PDF(Pubmed)
Abstract：
Acute colonic pseudo-obstruction or Ogilvie\'s syndrome is a disorder causing massive colonic dilation with no evidence of mechanical obstruction. The actual incidence of acute colonic pseudo-obstruction is unclear; However, electrolyte imbalance, psychiatric disorders, the use of medications such as anticholinergics or antipsychotics, and recent abdominal surgery are the most common predisposing factors associated with this syndrome. Ogilvie\'s syndrome is most likely caused due to impairment of the gut\'s motor system and an imbalance of the autonomic nervous system including a reduction in the activity of stimulatory neurotransmitters. The predisposition to psychotic disorders could be, in some instances, due to neurodevelopmental abnormalities of the brain and the gut\'s autonomic nervous system. The symptoms of Ogilvie\'s syndrome are similar to mechanical obstruction of the colon but no physical cause of obstruction is usually present. Ogilvie\'s syndrome can be managed conservatively; however, if left untreated, Ogilvie\'s syndrome can lead to bowel perforation, which is associated with a high mortality risk. Antipsychotics have been considered the cornerstone treatment for psychiatric disorders including schizophrenia. Even though they are highly effective in treating psychiatric illnesses, their usage carries multiple risks. Overall, constipation is a common side effect of antipsychotic medications with some classes posing more risk than others. Constipation can be severe and may lead to serious complications such as paralytic ileus, bowel ischemia, and death. We present here a case of delusional disorder managed with risperidone and complicated by intestinal pseudo-obstruction. This case reiterates the need to consider all complications of antipsychotic medications, even rare ones, and include them in the discussion with patients and their caregivers before commencement.
摘要：
急性结肠假性梗阻或Ogilvie综合征是一种引起结肠大量扩张的疾病，没有机械性梗阻的证据。急性结肠假性梗阻的实际发生率尚不清楚；然而，电解质不平衡，精神疾病,使用抗胆碱能药物或抗精神病药物，最近的腹部手术是与该综合征相关的最常见的诱发因素。Ogilvie综合征很可能是由于肠道运动系统受损和自主神经系统的不平衡，包括刺激性神经递质活动的减少。精神疾病的易感性可能是，在某些情况下,由于大脑和肠道自主神经系统的神经发育异常。Ogilvie综合征的症状与结肠机械性梗阻相似，但通常不存在梗阻的物理原因。Ogilvie综合征可以保守管理；然而，如果不及时治疗，Ogilvie综合征可导致肠穿孔,这与高死亡风险有关。抗精神病药物被认为是包括精神分裂症在内的精神疾病的基础治疗。尽管它们在治疗精神疾病方面非常有效，它们的使用存在多重风险。总的来说,便秘是抗精神病药物的常见副作用，某些类别比其他类别风险更大。便秘可能很严重，并可能导致严重的并发症，如麻痹性肠梗阻，肠缺血,和死亡。我们在此介绍一例使用利培酮治疗并并发肠假性梗阻的妄想症。此案重申需要考虑抗精神病药物的所有并发症，即使是稀有的，并在开始之前将他们纳入与患者及其护理人员的讨论中。
