Dysphagia is the term used to describe a problem with eating, drinking and/or swallowing. It can be associated with pain (odynophagia), coughing, or with a feeling of something getting stuck (globus), but the person may also be completely unaware of there being a problem (silent aspiration). The process of swallowing is very complex and involves coordinating over 50 pairs of muscles and nerves. Instead of arriving in the stomach, dysphagia may result in some food and/or drink entering the airway (aspiration). This can lead to choking or aspiration pneumonia; a chest infection resulting from food/drink entering the lungs.
Eating and drinking are usually enjoyable activities that positively impact on our quality of life. Most of the social events that we plan with our friends and family involve the sharing of food and drink, for example meeting for coffee or going out for dinner. It is therefore clear that eating and drinking occupy dual roles, both as an important part of our social functioning and also being vital in ensuring we get adequate nutrition and hydration. Any problem in the swallowing process can negatively affect a person’s physical health as well as their emotional wellbeing and perception of their quality of life.
Lots of people are aware of the risk of dysphagia amongst people who have had a stroke, have dementia, or who have a learning disability, but fewer people know about the risk of dysphagia in adults of working age who are experiencing mental illness. There can be lots of causes of dysphagia within this group, but the two main reasons are medication side-effects and risky behaviours when they are eating/drinking.
Some medications used to treat mental health issues can make the muscles involved in swallowing weaker or go into spasm. Others with a sedative effect can impair the swallowing reflex and the ability to protect the airway. Some medications can cause a dry mouth, which makes it more difficult to trigger a swallow, and others can cause us to produce too much saliva.
When someone is experiencing mental illness their behaviour can change. This might result in them feeling more agitated and so they might struggle to sit down to eat and drink, but lots of movement (e.g. pacing) can increase the risk of food/drink going ‘down the wrong way’ (towards the lungs instead of into the stomach). Some people can find it a real struggle to get out of bed, but eating or drinking when lying down can make it much more difficult to swallow safely. Other people may feel the need to rush their meals, resulting in them overfilling their mouth or bolting their food without chewing it enough, increasing the risk of choking.
Things to look out for include:
- Regular coughing or choking when eating/drinking
- Regularly having difficulty chewing or swallowing
- Voice regularly sound wet or gurgly after eating/drinking
- Repeated chest infections
If you or someone close to you is noticing these things then have a chat with your GP or health/social care professional so that you can talk about it in more detail and decide together what should happen next.