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

Associations between constipation risk and lifestyle, medication use, and affective symptoms in patients with schizophrenia: a multicenter cross-sectional study

PURPOSE

To investigate the association between lifestyle and atypical antipsychotic drug use in patients with schizophrenia and the risk of constipation and to assess the impact of anxiety and depressive symptoms on constipation risk.

METHODS

Cross-sectional convenience sampling was employed, and 271 participants aged 20-65 were enrolled. Data were collected via a structured questionnaire comprising participants' demographic data, medication information, dietary behavior assessment, and the Baecke Physical Activity Questionnaire, Beck Depression Inventory-II, and Beck Anxiety Inventory. IBM SPSS 24.0 with multivariate logistic regression was used for data analysis. We performed a subgroup analysis of anticholinergic drugs via multivariate logistic regression.

RESULTS

In total, 180 participants had functional constipation; risk factors included female sex, anxiety symptoms, depressive symptoms, and quetiapine and aripiprazole use. Patients who drank more than 3,000 cc of water daily or used risperidone were less likely to have functional constipation. Depressive and anxiety symptoms were risk factors even after adjusting for sex, use of anticholinergics and laxatives, consuming two servings of fruit, consuming three servings of vegetables, consuming more than 3,000 cc of water daily, physical activity, medical comorbidity, chlorpromazine equivalent dose, and atypical antipsychotic use. Similar associations were found for two affective symptoms and functional constipation in the subgroup analysis of anticholinergic drugs.

CONCLUSION

The prevalence of functional constipation in patients with schizophrenia was 66.4%. The risk factors included female sex, anticholinergics, aripiprazole, quetiapine, and depressive and anxiety symptoms. Risperidone users and those who drank 3000 cc of water daily were less likely to have constipation.

Acute Dystonia With Rhabdomyolysis Induced by Paliperidone Palmitate: A Rare Adverse Effect

Antipsychotic medications have been well-established to potentially cause extrapyramidal side effects (EPS) including hyperkinesia, tremor, dyskinesia, dystonia, and parkinsonism. Rhabdomyolysis secondary to extrapyramidal symptoms in patients under antipsychotics is a relatively rare presentation to be observed in patients. 

In this report, we present a 64-year-old female with rhabdomyolysis following a once-monthly injection of long-acting injectable (LAI) paliperidone palmitate (Invega Sustenna). The patient developed extrapyramidal symptoms one day after the paliperidone injection. She presented with acute dystonia in the form of antecollis, without any evidence of generalized myalgia or kidney involvement. Laboratory investigations demonstrated a creatine kinase (CK) level of 3239 unit/L on admission. The patient’s symptoms were resolved after the administration of benztropine and cyclobenzaprine and CK levels improved after IV hydration.

A high index of suspicion in the investigation of rhabdomyolysis for patients presenting with extrapyramidal symptoms being treated with long-acting injectable antipsychotics leads to prompt diagnosis, early treatment, and reduction in renal and cardiac toxicities in the aforementioned population. 

Adolescent Psychosis and Rectal Prolapse

Psychosis is a constellation of symptoms that present with a disconnect from reality. The duration, severity, and presentation of symptoms can present on a wide spectrum, and etiologies can vary from patient to patient. Psychosis is also associated with self-injurious thinking, behavior, and suicidality. Long-term treatment of psychosis with antipsychotics can often result in side effects like constipation, sedation, dry mouth, and metabolic syndrome. Though rectal prolapse is uncommon in adolescent patients, there was a noted correlation with rectal prolapse in adult patients that were treated for chronic psychiatric disease. We report a case of a 17-year-old female with psychosis and rectal prolapse, who was admitted for inpatient treatment.

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

Clozapine-induced constipation is an increasingly recognized adverse reaction that frequently impairs optimal management of treatment-resistant schizophrenia. The Food and Drug Administration recently strengthened an existing warning for clozapine, citing constipation as an adverse effect that can progress to serious bowel complications. Evidence-based guidelines for laxatives in the management of clozapine-induced constipation remain scarce, and there is a general need for improved algorithms in the management of this common condition. Lubiprostone is a relatively new laxative that has labeled indications for opioid-induced constipation, irritable bowel syndrome with constipation, and chronic idiopathic constipation. This case series describes clinical pearls associated with four cases of treatment-resistant schizophrenia who underwent treatment of clozapine-induced constipation with lubiprostone. The findings of this case series suggest that there may be significant therapeutic potential in the utilization of lubiprostone for the management of clozapine-induced constipation with a low risk of adverse reactions. The study of lubiprostone benefit (i.e., without coadministration of other laxatives) continues to be of prominent interest in understanding its ability to manage clozapine-induced constipation.

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

PURPOSE

To explore perceptions of antipsychotics associated side-effects among family caregivers of patients with schizophrenia.

PATIENTS AND METHODS

A descriptive qualitative study was applied in a tertiary referral hospital in China. Purposeful sampling of 18 family caregivers of patients with schizophrenia were interviewed about their perceptions towards antipsychotics related side effects.

RESULTS

According to content analysis, three themes emerged from the data: (a) nightmare in the treatment with the categories of sleep disturbances; physical impairment; appearance impairment; (b) opposite attitudes toward side-effect with the categories of being vigilant; do not care; (c) diverse ways of coping side-effects with the categories of asking for help from professionals; self-determined; try any quack's prescription.

CONCLUSION

The side effects of antipsychotics not only damage the health of patients, but also increase the burden and stress of caregivers. However, caregivers have different attitudes and coping styles about the side effects of antipsychotics. Health professionals should be aware of the influence of individual background and cultural factors on caregivers' attitudes towards drug side effects. Furthermore, health professionals should also provide caregivers with knowledge about drug side effects, coping skills, and appropriate management strategies to promote health outcomes for people with schizophrenia.

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

Currently, published systematic review protocols (SR protocols) have increasingly become a new trend in fields such as acupuncture and are therefore a new source of quotations in these fields. Systematic reviews are considered the pinnacle of the evidence pyramid as they embody comprehensive literature searching. Quotations are key elements to achieve this goal as they can support the assertions of the original authors, but the 'misquotation' exists, too, and they can be misleading to the reader. The aim of this study was to examine the quotation accuracy of SR protocols in a meta-analysis on acupuncture research. We searched SCOPUS through 31 December, 2020, and each protocol and its citations were analyzed and classified as correct or incorrect. We used descriptive statistics to report the quotation errors and characteristics of the included protocols. The results showed 248 SR protocols, where 124 protocols received quotations and 38 quotations (31.4%) were erroneous. Only 11 (4.4%) of the published SRs and SR protocols had been published previously. Furthermore, the scientific journal in which the most SR protocols were published was Medicine (193; 77.8%), followed by BMJ Open (39; 15.7%). Authors from China (86.5%) were the most productive in publishing SRs and SR protocols. Finally, we concluded that the number of SR protocols and meta-analyses published in scientific journals and indexed by databases exceeds the publication capacity of the SRs associated with them, generating scientific literature that does not make any novel contribution to knowledge.