Kulkarni Deepika P, Kamath Vandan D, Stewart Jonathan T
University of South Florida College of Medicine, Tampa, USA.
Audiology and Speech Pathology Service (126), James A Haley VA Hospital, Tampa, USA.
Dysphagia. 2017 Aug;32(4):467-471. doi: 10.1007/s00455-017-9802-6. Epub 2017 Apr 26.
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.
吞咽障碍在精神分裂症中特征描述不足，但相当常见。它们是该人群中相当一部分发病和死亡的原因，通常是由于气道阻塞导致的急性窒息，或更隐匿的误吸和肺炎。急性窒息的死亡率可能高达普通人群的一百倍。精神分裂症中的大多数吞咽障碍似乎可分为两类，一类是由于疾病本身导致的进食和吞咽变化，另一类是与精神药物相关的变化。与疾病相关的行为变化了解甚少，通常包括进食过快或摄入不适当的大量食物。医源性问题大多与药物引起的锥体外系副作用有关，包括药物性帕金森综合征、肌张力障碍和迟发性运动障碍，但也可能包括口干、流涎以及与镇静相关的变化。本文将概述精神分裂症患者常见的吞咽问题、其病理生理学及管理。虽然文献中高质量证据匮乏，但全面的病史和检查通常能阐明主要问题，常常能引出有效的管理策略。
