title: Dysphagia in psychiatric patients: clinical and videofluoroscopic study.
abstract: Deaths due to airway obstruction are more common in psychiatric inpatients than in the normal population. A dysphagia program was started in a 400 bed Massachusetts psychiatric hospital after 4 patients in 1 year died from asphyxia. In the year after the program was started, there were no deaths; however, 28 patients experienced 32 choking incidents. The 28 patients received clinical evaluations by speech pathologists, neurologists, psychiatrists, and internists. Of the incidents, 55% required use of the Heimlich maneuver to open the airway. Choking incidents could be classified into five types based on results of clinical examination: bradykinetic, dyskinetic, fast eating syndrome, paralytic, and medical. Twenty-one of the 28 patients were studied by videofluoroscopy and 86% of the videos were abnormal, showing aspiration in eight, webs in five, and delay in the oral phase in five. Patients with bradykinetic dysphagia (secondary to neuroleptic-induced extra-pyramidal syndrome [EPS]) and paralytic dysphagia appeared to experience a more severe form of choking.
authors.affiliation: University of Massachusetts Medical Center, Worcester.
authors.forename: P H
authors.initials: PH
authors.lastname: Bazemore
authors.forename: J
authors.initials: J
authors.lastname: Tonkonogy
authors.forename: R
authors.initials: R
authors.lastname: Ananth
mesh_terms: D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000209:etiology; D003680:Deglutition Disorders / Q000150:complications / Q000000981:diagnostic imaging* / Q000209:etiology*; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D007297:Inpatients; D008297:Male; D001523:Mental Disorders / Q000150:complications*; D008875:Middle Aged; D014743:Videotape Recording