Psychopharmacology and Psychiatry Updates Antipsychotics and Aspiration Risk
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Jul 30, 2025 In this discussion, Scott Beach, an expert on antipsychotic medications and their risks, highlights the unexpected link between antipsychotics and increased pneumonia risk in schizophrenia patients. He breaks down the significant role of anticholinergic burden and how certain medications, especially at high doses, can exacerbate this risk. The conversation emphasizes the need for careful monitoring and tailored treatment strategies to protect vulnerable patients, particularly the elderly, in managing their mental health.
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Clinical Overlook: Pneumonia Risk
- Margaret is a 67-year-old woman stable on quetiapine 600 mg who presents with cough and fatigue.
- Clinicians often overlook pneumonia risk linked with antipsychotics during medication reviews.
Pneumonia Risk in Schizophrenia
- Pneumonia is the fourth leading cause of death in schizophrenia patients and risk doubles every five years starting at age 50.
- Certain antipsychotics increase pneumonia risk in a dose-dependent way, with nearly 15,000 hospitalizations recorded in one large study.
Anticholinergic Burden Drives Risk
- Antipsychotic polypharmacy does not increase pneumonia risk compared to no use, unlike high-dose monotherapy which does.
- High anticholinergic burden, not dopamine blockade, drives pneumonia risk, implicating quetiapine, clozapine, and olanzapine specifically.