Dysphagia in psychiatric patients: clinical and videofluoroscopic study

UMMS Affiliation

Department of Psychiatry



Document Type


Medical Subject Headings

Adult; Aged; Airway Obstruction; Deglutition Disorders; Female; Fluoroscopy; Humans; Inpatients; Male; Mental Disorders; Middle Aged; Videotape Recording




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.

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Citation: Dysphagia. 1991;6(1):2-5.

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