Psychiatric Quarterly

, Volume 83, Issue 1, pp 83–89 | Cite as

Antipsychotic-Induced Somnolence in Mothers with Schizophrenia

  • Mary V. Seeman
Original Paper


Although it is known that many antipsychotic drugs, at the doses prescribed for schizophrenia, are sedative and cause daytime drowsiness, the effect of potentially diminished vigilance on parenting parameters has not been studied. The aim of this paper is to advise clinicians about sedative load in mothers who are prescribed antipsychotic medication. A Medline search was conducted into the sedative effects of antipsychotics, with the following search terms: sleep; sedation; somnolence; wakefulness; antipsychotics; schizophrenia, parenting, maternal behavior, and custody. The results showed that antipsychotic drugs differ in their propensity to induce sedation and do so via their effects on a variety of neurotransmitter systems. It is important to note that mothers with schizophrenia risk losing custody of their infants if they are perceived as potentially neglectful because of excessive daytime sleepiness. Clinicians must choose antipsychotic medications carefully and monitor for sedative effects whenever the patient has important responsibilities that require the maintenance of vigilance.


Schizophrenia Women Antipsychotics Sedation Mother Custody 


  1. 1.
    Roehrs T, Greenwald M, Roth T: Risk-taking behavior: Effects of ethanol, caffeine, and basal sleepiness. Sleep 27:887–893, 2004PubMedGoogle Scholar
  2. 2.
    Roth T, Roehrs TA: Etiologies and sequelae of excessive daytime sleepiness. Clinical Therapeutics 18:562–576, 1996PubMedCrossRefGoogle Scholar
  3. 3.
    de Moura Campos E, Mourão Melo C, Soares MW, et al.: Sleep disturbances and gender differences in schizophrenia. Sleep Science 21:27–30, 2008Google Scholar
  4. 4.
    Johns MW: A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale. Sleep 14:540–545, 1991.PubMedGoogle Scholar
  5. 5.
    Lindberg N, Virkkunen M, Tani P, et al.: Effect of a single-dose of olanzapine on sleep in healthy females and males. International Clinical Psychopharmacology 17:177–184, 2002.PubMedCrossRefGoogle Scholar
  6. 6.
    Roth T, Roehrs TA, Moskowitz H: Issues in drug-related performance impairment. Clinical Therapeutics 14:654–666, 1992.PubMedGoogle Scholar
  7. 7.
    Brunnauer A, Laux G, Zwick S: Driving simulator performance and psychomotor functions of schizophrenic patients treated with antipsychotics. European Archives of Psychiatry and Clinical Neuroscience 259:483–489, 2009.PubMedCrossRefGoogle Scholar
  8. 8.
    De Las Cuevas C, Ramallo Y, Sanz EJ: Psychomotor performance and fitness to drive: The influence of psychiatric disease and its pharmacological treatment. Psychiatric Research 176:236–241, 2010.Google Scholar
  9. 9.
    Rapoport MJ, Baniña MC: Impact of psychotropic medications on simulated driving: A critical review. CNS Drugs 21:503–519, 2007.PubMedCrossRefGoogle Scholar
  10. 10.
    Ravera S, Hummel SA, Stolk P, et al.: The use of driving impairing medicines: A European survey. European Journal of Clinical Pharmacology 65:1139–1147, 2009.PubMedCrossRefGoogle Scholar
  11. 11.
    Botch SR, Johnson RD: Antiemetic and sedative levels found together in 26 civil aviation pilot fatalities, 2000–2006. Aviation, Space, and Environmental Medicine 79:607–610, 2008.PubMedCrossRefGoogle Scholar
  12. 12.
    Canfield DV, Salazar GJ, Lewis RJ, et al.: Pilot medical history and medications found in post mortem specimens from aviation accidents. Aviation, Space, and Environmental Medicine 77:1171–1173, 2006PubMedGoogle Scholar
  13. 13.
    Chaturvedi AK, Craft KJ, Canfield DV, et al.: Toxicological findings from 1587 civil aviation accident pilot fatalities, 1999–2003. Aviation, Space, and Environmental Medicine 76:1145–1150, 2005PubMedGoogle Scholar
  14. 14.
    Cashman CM, Ruotsalainen JH, Greiner BA, et al.: Alcohol and drug screening of occupational drivers for preventing injury. Cochrane Database of Systematic Reviews 2:CD006566, 2009.Google Scholar
  15. 15.
    Kraus JF: The effects of certain drug-testing programs on injury reduction in the workplace: An evidence-based review. International Journal of Occupational Environmental Health 7:103–108, 2001.Google Scholar
  16. 16.
    Lehtola MM, van der Molen HF, Lappalainen J, et al.: The effectiveness of interventions for preventing injuries in the construction industry: A systematic review. American Journal of Preventive Medicine 35:77–85, 2008.PubMedCrossRefGoogle Scholar
  17. 17.
    Howard LM: Fertility and pregnancy in women with psychotic disorders. European Journal of Obstetrics, Gynecology and Reproductive Biology 119:3–10, 2005.CrossRefGoogle Scholar
  18. 18.
    Laursen TM, Munk-Olsen T: Reproductive patterns in psychotic patients. Schizophrenia Research 121:234–240, 2010.PubMedCrossRefGoogle Scholar
  19. 19.
    Kurth E, Spichiger E, Zemp Stutz E, et al.: Crying babies, tired mothers—challenges of the postnatal hospital stay: An interpretive phenomenological study. BMC Pregnancy Childbirth 10:21, 2010.PubMedCrossRefGoogle Scholar
  20. 20.
    Anonymous: 2/22/2010. Retrieved Oct 6, 2010.
  21. 21.
    Miller LJ: Sexuality, reproduction, and family planning in women with schizophrenia. Schizophrenia Bulletin 23:623–635, 1997.PubMedGoogle Scholar
  22. 22.
    Nilsson E, Lichtenstein P, Cnattingius S, et al.: Women with schizophrenia: Pregnancy outcome and infant death among their offspring. Schizophrenia Research 58:221–229, 2002.PubMedCrossRefGoogle Scholar
  23. 23.
    Nicholson J: Use of child custody as leverage to improve treatment adherence. Psychiatric Services 56:357–358, 2005.PubMedCrossRefGoogle Scholar
  24. 24.
    Benson KL: Sleep in schizophrenia: Impairments, correlates, and treatment. Psychiatric Clinics of North America 29:1033–1045, 2006.PubMedCrossRefGoogle Scholar
  25. 25.
    Cohrs S: Sleep disturbances in patients with schizophrenia: Impact and effect of antipsychotics. CNS Drugs 22:939–962, 2008.PubMedCrossRefGoogle Scholar
  26. 26.
    Kane JM: Sedation as a side effect of the treatment of mental disorders. Journal of Clinical Psychiatry 69:e20, 2008.PubMedCrossRefGoogle Scholar
  27. 27.
    Kane JM, Sharif ZA: Atypical antipsychotics: Sedation versus efficacy. Journal of Clinical Psychiatry 69(Suppl 1):18–31, 2008.Google Scholar
  28. 28.
    Krystal AD, Goforth HW, Roth T: Effects of antipsychotic medications on sleep in schizophrenia. International Clinical Psychopharmacology 23:150–160, 2008.PubMedCrossRefGoogle Scholar
  29. 29.
    Schubert EW, Blennow G, McNeil TF: Wakefulness and arousal in neonates born to women with schizophrenia: Diminished arousal and its association with neurological deviations. Schizophrenia Research 22:49–59, 1996.PubMedCrossRefGoogle Scholar
  30. 30.
    Silva MR, Bernardi MM, Felicio LF: Effects of dopamine receptor antagonists on ongoing maternal behavior in rats. Pharmacology, Biochemistry and Behavior 68:461–468, 2001.CrossRefGoogle Scholar
  31. 31.
    Li M, Davidson P, Budin R, et al.: Effects of typical and atypical antipsychotic drugs on maternal behavior in postpartum female rats. Schizophrenia Research 70:69–80, 2004.PubMedCrossRefGoogle Scholar
  32. 32.
    Zhao C, Li M: Sedation and disruption of maternal motivation underlie the disruptive effects of antipsychotic treatment on rat maternal behavior. Pharmacology, Biochemistry and Behavior 92:147–156, 2009.CrossRefGoogle Scholar
  33. 33.
    Fleming AS, Corter C: Factors influencing maternal responsiveness in humans: Usefulness of an animal model. Psychoneuroendocrinology 13:189–212, 1988.PubMedCrossRefGoogle Scholar
  34. 34.
    Kristal MB: The biopsychology of maternal behavior in nonhuman mammals. ILAR Journal 50:51–63, 2009.PubMedGoogle Scholar
  35. 35.
    Larsson K: The psychobiology of parenting in mammals. Scandinavian Journal of Psychology 35:97–143, 1994.PubMedCrossRefGoogle Scholar
  36. 36.
    Poindron P: Mechanisms of activation of maternal behaviour in mammals. Reproduction, Nutrition, Development 45:341–351, 2005PubMedCrossRefGoogle Scholar
  37. 37.
    Murillo-Rodríguez E, Arias-Carrión O, Sanguino-Rodríguez K, et al.: Mechanisms of sleep-wake cycle modulation. CNS & Neurological Disorders Drug Targets 8:245–253, 2009.CrossRefGoogle Scholar
  38. 38.
    Dzirasa K, Ribeiro S, Costa R, et al.: Dopaminergic control of sleep-wake states. Journal of Neuroscience 26:10577–10589, 2006.PubMedCrossRefGoogle Scholar
  39. 39.
    Monti JM, Monti D: The involvement of dopamine in the modulation of sleep and waking. Sleep Medicine Reviews 11:113–133, 2007.PubMedCrossRefGoogle Scholar
  40. 40.
    Monti JM, Jantos H: The roles of dopamine and serotonin, and of their receptors, in regulating sleep and waking. Progress in Brain Research 172:625–646, 2008.PubMedCrossRefGoogle Scholar
  41. 41.
    Qu W-M, Xu X-H, Yan M-M, et al.: Essential role of dopamine D2 receptor in the maintenance of wakefulness, but not in homeostatic regulation of sleep, in Mice. The Journal of Neuroscience 30:4382–4389, 2010.PubMedCrossRefGoogle Scholar
  42. 42.
    Giménez S, Clos S, Romero S, et al.: Effects of olanzapine, risperidone and haloperidol on sleep after a single oral morning dose in healthy volunteers. Psychopharmacology (Berlin) 190:507–516, 2007CrossRefGoogle Scholar
  43. 43.
    Leucht S, Corves C, Arbter D, et al.: Second-generation versus first-generation antipsychotic drugs for schizophrenia: A meta-analysis. Lancet 373:31–41, 2009.PubMedCrossRefGoogle Scholar
  44. 44.
    Ishida T, Obara Y, Kamei C: Effects of some antipsychotics and a benzodiazepine hypnotic on the sleep-wake pattern in an animal model of schizophrenia. Journal of Pharmacological Science 111:44–52, 2009.CrossRefGoogle Scholar
  45. 45.
    Bell JS, Taipale HT, Soini H, et al.: Sedative load among long-term care facility residents with and without dementia: A cross-sectional study. Clinical Drug Investigation 30:63–70, 2010.PubMedCrossRefGoogle Scholar
  46. 46.
    Said Q, Gutterman EM, Kim MS, et al.: Somnolence effects of antipsychotic medications and the risk of unintentional injury. Pharmacoepidemiology and Drug Safety 17:354–364, 2008.PubMedCrossRefGoogle Scholar
  47. 47.
    Chen YY, Wu KC: Sleep habits and excessive daytime sleepiness correlate with injury risks in the general population in Taiwan. Injury Prevention 16:172–177, 2010.PubMedCrossRefGoogle Scholar
  48. 48.
    Ackerson BJ: Coping with the dual demands of severe mental illness and parenting: The parents’ perspective. Families in Society 84:109–118, 2003.Google Scholar
  49. 49.
    Hollingsworth L: Child custody loss among women with persistent severe mental illness. Social Work Research 28:199–209, 2004.CrossRefGoogle Scholar
  50. 50.
    Gewurtz R, Krupa T, Eastabrook S, et al.: Prevalence and characteristics of parenting among people served by Assertive Community Treatment. Psychiatric Rehabilitation Journal 28:63–65, 2004.PubMedCrossRefGoogle Scholar
  51. 51.
    Nicholson J, Sweeny E, Geller J (1998) Mothers with mental illness: II. Family relationships and the context of parenting. Psychiatric Services 49:643–649.PubMedGoogle Scholar
  52. 52.
    Black J, Duntley SP, Bogan RK (2007) Recent advances in the treatment and management of excessive daytime sleepiness. CNS Spectrum 12(2 Suppl 2):1–14.Google Scholar
  53. 53.
    Leibowitz SM, Brooks SN, Black JE, et al.: Excessive daytime sleepiness: Considerations for the psychiatrist. Psychiatric Clinics of North America 29:921–945, 2006.PubMedCrossRefGoogle Scholar
  54. 54.
    Pagel JF: Excessive daytime sleepiness. American Family Physician 79:391–396, 2009.PubMedGoogle Scholar
  55. 55.
    Wezenberg E, Sabbe BGC, Verkes RJ: The role of sedation tests in identifying sedative drug effects in healthy volunteers and their power to dissociate sedative-related impairments from memory dysfunctions. Journal of Psychopharmacology 21:579–587, 2007.PubMedCrossRefGoogle Scholar
  56. 56.
    Wise MS: Objective measures of sleepiness and wakefulness: Application to the real world? Journal of Clinical Neurophysiology 23:39–49, 2006.PubMedCrossRefGoogle Scholar
  57. 57.
    Wichniak A, Waliniowska E, Wierzbicka A: Sleep quality and daytime sleepiness in schizophrenia spectrum disorders during antipsychotic treatment. Psychiatria Polska 43:193–202, 2009.PubMedGoogle Scholar
  58. 58.
    Morein-Zamir S, Turner DC, Sahakian BJA: Review of the effects of modafinil on cognition in schizophrenia. Schizophrenia Bulletin 33:1298–1306, 2007.PubMedCrossRefGoogle Scholar
  59. 59.
    Saavedra-Velez C, Yusim A, Anbarasan D, et al.: Modafinil as an adjunctive treatment of sedation, negative symptoms, and cognition in schizophrenia: A critical review. Journal of Clinical Psychiatry 70:104–112, 2009.PubMedCrossRefGoogle Scholar
  60. 60.
    Freudenreich O, Henderson DC, Macklin EA, et al.: Modafinil for clozapine-treated schizophrenia patients: A double-blind, placebo-controlled pilot trial. Journal of Clinical Psychiatry 70:1674–1680, 2009.PubMedCrossRefGoogle Scholar
  61. 61.
    Rychnovsky J, Hunter LP: The relationship between sleep characteristics and fatigue in healthy postpartum active duty women. Women’s Health Issues 19:38–44, 2009PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of Psychiatry, Centre for Addiction and Mental HealthUniversity of TorontoTorontoCanada

Personalised recommendations