Skip to main content

Dysphagia is a Common and Serious Problem for Adults with Mental Illness: A Systematic Review

Abstract

Adults with mental illness may experience a higher incidence of dysphagia and choking due to factors such as medication side effects and behavioural abnormalities. The aim of this study was to determine the frequency of dysphagia and the most effective interventions for this population. Studies published up to August 2010 were sought via a comprehensive electronic database search (CINAHL, PsycINFO, MEDLINE, PubMed, Cochrane, and Embase). Studies reporting dysphagia frequency or dysphagia intervention outcomes in adults with mental illness were included. Two reviewers independently assessed study eligibility and quality, and the results were synthesised descriptively. Ten studies were identified, each describing dysphagia frequency or death due to choking asphyxiation. No studies evaluating intervention effectiveness were identified. Study quality was limited by subjective assessment of outcomes. Six studies presented dysphagia frequencies ranging from 9 to 42% in varying subgroups. Four studies presented the frequency of choking asphyxiation death, including a large survey that concluded that adults with organic mental illness were 43 times more likely to die of this cause than the general population. Dysphagia is a common and significant cause of morbidity and mortality in adults with mental illness and our review found that there is a lack of studies evaluating the effectiveness of intervention techniques.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. 1.

    Speech Pathology Australia. Dysphagia: General position paper, 2009, Speech Pathology Association of Australia. Available at www.speechpathologyaustralia.org.au. Accessed 26 Oct 2010.

  2. 2.

    RCSLT, Dysphagia, in RCSLT Resource Manual for Commissioning and Planning Services for SCLN, RCSLT. 2009, Royal College of Speech & Language Therapists. Available at www.rcslt.org.uk. Accessed 26 Oct 2010.

  3. 3.

    Langmore SE, Terpenning M, Schork A, Chen Y, Murray J, Lopatin D, Loesche W. Predictors of aspiration pneumonia: how important is dysphagia? Dysphagia. 1998;13:69–81.

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Groher ME, Bukatman R. The prevalence of swallowing disorders in two teaching hospitals. Dysphagia. 1986;1:3–6.

    Article  Google Scholar 

  5. 5.

    Bazemore PH, Tonkonogy J, Ananth R. Dysphagia in psychiatric patients: clinical and videofluoroscopic study. Dysphagia. 1991;6(1):2–5.

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Regan J, Sowman R, Walsh I. Prevalence of dysphagia in acute and community mental health settings. Dysphagia. 2006;21(2):95–101.

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    World Health Organisation. Mental health. Available at http://www.who.int/mental_health/en/ (Accessed 22 March 2011).

  8. 8.

    Ruschena D, Mullen PE, Palmer S, Burgess P, Cordner SM, Drummer OH, Wallace C, Barry-Walsh J. Choking deaths: the role of antipsychotic medication. Br J Psychiatry. 2003;183:446–50.

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Logemann J. Evaluation and treatment of swallowing disorders. 2nd ed. Austin: Pro-Ed; 1998.

    Google Scholar 

  10. 10.

    Speyer R, Baijens L, Heijnen M, Zwijnenberg I. Effects of therapy in oropharyngeal dysphagia by speech and language therapists: a systematic review. Dysphagia. 2010;25(1):40–65.

    PubMed  Article  Google Scholar 

  11. 11.

    Bath PM, Bath-Hextall FJ, Smithard D. Interventions for dysphagia in acute stroke. Cochrane Database Syst Rev. 1999(4).

  12. 12.

    Foley N, Teasell R, Salter K, Kruger E, Martino R. Dysphagia treatment post stroke: a systematic review of randomised controlled trials. Age Ageing. 2008;37:258–64.

    PubMed  Article  Google Scholar 

  13. 13.

    Moher D, Liberati A, Tetzlaff J, Altman DG. The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. PLoS Med. 2009;6(7):e1000097.

    PubMed  Article  Google Scholar 

  14. 14.

    Khan KS, Ter Riet G, Popay J, Nixon J, Kleijnen J: CRD Report 4. Stage II, Conducting the review, Phase 5, Study Quality Assessment, 2001. Centre for Reviews and Dissemination, University of York, York, UK.

  15. 15.

    Siwek J, Gourlay ML, Slawson DC, Shaughnessy AF. How to write an evidence-based clinical review article. Am Fam Physician. 2002;65(2):251–8.

    PubMed  Google Scholar 

  16. 16.

    Hussar AE, Bragg DG. The effect of chlorpromazine on the swallowing function in chronic schizophrenic patients. Am J Psychiatry. 1969;126(4):570–3.

    PubMed  CAS  Google Scholar 

  17. 17.

    Nagamine T. Serum substance P levels in patients with chronic schizophrenia treated with typical or atypical antipsychotics. Neuropsychiatr Dis Treat. 2008;4(1):289–94.

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Kagaya H, Okada S, Saitoh E, Baba M, Yokoyama M, Takahashi H. Simple swallowing provocation test has limited applicability as a screening tool for detecting aspiration, silent aspiration, or penetration. Dysphagia. 2010;25(1):6–10.

    PubMed  Article  Google Scholar 

  19. 19.

    Hussar AE. Leading causes of death in institutionalised chronic schizophrenic patients: a study of 1, 275 autopsy protocols. J Nerv Ment Dis. 1966;142(1):45–57.

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Craig TJ. Medication use and deaths attributed to asphyxia among psychiatric patients. Am J Psychiatry. 1980;37(11):1366–73.

    Google Scholar 

  21. 21.

    Corcoran E, Walsh D. Obstructive asphyxia: a cause of excess mortality in psychiatric patients. Ir J Psychol Med. 2003;20(3):88–90.

    Google Scholar 

  22. 22.

    World Health Organisation. ICD-10 classifications of mental and behavioural disorder: clinical descriptions and diagnostic guidelines. Geneva: World Health Organisation, 2007. Available at http://apps.who.int/classifications/apps/icd/icd10online/.

  23. 23.

    Speech Pathology Australia: Fibre Endoscopic Evaluation of Swallowing (FEES). An advanced practice for speech pathologists (position paper), 2007. Melbourne: The Speech Pathology Association of Australia.

  24. 24.

    Atherton M. Speech Pathology Australia Submission. In: Development of a National Mental Health Workforce Strategy and Plan—Mental Health Workforce Advisory Committee, 2009, Speech Pathology Australia. Available at www.speechpathologyaustralia.org.au. Accessed 26 Oct 2010.

  25. 25.

    Feve A, Angelard B, Lacau St Guily J. Laryngeal tardive dyskinesia. J Neurol. 1995;242(7):455–9.

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Fioritti A, Giaccotto L, Melega V. Choking incidents among psychiatric patients: retrospective analysis of thirty-one cases from the West Bologna psychiatric wards. Can J Psychiatry. 1997;42(5):515–20.

    PubMed  CAS  Google Scholar 

  27. 27.

    Al-Shehri AM. Drug-induced dysphagia. Ann Saudi Med. 2003;23(5):249–53.

    PubMed  Google Scholar 

  28. 28.

    Appelbaum KL, Bazemore PH, Tonkonogy J, Ananth R, Shull S. Privilege and discharge decisions for psychiatric inpatients with dysphagia. Hosp Community Psychiatry. 1992;43(10):1023–5.

    PubMed  CAS  Google Scholar 

  29. 29.

    Armstrong D, Ahuja N, Lloyd AJ. Quietapine-related dysphagia. Psychosomatics. 2008;49(5):450–2.

    PubMed  Article  Google Scholar 

  30. 30.

    Bergman P, Malasky C, Zahn TP. Oral functions in schizophrenia. J Nerv Ment Dis. 1998;146(5):351–9.

    Google Scholar 

  31. 31.

    Bragg DG, Hussar AE. Cineradiographic evaluation of the swallowing act in schizophrenic patients. Gastroenterology. 1971;60(2):299–304.

    PubMed  CAS  Google Scholar 

  32. 32.

    The Brown University Geriatric Psychopharmacology Update, 12:1–8. doi:10.1002/gpu.20081.

  33. 33.

    Bulling M. Drug-induced dysphagia. Aust N Z J Med. 1999;29(5):8–748.

    Article  Google Scholar 

  34. 34.

    Butkovic-Soldo S, Tomic S, Stimac D, Knezevic L, Palic R, Juric S. Patients review: drug-induced movement disorders. Coll Antropol. 2005;29(2):579–82.

    PubMed  Google Scholar 

  35. 35.

    Coombes R. Easier to swallow. Nurs Times. 2002;98(25):10–1.

    Google Scholar 

  36. 36.

    Craig T, Richardson MA. “Cafe coronaries” in psychiatric patients. JAMA. 1982;248(17):2114.

    PubMed  Article  CAS  Google Scholar 

  37. 37.

    Craig TJ, Richardson MA. Swallowing, tardive dyskinesia and anticholinergics. Am J Psychiatry. 1982;139(8):1083.

    PubMed  CAS  Google Scholar 

  38. 38.

    Ekberg OFM. Clinical and demographic data in 75 patients with near fatal choking episodes. Dysphagia. 1992;7:205–8.

    PubMed  Article  CAS  Google Scholar 

  39. 39.

    Flaherty JA, Lahmeyer HW. Laryngeal-pharyngeal dystonia as a possible cause of asphyxia with haloperidol treatment. Am J Psychiatry. 1978;135(11):1414–5.

    PubMed  CAS  Google Scholar 

  40. 40.

    Frangos E, Christodoulides H. Clinical observations of the treatment of tardive dyskinesia with haloperidol. Acta Psychiatr Belg. 1975;75(1):19–32.

    PubMed  CAS  Google Scholar 

  41. 41.

    Glassman AH, Bigger JT. Antipsychotic drugs: prolonged QTc interval, torsade de pointes, and sudden death. Am J Psychiatry. 2001;158:1774–82.

    PubMed  Article  CAS  Google Scholar 

  42. 42.

    Harrison E, Jeffrey K, Kasif M, McGarry D, Mobbs L, Storey A. Identifying and managing risks of dysphagia in a long stay psychiatric hospital. Mind to Care–35th International Mental Health Nursing Conference of the Australian College of Mental Health Nurses, 2009. 29 September–2 October, Sheraton on the Park, Sydney, NSW, Australia. Int J Ment Health Nurs. 2009;18:A10–1.

    Article  Google Scholar 

  43. 43.

    Haugen RK. Food apshyxiation. JAMA. 1964;188:1026.

    Google Scholar 

  44. 44.

    Haugen RK. The Cafe Coronary: sudden deaths in restaurants. JAMA. 1963;186(2):142–3.

    PubMed  Article  CAS  Google Scholar 

  45. 45.

    Haw C, Stubbs J. Administration of medicines in food and drink: a study of older in-patients with severe mental illness. Int Psychogeriatr. 2010;22(3):409–16.

    PubMed  Article  Google Scholar 

  46. 46.

    Heritage M. A collaborative approach to the assessment and management of dysphagia. Int J Lang Commun Disord. 2001;36(1):369–74.

    PubMed  Article  Google Scholar 

  47. 47.

    Hollister LE. Unexpected asphyxial death and tranquilizing drugs. Am J Psychiatry. 1957;114(4):366–7.

    PubMed  CAS  Google Scholar 

  48. 48.

    Hollister LE, Kosek JC. Sudden death during treatment with phenothiazine derivatives. JAMA. 1965;192(12):1035–8.

    PubMed  Article  CAS  Google Scholar 

  49. 49.

    Hsieh HH, Bhatia SC, Andersen JM, Cheng SC. Psychotropic medication and nonfatal cafe coronary. J Clin Psychopharmacol. 1986;6(2):101–2.

    PubMed  Article  CAS  Google Scholar 

  50. 50.

    Hussar AE, Bragg DG. Swallowing function in schizophrenia. Ann Int Med. 1970;73(2):343–4.

    PubMed  CAS  Google Scholar 

  51. 51.

    Jain S, Gibson RH, Guedet PJ, Lehrmann JA, Tsao CI. Aspiration pneumonia as a complication of severe mania. Gen Hosp Psychiatry. 2003;25(2):136–7.

    PubMed  Article  Google Scholar 

  52. 52.

    Kamin J, Manwani S, Hughes D. Extrapyramidal side effects in the psychiatric emergency service. Psychiatr Serv. 2000;51(3):287–9.

    PubMed  Article  CAS  Google Scholar 

  53. 53.

    Keith RM. Swallowing style in adults with schizophrenia. Am J Psychiatry. 1986;143(11):1504–5.

    PubMed  CAS  Google Scholar 

  54. 54.

    Kelly J, Wright D. Administering medication to adult patients with dysphagia. Nurs Stand. 2009;23(29):62–8.

    PubMed  Google Scholar 

  55. 55.

    Knol W, Van Marum RJ, Jansen PAF, Souverein PC, Schobben A, Egberts A. Antipsychotic drug use and risk of pneumonia in elderly people. J Am Geriatr Soc. 2008;56(4):661–6.

    PubMed  Article  Google Scholar 

  56. 56.

    Kuruvilla J, Trewby PN. Gastro-oesophageal disorders in adults with severe mental impairment. BMJ. 1989;299(6691):95–6.

    PubMed  Article  CAS  Google Scholar 

  57. 57.

    Massengill R, Nashold B. A swallowing disorder denoted in tardive dyskinesia patients. Acta Otolaryngol. 1969;68:457–8.

    PubMed  Article  Google Scholar 

  58. 58.

    McManus M. Dysphagia in psychiatric patients. J Psychosoc Nurs Ment Health Serv. 2001;39(2):24–30.

    PubMed  CAS  Google Scholar 

  59. 59.

    Mittleman RE, Wetli CV. The Fatal Cafe Coronary. JAMA. 1982;247(9):1285–8.

    PubMed  Article  CAS  Google Scholar 

  60. 60.

    Mortensen PB, Juel K. Mortality and causes of death in schizophrenic patients in Denmark. Acta Psychiatr Scand. 1990;81:372–7.

    PubMed  Article  CAS  Google Scholar 

  61. 61.

    Moss HB, Green A. Neuroleptic-associated dysphagia confirmed by esophageal manometry. Am J Psychiatry. 1982;139(4):515–6.

    PubMed  CAS  Google Scholar 

  62. 62.

    Nagamine T, Nakayama H. Serum substance P concentration in pneumonia patients with chronic schizophrenia. Int Med J. 2009;16(3):181–2.

    CAS  Google Scholar 

  63. 63.

    Newton-John H. Acute upper airway obstruction due to supraglottic dystonia induced by a neuroleptic. BMJ. 1988;297(6654):964–5.

    PubMed  Article  CAS  Google Scholar 

  64. 64.

    Pearlman C. Clozapine, nocturnal sialorrhea, and choking. J Clin Psychopharmacol. 1994;14(4):283.

    PubMed  Article  CAS  Google Scholar 

  65. 65.

    Rosenstein LD, Price RF. Shaping a normal rate of eating using audiotaped pacing in conjunction with a token economy. Neuropsychol Rehabil. 1994;4(4):387–98.

    Article  Google Scholar 

  66. 66.

    Rudolph JL, Gardner KF, Gramigna GD, McGlinchey RE. Antipsychotics and oropharyngeal dysphagia in hospitalized older patients. J Clin Psychopharmacol. 2008;28(5):532–5.

    PubMed  Article  CAS  Google Scholar 

  67. 67.

    Sagar R, Varghese ST, Balhara YP. Dysphagia due to olanzepine, an antipsychotic medication. Indian J Gastroenterol. 2005;24(1):37–8.

    PubMed  Google Scholar 

  68. 68.

    Sims CA. Do neuroleptics increase the risk of choking? Br J Psychiatry. 1980;136:608.

    PubMed  Article  CAS  Google Scholar 

  69. 69.

    Stewart JT. Reversible dysphagia associated with neuroleptic treatment. J Am Geriatr Soc. 2001;49(9):1260–1.

    PubMed  Article  CAS  Google Scholar 

  70. 70.

    Stones M, Kennie DC, Fulton JD. Dystonic dysphagia associated with fluspirilene. BMJ. 1990;301(6753):668–9.

    PubMed  Article  CAS  Google Scholar 

  71. 71.

    Stovall JG, Gussak LS. Dysphagia and chronic mental illness: looking beyond hysteria and broadening the psychiatric differential diagnosis. Prim Care Companion J Clin Psychiatry. 2001;3(3):143–400.

    PubMed  Article  Google Scholar 

  72. 72.

    Stroup S, Swartz M, Appelbaum P. Concealed medicines for people with schizophrenia: A U.S. perspective. Schizophr Bull. 2002;28(3):537–42.

    PubMed  Article  Google Scholar 

  73. 73.

    Varghese ST, Balhara YP, George SA, Sagar R. Risperidone and dysphagia. J Postgrad Med. 2006;52(4):327–8.

    PubMed  CAS  Google Scholar 

  74. 74.

    Von Brauchitsch H, May W. Deaths from aspiration and asphyxiation in a mental hospital. Arch Gen Psychiatry. 1968;18(2):129–36.

    Article  Google Scholar 

  75. 75.

    Walsh I, Regan J, Sowman R, Parsons B, McKay AP. A needs analysis for the provision of a speech and language therapy service to adults with mental health disorders. Ir J Psychol Med. 2007;24(3):89–93.

    Google Scholar 

  76. 76.

    Warner J. Risk of choking in mental illness. Lancet. 2004;363(9410):674.

    PubMed  Article  Google Scholar 

  77. 77.

    Weiden P, Harrigan M. A clinical guide for diagnosing and managing patients with drug-induced dysphagia. Hosp Community Psychiatry. 1986;37(4):396–8.

    PubMed  CAS  Google Scholar 

  78. 78.

    Wendkos MH. Aspiration of food by psychiatric patients. JAMA. 1982;248(14):1712.

    PubMed  Article  CAS  Google Scholar 

  79. 79.

    Wendkos MH, Clay BW. Unusual causes for sudden unexpected death of regressed hospitalized schizophrenic patients. J Am Geriatr Soc. 1965;13:663–71.

    PubMed  CAS  Google Scholar 

  80. 80.

    Wick R, Gilbert JD, Byard RW. Cafe coronary syndrome - fatal choking on food: an autopsy approach. J Clin Forensic Med. 2006;13(3):135–8.

    PubMed  Article  Google Scholar 

  81. 81.

    Wilkins T, Gillies RA, Thomas AM, Wagner PJ. The Prevalence of dysphagia in primary care patients: a HamesNet Research Network study. J Am Board Fam Med. 2007;20(2):144–50.

    PubMed  Article  Google Scholar 

  82. 82.

    Zugibe FT. Sudden death related to the use of psychotropic drugs. Leg Med Ann. 1980:75–90.

  83. 83.

    Avidan B, Sonnenberg A, Giblovich H, Sontag SJ. Reflux symptoms are associated with psychiatric disease. Aliment Pharmacol Ther. 2001;15(12):1907–12.

    PubMed  Article  CAS  Google Scholar 

Download references

Conflict of Interest

No grant or financial support was received for this project.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Kristy J. Aldridge.

Appendix

Appendix

See Tables 5 and 6.

Table 5 Search strategy for medline with full-text database
Table 6 Justification for excluding articles

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Aldridge, K.J., Taylor, N.F. Dysphagia is a Common and Serious Problem for Adults with Mental Illness: A Systematic Review. Dysphagia 27, 124–137 (2012). https://doi.org/10.1007/s00455-011-9378-5

Download citation

Keywords

  • Systematic review
  • Dysphagia
  • Deglutition
  • Deglutition disorders
  • Mental illness
  • Mental disorders