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Clozapine-Induced Refractory Colonic Pseudo-Obstruction.
Diana Siriwardena1, Chahaya M Gauci1,2,3,4, Ali Mohtashami1
1Colorectal Surgery, Royal North Shore Hospital, Sydney, AUS.
Cureus
|March 4, 2024
Summary
Treatment-resistant schizophrenia (TRS) management with clozapine can cause severe gastrointestinal issues. Close monitoring of bowel motility is crucial to prevent serious complications like pseudo-obstruction and ischemic colitis.
Area of Science:
- Psychiatry
- Gastroenterology
- Pharmacology
Background:
- Treatment-resistant schizophrenia (TRS) management often involves atypical antipsychotics.
- Adverse effects of these medications necessitate careful monitoring.
- Gastrointestinal (GI) effects of clozapine are less recognized than hematological risks.
Observation:
- A case study of TRS patient experiencing chronic treatment-resistant pseudo-obstruction.
- The condition eventually required a total colectomy.
- This highlights significant gastrointestinal sequelae associated with clozapine.
Findings:
- Clozapine use in TRS can lead to severe GI complications beyond constipation.
- Potential risks include ischemic colitis, stercoral perforation, and intraabdominal sepsis.
- These complications underscore the need for caution when prescribing clozapine.
Implications:
- Monitoring bowel motility is essential when administering antipsychotics, especially clozapine.
- Early detection and intervention can prevent severe GI consequences.
- This case emphasizes the importance of a comprehensive risk-benefit assessment in psychiatric pharmacotherapy.
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