Schizophreniu Research, 7 (1992) 192 Q 1992 Elsevier Science Publishers B.V. All rights reserved

SCHIZO

197 0920-9964/92/$05.00

00232

Letter to the editors

Increased vomiting among patients treated with neuroleptics J.F.

Thornton,

Clarke Institute (Received

28 June

1991; revision

C. Hudson qf Psychiatry, received

Dear editors, Over the years, one of the authors (J.F.T.) noted that patients treated with neuroleptics reported vomiting on a frequent basis. Such reports were unexpected in that neuroleptics are thought to function as antiemitics (Baldessarini, 1985). These reports were also alarming in a patient population with an impaired protective gag reflex (Hudson et al. 1990) since it could lead to aspiration. We assessed fifty-six outpatients, forty-two males and fourteen females from the Continuing Care Division at the Clarke Institute of Psychiatry for frequency of vomiting in the past day, week and month. Subjects who vomited were also asked to identify the perceived cause of their vomiting from one of several categories: Stomach Upset, Medications, Consumption of Alcohol, No Reason, or Other. Their diagnosis was assessed by the Structured Clinical Interview for DSM-IIIR (SCID) and were found to fall into two categories: fifty-two patients suffering from schizophrenia, and four patients suffering from schizoaffective disorder. All patients had received depot neuroleptics for at least one year. The mean dosage in Chlorpromazine (CPZ) equivalents was 1111 mg/day. In addition, twenty-eight patients were also treated with anticholinergics, and four of the patients received lithium as well as their neuroleptic. The average age of patients was 38.3 years (range 24-57) for males 36.9 (range 24-56) and 44.4 for females (range 27-57). Fifty-six controls were recruited from the staff of the Clarke Institute of Psychiatry and were matched for age and sex. The controls had never been treated with a neuroleptic or antiemitic. Analysis of Variance (ANOVA) which followed Correspondence atry, 250 College

lo: J.F. Thornton, Clarke Institute of PsychiStreet, Toronto, Ont. M5T lR8, Canada.

and

G. Cavner

Toronto, Ont. Canada.

28 January

1992; accepted

9 February

1992)

a 2 x 2 level design with group (patients vs control) and sex as between-subject factors was performed on the number of reports of vomiting in the past day, week, and month. The analysis revealed significant differences in all three time frames: on average patients reported vomiting 0.13 (range O-3) times in the past day compared with no report of vomiting in controls (F= 3.91, p < 0.05); 0.43 (range O-6) times in the past week compared with no report of vomiting in controls (F=6.22, p < 0.01); and 1.47 (range O-15) times in the past month compared with 0.11 (O-2) times for controls (F= 9.28, p < 0.005). Of the five controls who vomited, three thought it was due to excess alcohol ingestion and two because of gastrointestinal upset. None of the controls selected the ‘no reason’ category. Of the nineteen patients that reported vomiting six thought that alcohol played a role, eight thought that gastrointestinal upset was responsible, and five selected ‘no reason’. There was a significant positive correlation between frequency of vomiting in the past month and dosage of medication (as expressed in CPZ equivalents) (Y= 0.522, p < 0.01). Also, there was a positive correlation between frequency of vomiting and number of cigarettes smoked (Y= 0.479, p < 0.01) in the patient sample. This single questionnaire conducted on fifty-six patients and controls indicates that chronic patients on large dosages of medication report vomiting significantly more often than normal controls. A larger sample of patients on and off medication would allow teasing out the probable etiologies such as medication effects, cigarette smoking, and possibly an association with schizophrenia itself. It is important to note that none of the four patients treated with lithium reported vomiting. Clearly, there is a need for more sophisticated studies on large sample sizes.

Increased vomiting among patients treated with neuroleptics.

Schizophreniu Research, 7 (1992) 192 Q 1992 Elsevier Science Publishers B.V. All rights reserved SCHIZO 197 0920-9964/92/$05.00 00232 Letter to th...
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