Atypical antipsychotics: sedation versus efficacy.
Many patients with schizophrenia or bipolar disorder experience disturbances in their sleep-wake cycle, which may be a result of the disorder itself, of pharmacotherapy, or of a comorbid sleep disorder. These sleep disruptions can seriously impair patients' functioning as well as their quality of life. Therefore, accurate assessment of sleep problems is essential to appropriately treat patients and promote symptomatic remission. Sedating antipsychotics may ameliorate sleep disturbances, as well as agitation or other behavioral emergencies; however, these agents may also sedate patients to the point of dissatisfaction with the medication and/or impaired functioning, which may, in turn, increase treatment noncompliance and nonadherence. Using short-term adjunctive medications, such as benzo-diazepines or hypnotic agents, with a nonsedating antipsychotic to alleviate sleep disturbances is a reasonable treatment option for patients with schizophrenia or bipolar disorder. Overall, the pharma-cokinetics and pharmacodynamics of atypical antipsychotics are important factors to consider in the risk-benefit analysis, as are dosing strategies and individual patient factors, and clinicians must decide which agents are most appropriate for which patients.
Kane
John M
JM
Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY 11004, USA. psychiatry@lij.edu
Sharif
Zafar A
ZA
D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000097:blood / Q000188:drug therapy* / Q000523:psychology; D001921:Brain / Q000187:drug effects; D006970:Disorders of Excessive Somnolence / Q000097:blood / Q000139:chemically induced / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D006207:Half-Life; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D017286:Polysomnography; D018570:Risk Assessment; D012559:Schizophrenia / Q000097:blood / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D007319:Sleep Initiation and Maintenance Disorders / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy; D012894:Sleep Stages / Q000187:drug effects
D014150:Antipsychotic Agents; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines