Dyspepsia and constipation in patients with schizophrenia spectrum disorders

Abstract

Constipation and dyspepsia are disturbing gastrointestinal symptoms that are often ignored in research on physical comorbidities of schizophrenia. The aim was to assess dyspepsia and constipation in a sample of outpatients with schizophrenia spectrum psychoses. A general practitioner performed a thorough physical health check for 275 outpatients and diagnosed constipation and dyspepsia. This study assessed the possible contribution of several sociodemographic, lifestyle, and clinical variables to constipation and dyspepsia using logistic regression analysis. This study also assessed whether these symptoms were associated with abnormal laboratory findings. The prevalence of constipation was 31.3%, and of dyspepsia 23.6%. Paracetamol (OR =3.07, 95% CI =1.34–7.02) and clozapine use (OR =5.48, 95% CI =2.75–10.90), older age (OR =1.04, 95% CI =1.01–1.06), and living in sheltered housing (OR =2.49, 95% CI =1.16–5.33) were risk factors for constipation. For dyspepsia the risk factors were female sex (OR =2.10, 95% CI =1.15–3.83), non-steroidal anti-inflammatory drugs (OR =2.47, 95% CI =1.13–5.39), and diabetes medication (OR =2.42, 95% CI =1.12–5.25). Patients with dyspepsia had lower haemoglobin and haematocrit and higher glucose values than those without dyspepsia. Patients with constipation had lower thrombocyte values than patients without constipation. However, these findings were explained by factors pre-disposing to constipation and dyspepsia. Clozapine use markedly increases the risk of constipation and may lead to life-threatening complications. In addition, analgesics and diabetes medication were related to gastrointestinal symptoms. These medications and their association to gastrointestinal symptoms should be kept in mind when treating patients with schizophrenia.

Keywords:

• Schizophrenia
• constipation
• dyspepsia
• clozapine
• diabetes
• analgesics

Acknowledgements

This study was supported by the Hyvinkää Hospital Area and by unrestricted research grants from the Finnish Foundation for Psychiatric Research, the Finnish Medical Foundation, Jalmari and Rauha Ahokas’s Foundation, and Emil Aaltonen’s Foundation. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript, and in the decision to submit the article for publication.

We thank Marjut Grainger for data management, and all the participants and staff from the participating clinics.

Disclosure statement

Saana Eskelinen has worked as a consultant for Janssen-Cilag, and received lecture fees from Janssen-Cilag, Otsuka, and Lundbeck. Eila Sailas has received lecture fees from Janssen-Cilag, AstraZeneca, and Lundbeck. Tomi Virtanen and Jaana Suvisaari report no conflicts of interest.