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Constipation screening in people taking clozapine: A diagnostic accuracy study.

Susanna Every-Palmer1, Stephen J Inns2, Pete M Ellis1

  • 1Department of Psychological Medicine, University of Otago, Wellington, New Zealand.

Schizophrenia Research
|April 5, 2020
PubMed
Summary

Self-reported constipation is an unreliable screening tool for clozapine-induced gastrointestinal hypomotility (CIGH). Most CIGH cases are missed using symptom-based screening, necessitating proactive management strategies for patient safety.

Keywords:
Adverse drug reactionAntipsychoticDiagnostic testDrug safetyGastrointestinal motilitySensitivitySpecificity

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Area of Science:

  • Pharmacology
  • Gastroenterology
  • Psychiatry

Background:

  • Clozapine is a key antipsychotic for treatment-refractory schizophrenia.
  • Clozapine-induced gastrointestinal hypomotility (CIGH) is a serious, common adverse effect.
  • Effective CIGH management is crucial for safe clozapine use.

Purpose of the Study:

  • To assess the diagnostic accuracy of constipation screening for CIGH.
  • To compare self-reported constipation with Rome criteria against motility studies.

Main Methods:

  • Evaluated constipation reporting versus Rome criteria in clozapine-treated inpatients (n=69).
  • Used gastrointestinal motility studies as the reference standard.
  • Assessed diagnostic accuracy, including sensitivity and specificity.

Main Results:

  • Constipation screening showed very poor diagnostic properties.
  • Only 26% self-reported constipation despite 73% objective CIGH (18% sensitivity).
  • Rome criteria improved sensitivity to 50%, but still missed half of cases.

Conclusions:

  • Self-reported constipation has low sensitivity for diagnosing CIGH, often being 'silent'.
  • Symptom-based screening misses most CIGH cases.
  • Prophylactic laxatives are recommended for clozapine patients due to screening limitations.