Skizofrenia Hebefrenik Disertai Prolaps Rektum pada Pasien Pria Usia Muda dengan Perilaku Seksual Beresiko: Laporan Kasus
Keywords:
Hebephrenic Schizophrenia, Rectal Prolapse, Antipsychotics, Constipation, High-Risk Sexual BehaviorAbstract
Hebephrenic schizophrenia is a mental disorder characterized by disorganized behavior, speech, and thought processes. Rectal prolapse is a condition in which the rectal mucosa protrudes through the anus. It commonly occurs in children, women, and the elderly, and is rarely found in young adult males. Multiple factors are associated with rectal prolapse; however, its exact etiology remains unclear. Long-term treatment of hebephrenic schizophrenia with antipsychotics often causes cholinergic side effects such as constipation. Constipation can lead to rectal prolapse. Approximately 30%–67% of rectal prolapse cases are associated with chronic constipation, and up to 50% of rectal prolapse cases occur in patients with chronic psychiatric disorders. We report a case of a 35-year-old man brought by his family to the emergency department of Kalawa Atei Psychiatric Hospital with complaints of agitation and restlessness. The patient had been regularly taking psychiatric medications for nearly 20 years but had discontinued treatment for the past three months. During inpatient care, he repeatedly complained of pain and bleeding during defecation. Physical examination revealed protrusion of rectal mucosa through the anus. The patient admitted to frequent constipation requiring excessive straining during bowel movements. Further history-taking revealed that the patient had a homosexual orientation and frequently engaged in receptive anal intercourse. He also reported obtaining sexual gratification by inserting his own hand into his anus. Rectal prolapse is uncommon in young adult males; however, data show a correlation between rectal prolapse and chronic psychiatric hospitalization in adults. In this patient, the contributing factors included antipsychotic-induced chronic constipation and high-risk sexual behaviors. Comprehensive management involving a psychiatrist, andrologist, and general surgeon is required
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