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Manage, don’t accept adverse ‘calming’ effect Sedation is a frequent side effect of antipsychotics, especially at relatively high doses. Binding of antipsychotic drugs to human brain receptors focus on newer generation compounds.
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. Early-onset hypothesis of antipsychotic drug action: a hypothesis tested, confirmed and extended.
Hypothalamic arousal regions are activated during modafinil-induced wakefulness. 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. Intramuscular ziprasidone compared with intramuscular haloperidol in the treatment of acute psychosis.
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.
Initiate the antipsychotic at or titrate to a reasonable, not overly high dose—such as: Continue the patient on that dose, and use a nonantipsychotic such as a benzodiazepine to help control insomnia, anxiety, and agitation. Int J Neuropsychopharmacol 2002;5(suppl 1): S176.- 2. A meta-analysis of the efficacy of second-generation antipsychotics.
Electroencephalographic sleep abnormalities in schizophrenia. Relationship to positive/negative symptoms and prior neuroleptic treatment. Without sedation, patients are better able to engage in therapy; participate in family, social, school, and work activities; and increase their chances of recovery.
Intramuscular aripiprazole for the treatment of acute agitation in patients with schizophrenia or schizoaffective disorder: a double-blind, placebo-controlled comparison with intramuscular haloperidol.