[Dysphagia or dysphagias during neuroleptic medication?]

Area of Science:

• Neuroscience
• Psychiatry
• Gastroenterology

Background:

• Dysphagia is a prevalent yet underestimated symptom in psychiatric patients, posing risks of suffocation and complications.
• Neuroleptic medications are increasingly recognized for their role in inducing or exacerbating dysphagia through various pathophysiological mechanisms.

Observation:

• A case of a 28-year-old male with schizophrenia developed severe dysphagia after initiation and dose escalation of loxapine.
• The dysphagia resolved rapidly upon discontinuation of loxapine, suggesting a direct drug-induced etiology.
• No extrapyramidal symptoms or anatomical lesions were identified, highlighting the potential for isolated neuroleptic-induced dysphagia.

Findings:

• Neuroleptic-induced dysphagia can manifest through multiple mechanisms, including dopamine D2 receptor blockade, serotonin 5-HT2A antagonism, cholinergic blockade, and sedation.
• Swallowing disorders can affect oral, pharyngeal, and esophageal phases, and may occur independently of other neurological signs.

Implications:

• Recognizing and diagnosing neuroleptic-induced dysphagia is critical for patient safety and requires interdisciplinary collaboration.
• Discontinuation of the offending neuroleptic is often effective, emphasizing the need for careful medication management in psychiatric care.