Successful stabilization of patients with mental disorders requires most of the times the use of more than one antipsychotic medications with increase prevalence of clozapine in refractory cases. Constipation consists one of the most debilitating side effect of the therapy, which gradually progresses to a chronic state of bowel movement dysfunction, with recurrent episode of paralytic ileus of various severity.

We describe the case of a middle age male treated with clozapine for refractory mental disorder, who developed ileus and subsequent bowel dysfunction not amenable to laxatives.

The acute episode have been treated conservatively with nasogastric decompression, intravenous replacement of fluids and electrolytes, antibiotics chemoprophylaxis and low molecular weight heparin. His overall physical status was unremarkable for obesity, diabetes, hypertension, allergies, previous operations and a former endoscopic evaluation conducted in the recent past, which had ruled out malignant neoplastic disease.

A course of per os prucalopride have been instituted, which showed preliminary promising results in restoring proper bowel movements, without any serious side effect and without the need to discontinue his course with antipsychotics. Prucalopride is a 5 HT4 agonist which selectively binds to the receptors of the intestine, resulting in muscular contractions as well as clorium secretion from the mucosa promoting an osmotic defecation.The substance has been extensively use in the treatment of irritable bowel disease of the chronic constipation type.

We suggest the more systematic use of this agent in this group of patients after proper endoscopic evaluation and restoration of all secondary causes of constipation.

No significant relationships.

5-HT4 receptor stimulation has pro-cognitive and antidepressant-like effects in animal experimental studies; however, this pharmacological approach has not yet been tested in humans. Here we used the 5-HT4 receptor partial agonist prucalopride to assess the translatability of these effects and characterise, for the first time, the consequences of 5-HT4 receptor activation on human cognition and emotion.

Forty one healthy volunteers were randomised, double-blind, to a single dose of prucalopride (1 mg) or placebo in a parallel group design. They completed a battery of cognitive tests measuring learning and memory, emotional processing and reward sensitivity.

Prucalopride increased recall of words in a verbal learning task, increased the accuracy of recall and recognition of words in an incidental emotional memory task and increased the probability of choosing a symbol associated with a high likelihood of reward or absence of loss in a probabilistic instrumental learning task. Thus acute prucalopride produced pro-cognitive effects in healthy volunteers across three separate tasks.

These findings are a translation of the memory enhancing effects of 5-HT4 receptor agonism seen in animal studies, and lend weight to the idea that the 5-HT4 receptor could be an innovative target for the treatment of cognitive deficits associated with depression and other neuropsychiatric disorders. Contrary to the effects reported in animal models, prucalopride did not reveal an antidepressant profile in human measures of emotional processing.