From the Research
For patients with psychosis who also require bowel resection, quetiapine is often the preferred antipsychotic medication due to its lower risk of gastrointestinal complications and extrapyramidal symptoms. A typical starting dose would be 25-50 mg daily, gradually titrated up to 300-400 mg daily as needed and tolerated. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of minimizing anticholinergic effects and gastrointestinal risks in patients undergoing bowel resection 1.
Key Considerations
- Quetiapine has a lower risk of causing ileus or other gastrointestinal complications compared to other antipsychotics, particularly those with strong anticholinergic properties.
- It also has a relatively low risk of extrapyramidal symptoms which could complicate post-surgical recovery.
- For acute management in the perioperative period, lower doses (25-50 mg) can be used as needed.
- If quetiapine is not suitable, olanzapine (starting at 2.5-5 mg daily) could be considered as an alternative, though it has more anticholinergic effects.
- Monitoring for QT prolongation and constipation is essential, especially in patients receiving other medications that affect cardiac conduction or have slowed gastrointestinal motility.
Evidence Summary
The most recent study on antipsychotic dosing 1 provides valuable insights into the optimal use of these medications, including quetiapine, in patients with psychosis. While older studies 2, 3, 4, 5 offer additional context on the efficacy and safety of various antipsychotics, the 2023 consensus study 1 is the most relevant and authoritative guide for current clinical practice.
Clinical Implications
In clinical practice, the choice of antipsychotic medication for patients with psychosis who require bowel resection should prioritize minimizing risks associated with gastrointestinal complications and extrapyramidal symptoms. Quetiapine, due to its favorable profile in these aspects, is a preferred option. However, individual patient factors, including response to treatment and side effect profiles, must be carefully considered in making treatment decisions.