Journal Article

Longitudinal effect of clozapine-associated sedation on motivation in schizophrenia: naturalistic longitudinal study

Chen, Shanquan, Jenkins, Christopher, Kirkpatrick, Brian, Jones, Peter B., Cardinal, Rudolf N., Fernandez-Egea, Emilio, Wolpe, Noham

2023

Overview

Negative symptoms of schizophrenia manifest as reduced motivation and pleasure (MAP) and impaired emotional expressivity (EXP). These can occur as primary phenomena, but have also been suggested to occur secondary to other clinical factors, including antipsychotic-induced sedation. However, this relationship has not been established formally. Here, we examined the effect of antipsychotic-induced sedation (assessed via the proxy of total daily sleep duration) on MAP and EXP in a cohort of 187 clozapine-treated patients with schizophrenia followed for over 2 years on average, using multilevel regression and mediation models. MAP, but not EXP, was adversely influenced by sedation, independently of the severity of psychosis or depression. Moreover, clozapine impaired MAP indirectly by worsening sedation, but after accounting for clozapine-induced sedation, clozapine improved MAP. Our results highlight the importance of addressing sedative side-effects of antipsychotics to improve clinical outcomes.

• Publisher: Cambridge University Press
• Subject: Anesthesia / Antipsychotic Agents - adverse effects / Antipsychotics / Clinical outcomes / Clozapine / Clozapine - adverse effects / Emotional behavior / Gender / General Adult / Humans / Induced / Longitudinal Studies / Mediation / Mental depression / Mental disorders / Motivation / Negative symptoms / Patients / Pleasure / Psychiatry / Psychosis / Psychotropic drugs / Regression analysis / Schizophrenia / Schizophrenia - drug therapy / Sedation / Self expression / Short Report / Side effects / Sleep / Sociodemographics / Treatment outcomes