2014 Volume 18 Issue 3 Pages 249-256
Purpose: The aim of this study was to determine the incidence and pathophysiology of dysphagia associated with an atypical antipsychotic drug administered for sedation.
Subjects: From July 2010 to June 2011, 69 hospitalized patients, who were being treated for unrest and excitement during their stay, were given an atypical antipsychotic drug.
Patients with psychiatric disorders or central nervous system diseases were excluded from the study.
Methods: Risperidone (0.5 or 1 mg) was administered to all 69 patients. After administration of the drug, we sequentially evaluated the deglutition status of patients using the repetitive saliva swallowing test and the modified water swallow test. Results over a 3-day period were scored using the dysphagia severity scale.
Of patients with dysphagia, the severity of extrapyramidal symptoms and daily living were rated using the Unified Parkinson’s Disease Rating Scale (UPDRS) and the Barthel Index, respectively, at the onset and time of relief of dysphagia. Patients’ swallowing abilities were further evaluated with videofluorography (VF).
Results: Thirteen of 69 patients (18.8%) developed dysphagia after receiving risperidone. Nine patients developed dysphagia after a single dose; 3 patients were affected after 2 consecutive doses; and 1 patient was affected after 3 consecutive doses of the drug. Administration of risperidone was immediately stopped when dysphagia occurred. The VF showed prolongation of oral transit time of the alimentary bolus, a delay in onset of the swallowing reflex, and reduced anterior displacement of the hyoid bone during the dysphagia period. Symptoms of dysphagia lasted from 2 to 28 days.
Discussion: The incidence of risperidone-related dysphagia was higher than expected. It is noteworthy that even small amounts of risperidone (0.5 mg) gave rise to dysphagia, resulting in prolonged symptoms in some cases. The VF revealed that risperidone affected both movement and perception associated with deglutition.
Patients receiving atypical antipsychotic drugs pharmacologically similar to risperidone for the treatment of unrest and excitement should be routinely monitored for the occurrence of dysphagia.
