Page 6 - Index

MEDICATION, ADMINISTRATION, COMPLIANCE AND SWALLOWING DIFFICULTIES cont.
Psychotic disorders and dysphagia
The treatment of psychotic disorders carries several risk factors for
dysphagia: antipsychotic drugs decrease oesophageal propulsion through
impairment of muscle function and in conjunction with anticholinergic
agents, cause dry mouth, contributing to difficulty swallowing20
.
All antipsychotics can cause extrapyramidal symptoms (EPS). Dysphagia
or swallowing difficulties have been identified in some patients as an
EPS with an incidence reported in both first, and second generation
antipsychotics21. The incidence of dysphagia reported through adverse
events however is small with a range of 0.43% to 2.08%21
.
The management of dysphagia associated with antipsychotics includes
discontinuing the medication, reducing the dose or dividing the dose.
Should these not be clinically suitable options, switching to another
antipsychotic can be considered21. There are several situations where it
may be appropriate to switch between antipsychotics, such as inadequate
therapeutic response and intolerable adverse effects. However, there are
also contraindications where the clinical risk associated with switching
the molecule or lowering the dose outweighs the benefit22. Switching
antipsychotic medication has uncertain clinical effects (positive or negative)
and carries the risk of clinical worsening22. Liquid medications are easier to
swallow, and dosage can readily be modified for individual patients23
.
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