Title: Study on Clinical Characteristics and Related Factors of Schizophrenia Patients with
Intestinal Obstruction Running title: Schizophrenia with Intestinal Obstruction
Version: 1 Date: 19 Oct 2021
Reviewer:  Takefumi Suzuki
Reviewer's report:
In this retrospective study of 1937 Chinese patients with schizophrenia it was found that
intestinal obstruction was noted in 97 patients (5.01%); 65 were treated surgically and six
people died. Such factors as older age, longer hospital stay, longer course of the disease,
history of previous abdominal surgery, male gender and delayed medical attendance were
found to increase the risk of intestinal obstruction. However these risk factors are well-known
and not particularly novel. Functional intestinal obstruction (or ileus) that frequently results
from chronic constipation is a highly relevant issue in the management of schizophrenia in
light of its high prevalence (doi: 10.1186/1471-230X-11-17). Ileus is likely to be recurrent
(doi: 10.1016/j.genhosppsych.2015.09.003) and constipation is oftentimes missed in clinical
practice (doi: 10.1016/j.genhosppsych.2013.06.007). It may also be well possible that some
physical mechanisms (e.g., adhesion from past abdominal surgery) may complicate the clinical
picture. Further refractory constipation may result in intestinal perforation (doi: 10.1345/
aph.1S117), a life-threatening medical condition. Lowered sensitivity to pain in patients with
schizophrenia (doi: 10.1097/00131746-200603000-00004) may at least in part account for the
occurrence of intestinal complications in this specific population. In this work mechanisms
of intestinal obstruction (i.e., functional or organic) remain unclear. Also unclear is possible
contribution of medications (e.g., laxatives and drugs with anticholinergic effects); dose
reduction of antipsychotics for instance may alleviate persistent constipation (doi: 10.1111/
j.1365-2710.2007.00843.x). Good clinical practice is to recommend physical activities, fluid
and dietary fiber intake in order to counteract intestinal hypomotility, which may be somewhat
difficult for people with schizophrenia in general. Possible effects from smoking may also be
considered (doi: 10.1080/14622200701188919). The authors may want to incorporate the above-
mentioned issues in the text. No further comments.
Title: Study on Clinical Characteristics and Related Factors of Schizophrenia Patients with
Intestinal Obstruction Running title: Schizophrenia with Intestinal Obstruction
Version: 1 Date: 19 Oct 2021
Reviewer:  Takefumi Suzuki
Reviewer's report:
In this retrospective study of 1937 Chinese patients with schizophrenia it was found that
intestinal obstruction was noted in 97 patients (5.01%); 65 were treated surgically and six
people died. Such factors as older age, longer hospital stay, longer course of the disease,
history of previous abdominal surgery, male gender and delayed medical attendance were
found to increase the risk of intestinal obstruction. However these risk factors are well-known
and not particularly novel. Functional intestinal obstruction (or ileus) that frequently results
from chronic constipation is a highly relevant issue in the management of schizophrenia in
light of its high prevalence (doi: 10.1186/1471-230X-11-17). Ileus is likely to be recurrent
(doi: 10.1016/j.genhosppsych.2015.09.003) and constipation is oftentimes missed in clinical
practice (doi: 10.1016/j.genhosppsych.2013.06.007). It may also be well possible that some
physical mechanisms (e.g., adhesion from past abdominal surgery) may complicate the clinical
picture. Further refractory constipation may result in intestinal perforation (doi: 10.1345/
aph.1S117), a life-threatening medical condition. Lowered sensitivity to pain in patients with
schizophrenia (doi: 10.1097/00131746-200603000-00004) may at least in part account for the
occurrence of intestinal complications in this specific population. In this work mechanisms
of intestinal obstruction (i.e., functional or organic) remain unclear. Also unclear is possible
contribution of medications (e.g., laxatives and drugs with anticholinergic effects); dose
reduction of antipsychotics for instance may alleviate persistent constipation (doi: 10.1111/
j.1365-2710.2007.00843.x). Good clinical practice is to recommend physical activities, fluid
and dietary fiber intake in order to counteract intestinal hypomotility, which may be somewhat
difficult for people with schizophrenia in general. Possible effects from smoking may also be
considered (doi: 10.1080/14622200701188919). The authors may want to incorporate the above-
mentioned issues in the text. No further comments.
Please review this paper.
user
Title: Study on Clinical Characteristics and Related Factors of Schizophrenia Patients with
Intestinal Obstruction Running title: Schizophrenia with Intestinal Obstruction
Version: 1 Date: 19 Oct 2021
Reviewer:  Takefumi Suzuki
Reviewer's report:
In this retrospective study of 1937 Chinese patients with schizophrenia it was found that
intestinal obstruction was noted in 97 patients (5.01%); 65 were treated surgically and six
people died. Such factors as older age, longer hospital stay, longer course of the disease,
history of previous abdominal surgery, male gender and delayed medical attendance were
found to increase the risk of intestinal obstruction. However these risk factors are well-known
and not particularly novel. Functional intestinal obstruction (or ileus) that frequently results
from chronic constipation is a highly relevant issue in the management of schizophrenia in
light of its high prevalence (doi: 10.1186/1471-230X-11-17). Ileus is likely to be recurrent
(doi: 10.1016/j.genhosppsych.2015.09.003) and constipation is oftentimes missed in clinical
practice (doi: 10.1016/j.genhosppsych.2013.06.007). It may also be well possible that some
physical mechanisms (e.g., adhesion from past abdominal surgery) may complicate the clinical
picture. Further refractory constipation may result in intestinal perforation (doi: 10.1345/
aph.1S117), a life-threatening medical condition. Lowered sensitivity to pain in patients with
schizophrenia (doi: 10.1097/00131746-200603000-00004) may at least in part account for the
occurrence of intestinal complications in this specific population. In this work mechanisms
of intestinal obstruction (i.e., functional or organic) remain unclear. Also unclear is possible
contribution of medications (e.g., laxatives and drugs with anticholinergic effects); dose
reduction of antipsychotics for instance may alleviate persistent constipation (doi: 10.1111/
j.1365-2710.2007.00843.x). Good clinical practice is to recommend physical activities, fluid
and dietary fiber intake in order to counteract intestinal hypomotility, which may be somewhat
difficult for people with schizophrenia in general. Possible effects from smoking may also be
considered (doi: 10.1080/14622200701188919). The authors may want to incorporate the above-
mentioned issues in the text. No further comments.
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