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

Accepted version
Peer-reviewed

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Article

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Authors

Kirkpatrick, Brian 
Jenkins, Christopher 

Abstract

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.

Description

Keywords

antipsychotic, apathy, motivation, negative symptoms, psychopharmacology, Humans, Clozapine, Antipsychotic Agents, Schizophrenia, Longitudinal Studies, Motivation

Journal Title

Br J Psychiatry

Conference Name

Journal ISSN

0007-1250
1472-1465

Volume Title

Publisher

Royal College of Psychiatrists
Sponsorship
Medical Research Council (MC_PC_17213)
Medical Research Council (MR/W014386/1)
National Institute for Health and Care Research (IS-BRC-1215-20014)
All research at the Department of Psychiatry in the University of Cambridge is supported by the NIHR Cambridge Biomedical Research Centre (BRC-1215-20014) and NIHR Applied Research Centre. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. RNC's research is funded by the Medical Research Council (MR/W014386/1). For the purpose of open access, the authors have applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript arising from this submission.