| Abstract [eng] |
Aim. To evaluate the effect of clozapine on gastrointestinal function and the prevalence of gastrointestinal symptoms, their associations with clozapine dose and patient wellbeing, and whether these side effects are recognised early enough. Material and methods. A quantitative, anonymous, cross-sectional study was conducted in the Vilnius City Mental Health Centre between 2025 and 2026. The study sample comprised 24 patients diagnosed with paranoid schizophrenia (F20.0). Gastrointestinal symptoms were assessed using adapted Rome IV criteria, the Bristol Stool Form Scale, and general wellbeing scale (0–10). Statistical analysis was performed using the R Commander program, the Shapiro-Wilk normality test, Spearman rank correlation coefficient, and Mann-Whitney U test. The level of statistical significance was set at p < 0.05. Results. According to Rome IV criteria, clozapine-induced constipation was identified in 62.5% of participants (15 out of 24). The most frequent symptoms were hard stools (58.3%), infrequent loose stools (54.2%), and straining (50.0%). Additionally, 29.2% of patients reported Bristol type 1–2 stools. The most common additional gastrointestinal symptoms were bloating and nausea (both 33.3%), abdominal pain, heartburn, and hypersalivation (all 25.0%). 8.3% of participants reported blood in stools. A strong negative correlation was found between clozapine dose and the Bristol Stool Scale score (rs = −0.630; p = 0.001), and a strong positive correlation between the Rome IV symptom sum and patient wellbeing (rs = 0.544; p = 0.006). Patients using laxatives had significantly higher Rome IV symptom scores (U = 19.5; p = 0.006) and poorer wellbeing (U = 6.0; p < 0.001) compared to those not using laxatives. Conclusions. Clozapine-induced gastrointestinal disorders are highly prevalent, complex, and directly associated with poor patient wellbeing. Higher clozapine doses are associated with harder stools, constipation and greater overall symptom burden. Laxatives are most likely prescribed reactively rather than prophylactically, suggesting that proactive assessment of gastrointestinal function and earlier laxative treatment should become an integral component of clozapine therapy. |
