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Key message: The sedative side effects of antipsychotics may have significant consequences for patients, leading to medication non-adherence, increased risk of unintentional injury, and reduced cognitive performance and functional capacity.
Patients with schizophrenia were randomized to 6 weeks of double-blind treatment with fixed doses of lurasidone 80mg/d (n=125), lurasidone 160mg/d (n=121), quetiapine XR 600mg/d (n=119), or placebo (n=121)
Daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS)
Functional capacity was assessed by the University of California–San Diego (UCSD) Performance-Based Skills Assessment–Brief Version (UPSA-B) total score
Cognitive performance was assessed at baseline and week 6 with the CogState Computerized Schizophrenia Battery
Increase in the ESS item 6 score (‘’dozing when talking’) was associated with a worsening of overall cognitive performance in the quetiapine XR group
Increase in the ESS total score (reflecting increased sedation) during quetiapine XR treatment was associated with a worsening in the UPSA-B total score
Data were analyzed from a 2007‒2008 nationwide survey of adults who self-reported a diagnosis of schizophrenia and were currently using an antipsychotic medication (N = 876)
Adherence was defined as a score of zero on the Morisky Medication Adherence Scale.
A single logistic regression model assessed the relationship between side-effect clusters and adherence.
The side-effect cluster of sedation/cognition was associated with a lower likelihood of adherence
The study population included patients of 18–64 years of age in a healthcare insurance database with claims from 2001 to 2004 and diagnoses of schizophrenia or affective disorder
Patients had a prescription for a first-generation antipsychotic (FGA) or second-generation antipsychotic (SGA)
Potential somnolence effects were defined as: low (referent) – aripiprazole/ziprasidone; medium – risperidone; high – olanzapine/quetiapine; or any single FGA.
Among 648 cases and 5214 controls, high-somnolence SGAs were associated with an OR of 1.41 95%CI (1.03–1.93) for risk of unintentional injury
The effect of a single dose of 10 mg olanzapine on healthy volunteers of both sexes was examined using polysomnography and power spectral analysis. The structure and continuity of sleep were unaffected by olanzapine in both sexes
The clinically important finding was that the same dose of olanzapine in females induced a clear increase in sleep while, in males, the increase was either absent or small, indicating that the effective dose of olanzapine may be lower in females