This study indicates that the incidence of intestinal obstruction in hospitalized schizophrenia patients is 5.01%. Univariate analysis and logistic multiple regression analysis show that the incidence of intestinal obstruction in hospitalized schizophrenia patients is related to the patient’s age, visiting time, length of hospital stay, abdominal surgery history, course of disease, gender, etc. The possible mechanisms are: (1) Lowered sensitivity to pain in patients with schizophrenia . With the increase of age, the body has poor constitution, slow reaction, decreased immunity, decreased conduction function of nervous system, and slow response to pain and stress, especially for the elderly mental patients over 70 years old ; (2) Due to the strong sedative effect of anti-schizophrenia drugs, the perception of abdominal pain and distention is slow, and the symptoms and signs at the onset of the disease cannot be reported in time [11,12,13]; (3) Inpatients with schizophrenia are mostly under closed management. Reduced activity leads to slower gastrointestinal peristalsis. The longer the hospital stay, the greater the chance of intestinal obstruction; (4) Intestinal adhesions are the most common complication after abdominal surgery and the most important risk factor for intestinal obstruction [14, 15], therefore, schizophrenia patients with a history of abdominal surgery are more likely to develop intestinal obstruction; (5) One of the most important risk factors for intestinal obstruction in schizophrenia patients is medication . The anticholinergic effect of drugs for the treatment of schizophrenia can inhibit the contraction of gastrointestinal smooth muscle and reduce gastrointestinal secretion and peristalsis. Therefore, the longer the course of the disease, the longer the medication time, and the greater the dosage, the more frequent the patient’s intestinal obstruction. (6) Male hormones can weaken gastrointestinal smooth muscle contraction and slow gastrointestinal peristalsis by affecting autonomic nerve function, causing male patients with schizophrenia to be more prone to intestinal obstruction than women [17, 18].
In short, the above risk factors are intertwined, causing the patient's intestinal wall to be relaxed and tension-free, the contents of the intestinal cavity cannot move downward, the exhaust and defecation are blocked, the intestinal pressure is increased, resulting in paralytic intestinal obstruction, which makes the patients' feces dry and further aggravate the formation of fecal stones, leading to mechanical intestinal obstruction [19,20,21]; if it is not detected in time and treated in time during the rounds, it will inevitably be accompanied by various complications and even endanger the life of the patient. Among the 97 cases of intestinal obstruction in this study, 6 patients died, and the mortality rate was 6.19%; 18 patients were misdiagnosed as other diseases, and the misdiagnosis rate was 18.56%.
Schizophrenia is a chronic disease with high disability rate. The patients' knowledge, emotion and intention are not consistent, and their thinking and behavior are abnormal. Long term use of antipsychotics makes the patients slow to respond and will not actively and correctly reflect and describe their physical discomfort. Their poor compliance with clinical physical examination and treatment has brought great difficulties to the diagnosis and treatment of intestinal obstruction in schizophrenia. In order to detect and treat schizophrenia with intestinal obstruction early, it should be strengthened from the following aspects: (1) Carefully observe and ask the patient's diet and stool conditions, and promptly treat the patient with constipation could prevent ileus ; (2) Actively carry out comprehensive work and entertainment treatment, behavior correction treatment and improve the cognitive function of patients, if there is discomfort in patients, take the initiative to tell the doctor about the condition; (3) Keep on doing appropriate exercises such as gymnastics every day, and do gardening therapy for rehabilitation training  to alleviate the adverse effects of antipsychotic drugs and sedation, despite some difficulties; (4) For patients with a history of abdominal surgery, physical examination should be carried out every day, especially abdominal visual and tactile percussion ; (5) For patients with schizophrenia who are hospitalized for a long time and have a long course of disease, timely adjust the dose of antipsychotic drugs and maintain a lower dose of maintenance therapy drugs . Dose reduction of antipsychotics may alleviate persistent constipation ; (6) For male patients, strengthen the control of active substances such as tobacco and alcohol, and regularly test various biochemical indicators .
This research still has the following shortcomings. First of all, this study is a retrospective study, not a randomized controlled experiment, so there is still a certain risk of bias. Secondly, this study is a single-center clinical study, and subsequent multi-center clinical studies are still needed for further discussion. Finally, the sample size included in this study is relatively small, and it is still necessary to increase the sample size for further research.