetration. Receiver operating characteristic curves were drawn for laryngeal vestibule closure (LVC) time to predict unsafe swallow. RESULTS 87.7% of patients with dementia presented impaired efficacy of swallow and 74.6% impaired safety [penetration-aspiration scale (PAS) 3.94 ± 1.94]. 86.2% of patients without dementia presented impaired efficacy and 44.8% impaired safety (PAS 2.21 ± 1.92). Time to LVC was significantly delayed in patients with dementia taking APs in comparison with patients without dementia (LVC 0.377 ± 0.093 vs 0.305 ± 0.026, P = .003). In contrast, there were no differences in the PAS and LVC time in patients with dementia taking and not taking APs (PAS 3.96 ± 0.26 vs 3.88 ± 0.22, LVC 0.398 ± 0.117 vs 0.376 ± 0.115, NS). LVC time ≥0.340 seconds predicted unsafe swallow in patients with dementia with an accuracy of 0.71. CONCLUSIONS/IMPLICATIONS Patients with dementia presented high prevalence and severity of videofluoroscopy signs of impaired efficacy and safety of swallow and a more severe impairment in airway protection mechanisms (higher PAS and LVC delay). Clinical practice should implement specific protocols to prevent OD and its complications in these patients. AP treatment did not significantly worsen swallowing impairments.
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Affiliation(s)
- Marta Miarons
- Pharmacy Department, Hospital de Mataró, Mataró, Spain.
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autónoma de Barcelona, Mataró, Spain; CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autónoma de Barcelona, Mataró, Spain; CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Viridiana Arreola
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autónoma de Barcelona, Mataró, Spain
| | - Weslania Nascimento
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autónoma de Barcelona, Mataró, Spain
| | - Laia Rofes
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
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Manduchi B, Fainman GM, Walshe M. Interventions for Feeding and Swallowing Disorders in Adults with Intellectual Disability: A Systematic Review of the Evidence. Dysphagia 2019; 35:207-219. [PMID: 31372756 DOI: 10.1007/s00455-019-10038-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 05/14/2019] [Accepted: 07/20/2019] [Indexed: 12/11/2022]
Abstract
Feeding and swallowing disorders are prevalent in adults with Intellectual Disability (ID) and can potentially lead to discomfort, malnutrition, dehydration, aspiration, and choking. Most common interventions include: diet modification, compensatory strategies, swallowing therapy, and non-oral feeding. Despite their common use, the research evidence for these interventions is lacking. The current study aimed to systematically review the evidence for the safety and the effectiveness of interventions for feeding and swallowing disorders in adults with ID. Seven electronic databases, conference proceedings, and reference lists of relevant studies were reviewed from online availability to March 2019, with no language restrictions. Eligibility criteria encompassed experimental or non-experimental study design, adults (> 18 years) with ID and feeding and/or swallowing disorders (any etiology and severity) and any intervention for feeding and/or swallowing disorders. Methodological quality was assessed by two independent reviewers using the Downs and Black checklist. Four articles met the inclusion criteria. All included studies considered enteral feeding as an intervention strategy and had a retrospective observational design. Overall, included studies reported positive change in nutritional status and a high incidence of adverse events following enteral feeding initiation. Risk of bias was high with variability in methodological quality. The safety and effectiveness of interventions for feeding and swallowing in adults with ID is unclear. This review highlights the lack of evidence-based practice in this area. Directions for further research are provided. Before enteral feeding initiation, risks and benefits should be appropriately balanced on an individual basis, and caregivers should be involved in the decision-making process.
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Affiliation(s)
- Beatrice Manduchi
- Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, D02KF66, Ireland.
| | - Gina Marni Fainman
- Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, D02KF66, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, D02KF66, Ireland
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Cicala G, Barbieri MA, Spina E, de Leon J. A comprehensive review of swallowing difficulties and dysphagia associated with antipsychotics in adults. Expert Rev Clin Pharmacol 2019; 12:219-234. [PMID: 30700161 DOI: 10.1080/17512433.2019.1577134] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION This is a comprehensive review of antipsychotic (AP)-induced dysphagia and its complications: choking and pneumonia. Areas covered: Four PubMed searches were completed in 2018. The limited literature includes: 1) 45 case reports of AP-induced dysphagia with pharmacological mechanisms, 2) a systematic review of APs as a risk factor for dysphagia, 3) reviews suggesting adult patients with intellectual disability (ID) and dementia are prone to dysphagia (APs are a risk factor among multiple others), 4) studies of the increased risk of choking in patients with mental illness (APs are a contributing factor), 5) naturalistic pneumonia studies suggesting that pneumonia may contribute to AP-increased death in dementia, and 6) naturalistic studies suggesting that pneumonia may be a major cause of morbidity and mortality in clozapine patients. Expert commentary: The 2005 Food and Drug Administration requirement that package inserts warn of AP-induced dysphagia jumpstarted this area, but current studies are limited by: 1) its naturalistic nature, 2) the lack of dysphagia studies of patients with IDs and dementia on APs, and 3) the assumed indirect association between dysphagia with choking and pneumonia. Future clozapine studies on pneumonia, if they lead to a package insert warning, may have high potential to save lives.
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Affiliation(s)
- Giuseppe Cicala
- a Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | | | - Edoardo Spina
- a Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | - Jose de Leon
- b Mental Health Research Center at Eastern State Hospital , University of Kentucky , Lexington , KY , USA.,c Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences , University of Granada , Granada , Spain.,d Biomedical Research Centre in Mental Healsth Net (CIBERSAM), Santiago Apostol Hospital , University of the Basque Country , Vitoria , Spain
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Miarons M, Rofes L. Systematic review of case reports of oropharyngeal dysphagia following the use of antipsychotics. GASTROENTEROLOGIA Y HEPATOLOGIA 2018; 42:209-227. [PMID: 30470564 DOI: 10.1016/j.gastrohep.2018.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/23/2018] [Accepted: 09/07/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this systematic review was to examine the effect of antipsychotic medication on dysphagia based on clinical case reports. PATIENTS AND METHODS Literature searches were performed using the electronic databases PubMed and Embase. In PubMed, we used the MeSH terms "antipsychotic agents" OR "tranquilizing agents" combined with "deglutition disorders" OR "deglutition". In Embase, we used the Emtree terms "neuroleptic agents" combined with "swallowing" OR "dysphagia". Two reviewers assessed the eligibility of each case independently. RESULTS A total of 1043 abstracts were retrieved, of which 36 cases met the inclusion criteria; 14 cases were related to typical antipsychotics and 22 to atypical antipsychotics. Dysphagia occurred together with extrapyramidal symptoms in half of the cases and was the only prominent symptom in the other half. The most common strategy against dysphagia was changing to another antipsychotic (n=13, 36.1%). CONCLUSIONS The data from this review indicate that antipsychotics can increase the prevalence of dysphagia.
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Affiliation(s)
- Marta Miarons
- Pharmacy department, Mataró Hospital, Spain; Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain.
| | - Laia Rofes
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain
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Crouse EL, Alastanos JN, Bozymski KM, Toscano RA. Dysphagia with second-generation antipsychotics: A case report and review of the literature. Ment Health Clin 2018; 7:56-64. [PMID: 29955499 PMCID: PMC6007670 DOI: 10.9740/mhc.2017.03.056] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: All antipsychotics are associated with extrapyramidal symptoms (EPS). These can present as dysphagia, esophageal dysmotility, or aspiration, all of which may not be recognized as EPS. Case Report: A 62-year-old with schizophrenia, prescribed olanzapine 5 mg daily, presented agitated and endorsed difficulty swallowing. Speech therapy suggested her complaints were related to either reflux or dysmotility. Esophageal manometry showed her lower esophageal sphincter was not fully relaxing, and identified an esophagogastric junction outflow obstruction. Despite therapeutic dilation, oral intake remained poor. Following an increase in olanzapine, she developed EPS, her dysphagia worsened, and she was choking on food. Following a switch to aripiprazole her EPS and appetite improved, and she ceased complaining of dysphagia. Discussion: Dysphagia has been reported with first- and second-generation antipsychotics. A review of the second-generation antipsychotic literature identified case reports of dysphagia with clozapine (n = 5), risperidone (n = 5), olanzapine (n = 2), quetiapine (n = 2), aripiprazole (n = 1), and paliperidone (n = 1). Postulated mechanisms of antipsychotic-induced dysphagia include that it may be an extrapyramidal adverse reaction or related to anticholinergic effects of antipsychotics. Management of dysphagia includes discontinuing the antipsychotic, reducing the dose, dividing the dose, or switching to another antipsychotic. Complications of dysphagia include airway obstruction (eg, choking, asphyxia), aspiration pneumonia, and weight loss. Additional complications include dehydration, malnutrition, and nonadherence to oral medications. Conclusion: It is important to recognize symptoms of dysphagia and esophageal dysmotility in antipsychotic-treated patients. Intervention is necessary to prevent complications.
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Affiliation(s)
- Ericka L Crouse
- Clinical Pharmacy Specialist-Psychiatry, Virginia Commonwealth University Health System, Richmond, Virginia,
| | - Jennifer N Alastanos
- Clinical Pharmacist-Psychiatry, Morton Plant North Bay Hospital, BayCare Health System, New Port Richey, Florida
| | - Kevin M Bozymski
- PGY-2 Psychiatric Pharmacy Resident, Virginia Commonwealth University Health System, Richmond, Virginia
| | - Robert A Toscano
- PGY-3 Psychiatry Resident Physician, Virginia Commonwealth University Health System, Richmond, Virginia
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Stewart JT. Covert dysphagia and recurrent pneumonia related to antipsychotic treatment. J Psychiatry Neurosci 2018; 43:143-144. [PMID: 29481321 PMCID: PMC5837886 DOI: 10.1503/jpn.170147] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Jonathan T Stewart
- From the James A. Haley VA Hospital, University of South Florida College of Medicine, Tampa, Florida, USA
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Abstract
The association between antipsychotics (also known as neuroleptics) and oropharyngeal dysphagia (OD) has been suggested in several case reports. The purpose of this systematic review was to examine the effect of antipsychotic medication on OD. A systematic literature search was carried out according to PRISMA guidelines using the electronic databases Pubmed and Embase. In Pubmed, we used the MeSH terms 'antipsychotic agents' OR 'tranquilizing agents' combined with 'deglutition disorders' OR 'deglutition'. In Embase, we used the Emtree terms 'neuroleptic agents' combined with 'swallowing' OR 'dysphagia'. Two reviewers assessed the eligibility of each report independently. The level of evidence of the included studies was also assessed according to pre-established criteria. Case reports were excluded. We found 18 clinical studies of dysphagia related to antipsychotics: 12 were related both to typical and atypical antipsychotics, four to atypical antipsychotics and two to typical antipsychotics. According to the clinical studies included, prevalence of patients with swallowing problems taking antipsychotics ranged from 21.9 to 69.5% whereas prevalence of patients without swallowing problems taking antipsychotics ranged from 5 to 30.5%. The available evidence suggests considering an etiology of dysphagia in patients with swallowing problems who are taking antipsychotics, even if no other symptoms are present. Although few general conclusions can be drawn from current evidence, both typical and atypical antipsychotics can be associated with OD.
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Robertson J, Chadwick D, Baines S, Emerson E, Hatton C. Prevalence of Dysphagia in People With Intellectual Disability: A Systematic Review. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2017; 55:377-391. [PMID: 29194030 DOI: 10.1352/1934-9556-55.6.377] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Dysphagia (feeding and swallowing disorder) is associated with serious health complications and psychosocial sequelae. This review summarizes international research relating to the prevalence of dysphagia in people with intellectual disability. Studies published from 1990 to July 2016 were identified using Medline, Cinahl, PsycINFO, Web of Science, email requests, and cross-citations. Twenty studies were identified. Dysphagia in people with intellectual disability appears to be associated with more severe levels of intellectual disability, comorbid cerebral palsy, and motor impairments. However, further research with representative samples of people with intellectual disability using adequate methods of assessment are required in order to provide more precise prevalence estimates and clarify factors that may be associated with dysphagia in this population.
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Affiliation(s)
- Janet Robertson
- Janet Robertson, Lancaster University, United Kingdom; Darren Chadwick, University of Wolverhampton, United Kingdom; Susannah Baines, Lancaster University, United Kingdom; Eric Emerson, Lancaster University, United Kingdom and University of Sydney, Australia; and Chris Hatton, Lancaster University, United Kingdom
| | - Darren Chadwick
- Janet Robertson, Lancaster University, United Kingdom; Darren Chadwick, University of Wolverhampton, United Kingdom; Susannah Baines, Lancaster University, United Kingdom; Eric Emerson, Lancaster University, United Kingdom and University of Sydney, Australia; and Chris Hatton, Lancaster University, United Kingdom
| | - Susannah Baines
- Janet Robertson, Lancaster University, United Kingdom; Darren Chadwick, University of Wolverhampton, United Kingdom; Susannah Baines, Lancaster University, United Kingdom; Eric Emerson, Lancaster University, United Kingdom and University of Sydney, Australia; and Chris Hatton, Lancaster University, United Kingdom
| | - Eric Emerson
- Janet Robertson, Lancaster University, United Kingdom; Darren Chadwick, University of Wolverhampton, United Kingdom; Susannah Baines, Lancaster University, United Kingdom; Eric Emerson, Lancaster University, United Kingdom and University of Sydney, Australia; and Chris Hatton, Lancaster University, United Kingdom
| | - Chris Hatton
- Janet Robertson, Lancaster University, United Kingdom; Darren Chadwick, University of Wolverhampton, United Kingdom; Susannah Baines, Lancaster University, United Kingdom; Eric Emerson, Lancaster University, United Kingdom and University of Sydney, Australia; and Chris Hatton, Lancaster University, United Kingdom
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Sasegbon A, Hamdy S. The anatomy and physiology of normal and abnormal swallowing in oropharyngeal dysphagia. Neurogastroenterol Motil 2017; 29. [PMID: 28547793 DOI: 10.1111/nmo.13100] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 04/05/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Eating and drinking are enjoyable activities that positively impact on an individual's quality of life. The ability to swallow food and fluid is integral to the process of eating. Swallowing occupies a dual role being both part of the enjoyment of eating and being a critically important utilitarian activity to enable adequate nutrition and hydration. Any impairment to the process of swallowing can negatively affect a person's perception of their quality of life. The process of swallowing is highly complex and involves muscles in the mouth, pharynx, larynx, and esophagus. The oropharynx is the anatomical region encompassing the oral cavity and the pharynx. Food must be masticated, formed into a bolus and transported to the pharynx by the tongue whereas fluids are usually held within the mouth before being transported ab-orally. The bolus must then be transported through the pharynx to the esophagus without any matter entering the larynx. The muscles needed for all these steps are coordinated by swallowing centers within the brainstem which are supplied with sensory information by afferent nerve fibers from several cranial nerves. The swallowing centers also receive modulatory input from higher centers within the brain. Hence, a swallow has both voluntary and involuntary physiologic components and the term dysphagia is given to difficult swallowing while oropharyngeal dysphagia is difficult swallowing due to pathology within the oropharynx. PURPOSE Problems affecting any point along the complex swallowing pathway can result in dysphagia. This review focuses on the anatomy and physiology behind normal and abnormal oropharyngeal swallowing. It also details the common diseases and pathology causing oropharyngeal dysphagia.
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Affiliation(s)
- A Sasegbon
- Gastrointestinal (GI) Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Salford Royal Hospital (part of the Manchester Academic Health Sciences Centre (MAHSC)), Salford, UK
| | - S Hamdy
- Gastrointestinal (GI) Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Salford Royal Hospital (part of the Manchester Academic Health Sciences Centre (MAHSC)), Salford, UK
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25
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Kulkarni DP, Kamath VD, Stewart JT. Swallowing Disorders in Schizophrenia. Dysphagia 2017; 32:467-471. [PMID: 28447217 DOI: 10.1007/s00455-017-9802-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 04/17/2017] [Indexed: 11/30/2022]
Abstract
Disorders of swallowing are poorly characterized but quite common in schizophrenia. They are a source of considerable morbidity and mortality in this population, generally as a result of either acute asphyxia from airway obstruction or more insidious aspiration and pneumonia. The death rate from acute asphyxia may be as high as one hundred times that of the general population. Most swallowing disorders in schizophrenia seem to fall into one of two categories, changes in eating and swallowing due to the illness itself and changes related to psychotropic medications. Behavioral changes related to the illness are poorly understood and often involve eating too quickly or taking inappropriately large boluses of food. Iatrogenic problems are mostly related to drug-induced extrapyramidal side effects, including drug-induced parkinsonism, dystonia, and tardive dyskinesia, but may also include xerostomia, sialorrhea, and changes related to sedation. This paper will provide an overview of common swallowing problems encountered in patients with schizophrenia, their pathophysiology, and management. While there is a scarcity of quality evidence in the literature, a thorough history and examination will generally elucidate the predominant problem or problems, often leading to effective management strategies.
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Affiliation(s)
| | - Vandan D Kamath
- Audiology and Speech Pathology Service (126), James A Haley VA Hospital, Tampa, USA
| | - Jonathan T Stewart
- University of South Florida College of Medicine, Tampa, USA. .,Psychiatry Service (116A), James A Haley VA Hospital, 13000 Bruce B Downs BLVD, Tampa, FL, 33612, USA.
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Robertson J, Chadwick D, Baines S, Emerson E, Hatton C. People with intellectual disabilities and dysphagia. Disabil Rehabil 2017; 40:1345-1360. [DOI: 10.1080/09638288.2017.1297497] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Janet Robertson
- Centre for Disability Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Darren Chadwick
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom
| | - Susannah Baines
- Centre for Disability Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Eric Emerson
- Centre for Disability Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
- Centre for Disability Research and Policy, University of Sydney, Sydney, Australia
| | - Chris Hatton
- Centre for Disability Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
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Ortega O, Espinosa MC. Oropharyngeal Dysphagia and Dementia. Dysphagia 2017. [DOI: 10.1007/174_2017_120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Baijens LW, Clavé P, Cras P, Ekberg O, Forster A, Kolb GF, Leners JC, Masiero S, Mateos-Nozal J, Ortega O, Smithard DG, Speyer R, Walshe M. European Society for Swallowing Disorders - European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging 2016. [PMID: 27785002 DOI: 10.2147/cia.s107750.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, and invited experts. It consists of 12 sections that cover all aspects of clinical management of oropharyngeal dysphagia (OD) related to geriatric medicine and discusses prevalence, quality of life, and legal and ethical issues, as well as health economics and social burden. OD constitutes impaired or uncomfortable transit of food or liquids from the oral cavity to the esophagus, and it is included in the World Health Organization's classification of diseases. It can cause severe complications such as malnutrition, dehydration, respiratory infections, aspiration pneumonia, and increased readmissions, institutionalization, and morbimortality. OD is a prevalent and serious problem among all phenotypes of older patients as oropharyngeal swallow response is impaired in older people and can cause aspiration. Despite its prevalence and severity, OD is still underdiagnosed and untreated in many medical centers. There are several validated clinical and instrumental methods (videofluoroscopy and fiberoptic endoscopic evaluation of swallowing) to diagnose OD, and treatment is mainly based on compensatory measures, although new treatments to stimulate the oropharyngeal swallow response are under research. OD matches the definition of a geriatric syndrome as it is highly prevalent among older people, is caused by multiple factors, is associated with several comorbidities and poor prognosis, and needs a multidimensional approach to be treated. OD should be given more importance and attention and thus be included in all standard screening protocols, treated, and regularly monitored to prevent its main complications. More research is needed to develop and standardize new treatments and management protocols for older patients with OD, which is a challenging mission for our societies.
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Affiliation(s)
- Laura Wj Baijens
- Department of Otorhinolaryngology - Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataró, Autonomous University of Barcelona, Mataró; CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - Patrick Cras
- Department of Neurology, Antwerp University Hospital, University of Antwerp, Born Bunge Institute, Edegem, Belgium
| | - Olle Ekberg
- Department of Translational Medicine, Division of Medical Radiology, Skåne University Hospital, Malmö, Sweden
| | | | - Gerald F Kolb
- Department of Geriatrics and Physical Medicine, Bonifatius Hospital, Lingen, Germany
| | | | - Stefano Masiero
- Rehabilitation Unit, Department of Neuroscience, University of Padua, Padova, Italy
| | | | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataró, Autonomous University of Barcelona, Mataró; CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - David G Smithard
- Clinical Gerontology, Princess Royal University Hospital, King's College Hospital Foundation Trust, London, UK
| | - Renée Speyer
- College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
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Baijens LWJ, Clavé P, Cras P, Ekberg O, Forster A, Kolb GF, Leners JC, Masiero S, Mateos-Nozal J, Ortega O, Smithard DG, Speyer R, Walshe M. European Society for Swallowing Disorders - European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging 2016; 11:1403-1428. [PMID: 27785002 PMCID: PMC5063605 DOI: 10.2147/cia.s107750] [Citation(s) in RCA: 372] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, and invited experts. It consists of 12 sections that cover all aspects of clinical management of oropharyngeal dysphagia (OD) related to geriatric medicine and discusses prevalence, quality of life, and legal and ethical issues, as well as health economics and social burden. OD constitutes impaired or uncomfortable transit of food or liquids from the oral cavity to the esophagus, and it is included in the World Health Organization's classification of diseases. It can cause severe complications such as malnutrition, dehydration, respiratory infections, aspiration pneumonia, and increased readmissions, institutionalization, and morbimortality. OD is a prevalent and serious problem among all phenotypes of older patients as oropharyngeal swallow response is impaired in older people and can cause aspiration. Despite its prevalence and severity, OD is still underdiagnosed and untreated in many medical centers. There are several validated clinical and instrumental methods (videofluoroscopy and fiberoptic endoscopic evaluation of swallowing) to diagnose OD, and treatment is mainly based on compensatory measures, although new treatments to stimulate the oropharyngeal swallow response are under research. OD matches the definition of a geriatric syndrome as it is highly prevalent among older people, is caused by multiple factors, is associated with several comorbidities and poor prognosis, and needs a multidimensional approach to be treated. OD should be given more importance and attention and thus be included in all standard screening protocols, treated, and regularly monitored to prevent its main complications. More research is needed to develop and standardize new treatments and management protocols for older patients with OD, which is a challenging mission for our societies.
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Affiliation(s)
- Laura WJ Baijens
- Department of Otorhinolaryngology – Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataró, Autonomous University of Barcelona, Mataró
- CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - Patrick Cras
- Department of Neurology, Antwerp University Hospital, University of Antwerp, Born Bunge Institute, Edegem, Belgium
| | - Olle Ekberg
- Department of Translational Medicine, Division of Medical Radiology, Skåne University Hospital, Malmö, Sweden
| | | | - Gerald F Kolb
- Department of Geriatrics and Physical Medicine, Bonifatius Hospital, Lingen, Germany
| | | | - Stefano Masiero
- Rehabilitation Unit, Department of Neuroscience, University of Padua, Padova, Italy
| | | | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataró, Autonomous University of Barcelona, Mataró
- CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - David G Smithard
- Clinical Gerontology, Princess Royal University Hospital, King’s College Hospital Foundation Trust, London, UK
| | - Renée Speyer
- College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
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Osman M, Devadas V. Clozapine-induced dysphagia with secondary substantial weight loss. BMJ Case Rep 2016; 2016:bcr-2016-216445. [PMID: 27543610 DOI: 10.1136/bcr-2016-216445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Dysphagia is listed as a 'rare' side effect following clozapine treatment. In this case report, we describe how significant clozapine-induced dysphagia has led to significant reduction of nutritional intake with subsequent substantial weight loss. An 18-year-old single man with an established diagnosis of treatment-resistant paranoid schizophrenia recovered well on a therapeutic dose of clozapine. However, he was noted to lose weight significantly (up to 20% of his original weight) as the dose was uptitrated. This was brought about by development of dysphagia, likely to be due to clozapine. Addition of nutritional supplementary liquids and initiation of a modified behavioural dietary/swallowing programme, while repeatedly mastering the Mendelsohn manoeuvre technique, alleviated the swallowing difficulties and restored his weight.
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Affiliation(s)
- Mugtaba Osman
- Department of Psychiatry, Letterkenny General Hospital, Letterkenny, Ireland
| | - Vekneswaran Devadas
- Department of Psychiatry, Letterkenny General Hospital, Letterkenny, Ireland
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Drugs Related to Oropharyngeal Dysphagia in Older People. Dysphagia 2016; 31:697-705. [DOI: 10.1007/s00455-016-9735-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/18/2016] [Indexed: 10/21/2022]
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Lee JC, Takeshita J. Antipsychotic-Induced Dysphagia: A Case Report. Prim Care Companion CNS Disord 2016; 17:15l01792. [PMID: 26835168 DOI: 10.4088/pcc.15l01792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- June C Lee
- Department of Psychiatry, John A. Burns School of Medicine, University of Hawaii, Honolulu
| | - Junji Takeshita
- Department of Psychiatry, John A. Burns School of Medicine, University of Hawaii, Honolulu
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Rösler A, Pfeil S, Lessmann H, Höder J, Befahr A, von Renteln-Kruse W. Dysphagia in Dementia: Influence of Dementia Severity and Food Texture on the Prevalence of Aspiration and Latency to Swallow in Hospitalized Geriatric Patients. J Am Med Dir Assoc 2015; 16:697-701. [DOI: 10.1016/j.jamda.2015.03.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 03/17/2015] [Accepted: 03/17/2015] [Indexed: 10/23/2022]
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Ishida T, Suzuki T, Watanabe K, Sakurai H, Uchida H, Mimura M. Prophylactic use of heparin for deep vein thrombosis in restrained psychiatric patients: a chart review. Gen Hosp Psychiatry 2014; 36:690-3. [PMID: 25070076 DOI: 10.1016/j.genhosppsych.2014.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 06/24/2014] [Accepted: 06/24/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Physical restraint sometimes causes deep vein thrombosis (DVT) and pulmonary embolism. Although unfractionated heparin (UFH) is used for the prophylaxis of DVT, its effectiveness remained unknown for restrained patients. METHOD We conducted a chart review of restrained inpatients at Sakuragaoka Memorial Hospital in Japan. Restrained patients received subcutaneous injection of UFH 5000 IU bid from December 2008 to September 2010 [heparin (+) period] while UFH was not used from December 2010 to September 2012 [heparin (-) period]. A Doppler ultrasound scanning was performed to examine the presence of DVT. The incidence of DVT was compared between the two periods by chi-square test. A multiple logistic regression model was used to examine effects of demographic and clinical characteristics on the incidence of DVT. RESULTS No significant difference was found in the incidence of DVT between the heparin (+) and (-) periods [11.8% (11/93) vs. 11.1% (13/117)]. Sedation [odds ratio (OR) = 3.78], physical comorbidities (OR = 6.29) and a longer duration of restraint (OR = 1.22) were associated with the incidence of DVT. CONCLUSION The use of UFH was not associated with any reduction in the incidence of DVT in restrained psychiatric patients.
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Affiliation(s)
- Takuto Ishida
- Department of Psychiatry, Sakuragaoka Memorial Hospital, Tokyo, Japan; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
| | - Takefumi Suzuki
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Department of Psychiatry, Inokashira Hospital, Tokyo, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Hitoshi Sakurai
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Department of Psychiatry, Inokashira Hospital, Tokyo, Japan
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Geriatric Mental Health Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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Todd JT, Stuart A, Lintzenich CR, Wallin J, Grace-Martin K, Butler SG. Stability of aspiration status in healthy adults. Ann Otol Rhinol Laryngol 2013; 122:289-93. [PMID: 23815044 DOI: 10.1177/000348941312200501] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES In multiple separate studies, we consistently found that approximately 30% of asymptomatic healthy older adults silently aspirated liquids during flexible endoscopic evaluation of swallowing (FEES). We subsequently questioned whether aspiration status remained stable in healthy older adults over time. The purpose of this study was to determine the stability of aspiration status in healthy older adults over time. METHODS Eighteen healthy older participants, comprising of 9 aspirators and 9 nonaspirators whose aspiration status was identified in a previous study, underwent a second FEES approximately 6 to 21 months later. The participants contributed 36 swallows, comprising 5-, 10-, 15-, and 20-mL boluses of milk (ie, 1 bolus of each volume of skim, 2%, whole, and soy milk) and water via cup and straw delivery, during the original FEES. An abbreviated protocol was administered for the repeat FEES. The Penetration-Aspiration Scale was used to rate all swallows. RESULTS A McNemar test demonstrated no change in aspiration status among participants between the initial test and the retest (p > 0.999). CONCLUSIONS In this cohort, the aspiration status was stable over about 12 months. This finding lends credence to the premise that trace aspiration of liquids may be a normal and consistent finding in some healthy older adults.
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Affiliation(s)
- J Tee Todd
- Department of Otolaryngology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Baheshree RD, Jonas SS. Dysphagia in a psychotic patient: Diagnostic challenges and a systematic management approach. Indian J Psychiatry 2012; 54:280-2. [PMID: 23226858 PMCID: PMC3512371 DOI: 10.4103/0019-5545.102464] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Dysphagia can be due to a variety of causes in a psychotic patient. It could be a side-effect of anti-psychotic medication or the manifestation of a psychotic phenomenon or even due to a co-morbid medical cause. We report a case of dysphagia in a young lady with psychosis who had been recently started on anti-psychotic medication. We would specifically like to highlight the practical challenges regarding its diagnosis and report success with a systematic management approach.
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Affiliation(s)
- Ramanaganga D Baheshree
- Department of Psychiatry, Karpaga Vinayaga Institute of Medical Sciences & Research Centre, Kanchipuram District, Tamil Nadu, India
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Swallowing dysfunction and dysphagia is an unrecognized challenge for oral drug therapy. Int J Pharm 2012; 430:197-206. [DOI: 10.1016/j.ijpharm.2012.04.022] [Citation(s) in RCA: 149] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 03/30/2012] [Accepted: 04/02/2012] [Indexed: 01/03/2023]
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Lin TW, Lee BS, Liao YC, Chiu NY, Hsu WY. High dosage of aripiprazole-induced dysphagia. Int J Eat Disord 2012; 45:305-6. [PMID: 21541978 DOI: 10.1002/eat.20934] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND Dysphagia as a main manifestation of extrapyramidal symptoms is an uncommon adverse effect of second-generation antipsychotics. METHOD We present a 54-year-old drug-naïve patient with schizophrenia, who developed dysphagia with aripiprazole 30 mg daily treatment. RESULTS This is the first case report on aripiprazole-induced dysphagia. We discuss the risk factors that led to dysphagia in this case. CONCLUSION Aripiprazole-induced dysphagia is rare, and it is important to be aware that it does occur with high-dosage treatment.
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Affiliation(s)
- Ta-Wei Lin
- Department of Psychiatry, Lu-Tung Branch of Changhua Christian Hospital, LuKang, Taiwan
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Chaumartin N, Monville M, Lachaux B. [Dysphagia or dysphagias during neuroleptic medication?]. Encephale 2011; 38:351-5. [PMID: 22980477 DOI: 10.1016/j.encep.2011.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 04/20/2011] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Dysphagia is a common symptom in the general population, and even more among psychiatric patients, but rarely seen as a sign of seriousness. It is a cause of death by suffocation, and more or less serious complications, and therefore should be diagnosed and treated. Among psychiatric patients, organic and iatrogenic aetiologies, as well as risk factors are identified, which worsen this symptom when associated. It is now accepted that neuroleptics can aggravate or cause dysphagia. They act by several pathophysiological ways on the different components of swallowing, which can be identified by dynamic tests in the upper aerodigestive tract endoscopy. LITERATURE FINDINGS This symptom is rarely reported by patients and often underestimated by caregivers. The frequency of swallowing disorders is not known. Dysphagia is a cause of complications and an increase in mortality rates among psychiatric patients. It has also been found that the average number of psychotropic drugs in patients who die by cafe coronary is significantly higher than in other patients. There are several phases in swallowing: oral, pharyngeal, and oesophageal. Swallowing disorders can affect each of these phases, or several at once: (a) Extrapyramidal syndrome: dysphagia is present in drug induced Parkinson's syndromes, but prevalence is not known. It is most often associated with another symptom of the extrapyramidal syndrome, but can also be isolated, making its diagnosis more difficult. Dysphagia is due to a slowing down in the oral and pharyngeal reflex, called bradykinesia; (b) Tardive dyskinesia: the oro-pharyngo-oesophageal dyskinesia is the most common type. Oesophageal dyskinesia causes asynchronous and random movements of the oesophagus, resulting in dysphagia. It appears mostly beyond 3 months of treatment with neuroleptics; (c) Acute laryngeal or oesophageal dystonia, associated or not with orofacial dystonia, is characterised by an impairment in the oesophageal muscle contraction and a hypertonia of the upper sphincter of the oesophagus; (d) Polyphagia or "binge eating", is frequent in psychotic patients; (e) Finally, there are risk factors for dysphagia: xerostomia, poor dental status, advanced age, neurological diseases, polypharmacy, sedative drugs, CNS depression, etc., which worsen the symptom. CASE REPORT Mr J., aged 28, with no psychiatric history, is admitted to the Unit for Difficult Patients in Villejuif for behavioural disorder with homicide on the street. The patient was restrained by passers-by and suffers a head injury and a fracture of the transverse process of L1 vertebra. A cranial CT scan is performed in the emergency room, it is normal. The patient is not known to psychiatric services, and has never taken neuroleptics. Mr J. is homeless, known in his neighbourhood for "his noisy delirium on the street and repeated alcohol abuse." After being arrested by the police in this context, a first psychiatric examination is conducted. The medical certificate states that his condition is not compatible with custody. Mr J. remains mute; he has stereotyped gestures and strange attitudes. No delusion is verbalized. He receives vials of loxapine 50mg causing sedation. At his arrival in the department, Mr J. has the same clinical picture, with a rigid and inexpressive face, reluctance, major unconformity, poor speech. The search for drugs in urine is positive for cannabis. The diagnosis of schizophrenia is rapidly raised, motivating further prescription of loxapine 300 mg daily in combination with clonazepam 6 mg daily. From the earliest days, dysphagia to solids with choking and regurgitation is noted, aggravated by the increase of loxapine treatment of 450 mg / day to 700 mg / day, 7 days after admission. A physical examination is performed before the worsening of dysphagia, it is normal, and in particular, reveals no extrapyramidal syndrome. An anti-cholinergic corrector is introduced, without clinical improvement. A new physical examination is performed; it is normal except for sedation and a slight deviation of the uvula. Upper gastrointestinal endoscopy shows no anatomical lesion. No functional assessment of swallowing is done however. At this stage, the suspicion of neuroleptic induced dysphagia appears to be the most likely hypothesis. Treatment with loxapine is then stopped, resulting in a very rapid clinical improvement. Aripiprazole 15 mg / d is introduced. Dysphagia does not reoccur. DISCUSSION Loxapine is an atypical antipsychotic, with a lower risk of neurological side effects than first generation of antipsychotics. These side effects are however numerous and from diverse pathophysiological mechanisms. Loxapine is an antagonist of dopamine and serotonin which is involved in the regulation of several neurotransmitters, explaining the multiple mechanisms involved in the onset of dysphagia: first, blocking dopamine D2 receptors in the striatum, causing motor side-effects of central origin, in addition to peripheral effects of the molecule, which impairs swallowing. In principle, the antagonist activity on serotonin 5-HT2A receptors increases dopaminergic activity in the striatum, reducing the risk of extrapyramidal symptoms and tardive dyskinesia, without avoiding them completely. In addition to these mechanisms, cholinergic blockade reduces oesophageal mobility and pharyngeal reflex. Moreover, the antihistamine, anti-cholinergic and adrenergic receptor blocking alpha-1 can cause sedation, which aggravates the symptom. Finally, the depression of the bulbar centres reduces the swallowing reflex and gag reflex altering the intake of food. CONCLUSIONS The swallowing disorder caused by neuroleptics may occur regardless of the molecule or drug class to which it belongs. It can be found even in the absence of any other neurological signs. It is important to search for the aetiological diagnosis for treatment. At the crossroads of several specialties, swallowing disorders are difficult to diagnose and treat. They are frequently underestimated, partly because patients rarely complain. In our case report, the diagnosis was ascertained by the removal of the medication, without functional evidence, probably by a lack of collaboration between the physician and the endoscopist who had not performed any dynamic investigation of swallowing. This case illustrates the importance of knowing the different mechanisms underlying dysphagia in psychiatric patients, and good communication with gastroenterologists to establish a precise diagnosis of the disorder, and adapt the therapy.
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Affiliation(s)
- N Chaumartin
- UMD Henri-Colin, EPS Paul-Guiraud, Villejuif, France.
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Teismann IK, Warnecke T, Suntrup S, Steinsträter O, Kronenberg L, Ringelstein EB, Dengler R, Petri S, Pantev C, Dziewas R. Cortical processing of swallowing in ALS patients with progressive dysphagia--a magnetoencephalographic study. PLoS One 2011; 6:e19987. [PMID: 21625445 PMCID: PMC3098861 DOI: 10.1371/journal.pone.0019987] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 04/20/2011] [Indexed: 11/29/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a rare disease causing degeneration of the upper and lower motor neuron. Involvement of the bulbar motor neurons often results in fast progressive dysphagia. While cortical compensation of dysphagia has been previously shown in stroke patients, this topic has not been addressed in patients suffering from ALS. In the present study, we investigated cortical activation during deglutition in two groups of ALS patients with either moderate or severe dysphagia. Whole-head MEG was employed on fourteen patients with sporadic ALS using a self-paced swallowing paradigm. Data were analyzed by means of time-frequency analysis and synthetic aperture magnetometry (SAM). Group analysis of individual SAM data was performed using a permutation test. We found a reduction of cortical swallowing related activation in ALS patients compared to healthy controls. Additionally a disease-related shift of hemispheric lateralization was observed. While healthy subjects showed bilateral cortical activation, the right sensorimotor cortex was predominantly involved in ALS patients. Both effects were even stronger in the group of patients with severe dysphagia. Our results suggest that bilateral degeneration of the upper motor neuron in the primary motor areas also impairs further adjusted motor areas, which leads to a strong reduction of ‘swallowing related’ cortical activation. While both hemispheres are affected by the degeneration a relatively stronger activation is seen in the right hemisphere. This right hemispheric lateralization of volitional swallowing observed in this study may be the only sign of cortical plasticity in dysphagic ALS patients. It may demonstrate compensational mechanisms in the right hemisphere which is known to predominantly coordinate the pharyngeal phase of deglutition. These results add new aspects to our understanding of the pathophysiology of dysphagia in ALS patients and beyond. The compensational mechanisms observed could be relevant for future research in swallowing therapies.
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Affiliation(s)
- Inga K Teismann
- Department of Neurology, University of Muenster, Muenster, Germany.
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44
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Teismann IK, Suntrup S, Warnecke T, Steinsträter O, Fischer M, Flöel A, Ringelstein EB, Pantev C, Dziewas R. Cortical swallowing processing in early subacute stroke. BMC Neurol 2011; 11:34. [PMID: 21392404 PMCID: PMC3061896 DOI: 10.1186/1471-2377-11-34] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 03/11/2011] [Indexed: 08/26/2023] Open
Abstract
Background Dysphagia is a major complication in hemispheric as well as brainstem stroke patients causing aspiration pneumonia and increased mortality. Little is known about the recovery from dysphagia after stroke. The aim of the present study was to determine the different patterns of cortical swallowing processing in patients with hemispheric and brainstem stroke with and without dysphagia in the early subacute phase. Methods We measured brain activity by mean of whole-head MEG in 37 patients with different stroke localisation 8.2 +/- 4.8 days after stroke to study changes in cortical activation during self-paced swallowing. An age matched group of healthy subjects served as controls. Data were analyzed by means of synthetic aperture magnetometry and group analyses were performed using a permutation test. Results Our results demonstrate strong bilateral reduction of cortical swallowing activation in dysphagic patients with hemispheric stroke. In hemispheric stroke without dysphagia, bilateral activation was found. In the small group of patients with brainstem stroke we observed a reduction of cortical activation and a right hemispheric lateralization. Conclusion Bulbar central pattern generators coordinate the pharyngeal swallowing phase. The observed right hemispheric lateralization in brainstem stroke can therefore be interpreted as acute cortical compensation of subcortically caused dysphagia. The reduction of activation in brainstem stroke patients and dysphagic patients with cortical stroke could be explained in terms of diaschisis.
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Affiliation(s)
- Inga K Teismann
- Department of Neurology, University of Muenster, Albert-Schweitzer-Str,33, 48149 Muenster, Germany.
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Complications of Oropharyngeal Dysphagia: Malnutrition and Aspiration Pneumonia. Dysphagia 2011. [DOI: 10.1007/174_2011_348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sico JJ, Patwa H. Risperidone-induced bulbar palsy-like syndrome. Dysphagia 2010; 26:340-3. [PMID: 20922432 DOI: 10.1007/s00455-010-9307-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2009] [Accepted: 09/02/2010] [Indexed: 11/26/2022]
Abstract
There have been several case reports of risperidone-associated dysphagia. Risperidone-induced bulbar palsy-like syndrome has not been previously described. We report on a 58-year-old gentleman with prior history of schizophrenia and remote chlorpromazine use with no history of extrapyramidal symptoms who experienced acute onset of dysphagia and facial diplegia with hyperprolactinemia while being treated with risperidone. To date there have been five reported cases of dysphagia associated with risperidone, occurring by such mechanisms as isolated pharyngeal dysfunction from pharyngeal constrictor palsy and dystonia, drug-induced parkinsonism, and acute dystonic reaction. These cases were associated either with initiation or up-titration of risperidone, with complete resolution of dysphagia after medication discontinuation or dose change. Our patient developed dysphagia within 2 weeks of taking risperidone and completely resolved 1 month after the medication was stopped. Unlike other reported cases, our patient also experienced symptomatic hyperprolactinemia, another known side effect of risperidone. Physicians should also be aware that risperidone can be associated with oropharyngeal dysphagia secondary to an acute bulbar palsy-like syndrome that places patients at increased risk of aspiration events and its associated morbidity and mortality.
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Affiliation(s)
- Jason Jonathon Sico
- Department of Neurology, Yale University School of Medicine, New Haven, CT 06520, USA.
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Tang KT, Hsieh MH. A case of schizophrenia with dysphagia successfully treated by a multidimensional approach. Gen Hosp Psychiatry 2010; 32:559.e11-3. [PMID: 20851279 DOI: 10.1016/j.genhosppsych.2010.01.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2009] [Revised: 01/24/2010] [Accepted: 01/26/2010] [Indexed: 01/28/2023]
Abstract
Dysphagia in patients with psychiatric illnesses contributes to morbidities and mortalities. It is, however, an overlooked problem in clinical practice. We report a patient of schizophrenia with dysphagia who was successfully treated using a multidimensional approach, which included medication adjustment, swallowing training and diet modification.
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Affiliation(s)
- Kuo T Tang
- Department of Psychiatry, National Taiwan University Hospital, Taipei 100, Taiwan.
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48
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Diagnosis and management of oropharyngeal Dysphagia and its nutritional and respiratory complications in the elderly. Gastroenterol Res Pract 2010; 2011. [PMID: 20811545 PMCID: PMC2929516 DOI: 10.1155/2011/818979] [Citation(s) in RCA: 216] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Accepted: 04/13/2010] [Indexed: 11/17/2022] Open
Abstract
Oropharyngeal dysphagia is a major complaint among older people. Dysphagia may cause two types of complications in these patients: (a) a decrease in the efficacy of deglutition leading to malnutrition and dehydration, (b) a decrease in deglutition safety, leading to tracheobronchial aspiration which results in aspiration pneumonia and can lead to death. Clinical screening methods should be used to identify older people with oropharyngeal dysphagia and to identify those patients who are at risk of aspiration. Videofluoroscopy (VFS) is the gold standard to study the oral and pharyngeal mechanisms of dysphagia in older patients. Up to 30% of older patients with dysphagia present aspiration-half of them without cough, and 45%, oropharyngeal residue; and 55% older patients with dysphagia are at risk of malnutrition. Treatment with dietetic changes in bolus volume and viscosity, as well as rehabilitation procedures can improve deglutition and prevent nutritional and respiratory complications in older patients. Diagnosis and management of oropharyngeal dysphagia need a multidisciplinary approach.
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Hwang SJ, Tsai SJ, Chen IJ, Hsu FC, Li C, Kao KP. Choking incidents among psychiatric inpatients: a retrospective study in Chutung Veterans General Hospital. J Chin Med Assoc 2010; 73:419-24. [PMID: 20728853 DOI: 10.1016/s1726-4901(10)70090-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Accepted: 07/02/2010] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Choking incidents have long been recognized as a cause of death in people with mental illness. This study attempted to determine the rate of choking incidents and deaths among psychiatric inpatients and identify the risk factors associated with choking incidents. Some preventive measures are also suggested. METHODS All choking incidents recorded over 3 years in 3 psychiatric wards of Chutung Veterans General Hospital (total of 210 beds) were retrospectively analyzed for demographic variables, psychiatric and medical diagnoses, and drug therapy at the time of the incidents. RESULTS During the 3-year period, 16 incidents were recorded, involving 11 patients at a rate of 1 incident every 451.4 months of hospitalization per person. Men were 3 times more likely to experience choking incidents than women, and the mean age of choking patients was higher than that of all patients (59.7 vs. 44.4 years). Among the 16 incidents, 3 fatal cases were noted, giving an annual choking death rate of 5.05 per 1,000 persons hospitalized. A high re-choking rate of up to 40.0% was noted, and patients with organic mental disorder had 3.4 times the choking incidence of all patients. The mean antipsychotic dosage of the choking cases was similar to that of all inpatients, but the mean hypnotic dosage of the fatal choking cases was significantly higher. Up to 62.5% of the choking accidents occurred at breakfast, and mantou (a type of steamed bun) was the most common food (9/16) that resulted in the accidents. Of the 11 patients, 9 were rated as "poor" or "very poor" with regard to self-care before the accidents. CONCLUSION Compared with studies in Western psychiatric inpatients, we have a lower choking incident rate but higher death rate due to choking. We found that older age, male sex, higher dosage of hypnotics, previous choking attacks, organic mental disorder, poor self-care, breakfast time and mantou were possible risk factors associated with choking, in which older age, poor self-care, and higher dosage of hypnotics for fatal cases were statistically significant.
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Affiliation(s)
- Shyh-Jou Hwang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
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Abstract
We report a case of quetiapine-induced dysphagia in a geriatric patient which improved with discontinuation of the antipsychotic. The patient had developed dysphagia while being treated with antipsychotics for bipolar disorder. The patient's dysphagia showed significant improvement when she was taken off quetiapine. We review the available literature on antipsychotic-related dysphagia and suggest that clinicians need to be aware of the potential for this syndrome even with lower potency antipsychotics.
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Affiliation(s)
- Izchak Kohen
- Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, NY 11004, USA.
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