CASE 1
A 60-year-old woman was on treatment for recurrent depressive disorder for the past 10 years with fluoxetine 80 mg/day and amitriptyline 150 mg/day. She was brought for psychiatric consultation with complaints of not talking, tremulousness, constipation and inability to pass urine for the past 4 days.
Physical examination revealed mild tachycardia (112 beats per minute), a tense abdomen and distended bladder.
She was admitted to the hospital with a provisional diagnosis of depressive stupor with anticholinergic side-effects following the use of antidepressant drugs.
Her bladder was catheterized, the antidepressants were stopped and zopiclone hydrochloride 5 mg was given at bedtime.
On day 2, she developed signs and symptoms of intestinal obstruction and on day 3, the bowel sounds were absent.
An erect plain radiograph of the abdomen confirmed the diagnosis of distal bowel obstruction without any evidence of perforation.
With conservative management, her condition improved on day 4 and she was discharged on day 8.