Others may have persistent daytime sedation that interferes with normal functioning.
Sedation is especially common in elderly patients receiving antipsychotics.
All available antipsychotics are, on average, equally effective in treating acute psychotic symptoms but vary considerably in the amount of sedation they produce.
Manage, don’t accept adverse ‘calming’ effect Sedation is a frequent side effect of antipsychotics, especially at relatively high doses.
Antipsychotics’ sedative effects can reduce agitation in acute psychosis and promote sleep in insomnia, but long-term sedation may: Many patients experience only mild, transient somnolence at the beginning of antipsychotic treatment, and most develop some tolerance to the sedating effects with continued administration.
Compared with younger patients, older patients receiving the same doses of the same medications become more heavily sedated for longer periods of time.
The resulting sedation can impair arousal levels during the day and increase the risk of falls.
Sedation can occur with first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs), but it is seen more commonly and tends to be more severe with low-potency FGAs than with SGAs.
Clinical challenges come with: Because the treatments are different, it is important to try to distinguish negative symptoms and/or cognitive impairment related to schizophrenia’s neurobiology from sedation related to the antipsychotic.
Ask patients if they nap during the day or just lie around, and if they want to do things but can’t: Antipsychotics are thought to exert their effect by antagonism of postsynaptic dopamine D2 and serotonin 5HT2A receptors and possibly other receptors in the brain.
Four SGAs—risperidone, olanzapine, quetiapine, and ziprasidone—act as dopamine D2 and 5HT2A antagonists.
Antipsychotic effects are not immediate and historically were thought to occur over several weeks.