Clinician Perspectives and Practices in Relation to Antipsychotic Side-effects in Psychosis

Holden, Ellen (2026) Clinician Perspectives and Practices in Relation to Antipsychotic Side-effects in Psychosis. Doctoral thesis, University of East Anglia.

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Abstract

Background:
Antipsychotic medications are vital for treatment of psychosis related symptoms; however, they are associated with a range of adverse side-effects. Cardiometabolic and neurological side-effects are more routinely prioritised within clinical monitoring guidelines, nonetheless specific side-effects such as sedation have received comparatively limited attention. Sedation may impact daily functioning, motivation and treatment adherence, yet little is known about how sedation is defined and managed within mental health services. This portfolio aimed to examine clinicians’ perspectives on antipsychotic side-effect practices, with specific focus on sedation.

Method:
A systematic review included 29 studies exploring clinicians’ attitudes and practices regarding antipsychotic side-effect assessment and management. A narrative synthesis was conducted following PRISMA guidance. Following review findings an empirical crosssectional online survey was completed by 155 multidisciplinary clinicians working in NHS secondary mental health services across England. A questionnaire was developed for the purpose of this study, gathering information on conceptualisations, assessment practices, management strategies and perceived impact of sedation.

Results:
The systematic review identified variability in side-effect monitoring practices, often influenced by an implicit hierarchy of harm. Observable or life-threatening adverse effects were prioritised, whereas quality of life related effects were less consistently assessed. The empirical paper found that clinicians estimated sedation affects approximately half of patients prescribed antipsychotics. Although most clinicians considered this a clinical problem, few viewed sedations as well understood. Assessment was predominantly informal, and management strategies were largely behavioural alongside medication adjustments. Sedation was perceived to have moderate to high impact on service engagement, employment, medication adherence, and hopefulness. Some clinicians also described sedation as therapeutically useful.

Conclusion:
Sedation associated to antipsychotic medication appeared to be widely recognised within mental health services and yet remains inconsistently conceptualised and informally assessed. Sedation is viewed at times as a means of short-term stabilisation whilst also limiting engagement and longer-term recovery. Greater clarity and more consistent monitoring practices may support multidisciplinary teams to address sedation in ways that better align with patient-centred care. Future research should explore how patients and clinicians understand and experience sedation across different stages of care and evaluate approaches to improve structured assessment and management.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	Amy Millward-Doherty
Date Deposited:	13 Nov 2026 15:28
Last Modified:	13 Nov 2026 15:28
URI:	https://ueaeprints.uea.ac.uk/id/eprint/105116
DOI:

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