{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T05:44:20Z","timestamp":1784699060808,"version":"3.55.0"},"reference-count":7,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T00:00:00Z","timestamp":1762732800000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Psychogeriatrics"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Constipation is highly prevalent (30%\u201360%) in older adults taking atypical antipsychotics (AAPs), a rate insufficiently explained by anticholinergic effects alone. This paper proposes an integrated model centered on the impaired defecation reflex, which weakens with age and is further compromised by AAP\u2013induced multi\u2010neurotransmitter imbalance. AAPs interfere with the descending pain inhibitory pathway, disrupting the central dopamine (DA) and serotonin (5\u2013HT) systems vital for initiating the defecation reflex via the sacral parasympathetic nuclei (SPN). Furthermore, enhanced GABAergic inhibition is implicated, potentially contributing to observed sex differences. This central impairment is compounded by gut dysbiosis\u2013common in this population\u2010which is hypothesized to damage neural circuits and weaken the reflex via the gut\u2013brain axis. We advocate for a holistic management approach beyond traditional laxatives. Targeting the gut microbiota with specific butyrate\u2010producing probiotics represents a novel, hypothesis\u2010generating strategy. This intervention may restore central dopaminergic function, thereby strengthening the compromised defecation reflex. This integrated framework\u2010addressing monoaminergic and gut microbiota mechanisms\u2010provides a more complete understanding for future research and clinical strategies.<\/jats:p>","DOI":"10.1111\/psyg.70111","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T05:52:51Z","timestamp":1762840371000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Managing Constipation in Older Adults on Atypical Antipsychotics: A Defecation Reflex and Gut Microbiota Approach"],"prefix":"10.1111","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0690-6271","authenticated-orcid":false,"given":"Takahiko","family":"Nagamine","sequence":"first","affiliation":[{"name":"Sunlight Brain Research Center  Hofu Japan"},{"name":"Graduate School of Medical and Dental Sciences Institute of Science Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,10]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40263\u2010021\u201000859\u20100"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/clinpract15020033"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpgi.00178.2018"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1159\/000527513"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/npr2.12464"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1113\/JP279942"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2020.09.060"}],"container-title":["Psychogeriatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/psyg.70111","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/psyg.70111","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/psyg.70111","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T01:07:37Z","timestamp":1781140057000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/psyg.70111"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":7,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1111\/psyg.70111"],"URL":"https:\/\/doi.org\/10.1111\/psyg.70111","archive":["Portico"],"relation":{},"ISSN":["1346-3500","1479-8301"],"issn-type":[{"value":"1346-3500","type":"print"},{"value":"1479-8301","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11]]},"assertion":[{"value":"2025-09-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70111"}}