Patients with schizophrenia are susceptible to constipation requiring frequent use of laxatives, which is thought to occur mainly as an adverse effect of psychotropic drug administration. The constipation may progress to paralytic ileus, bowel ischemia, and bowel perforation, and may sometimes be fatal. Despite numerous case reports of paralytic ileus in schizophrenia, few studies have examined the risk factors of this condition. The present study aimed to investigate the relationship between paralytic ileus in schizophrenia, psychotropics, and laxatives. The medical records of 3,775 consecutive patients with schizophrenia who were admitted to (A) hospital between November 2014 and October 2019 were retrospectively reviewed. Of these, 25 received the diagnosis of paralytic ileus. Multivariable analysis showed that the use of clozapine (OR 71.815; 95%CI 12.838-401.733; P< 0.001), magnesium oxide (OR 3.536; 95%CI 1.544-8.099; P=0.003), haloperidol (OR 3.079; 95%CI 1.192-7.954; P=0.020), sennoside (OR 2.376; 95%CI 1.048-5.388; P=0.038), and higher age (OR 1.053; 95%CI 1.023-1.084; P=0.001) were associated with an increased risk of paralytic ileus. Caution should therefore be exercised when using use clozapine, haloperidol or laxatives to prevent paralytic ileus, especially in elderly patients with schizophrenia.
 Authors' abstract