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Patients with schizophrenia have increased mortality and morbidity compared with the general population. These patients have a 20-year shorter lifespan than peers without schizophrenia, mainly due to premature cardiovascular disease, suicide, and cancer. Patients with severe mental illness are at increased risk for cardiovascular disease related to increased incidence of diabetes, hypertension, smoking, poor diet, obesity, dyslipidaemia, metabolic syndrome, low physical activity, and side-effects of antipsychotic drugs. Some second-generation antipsychotics (eg, clozapine, olanzapine, quetiapine, and risperidone) are associated with an increased risk of weight gain and obesity, impaired glucose tolerance and new-onset diabetes, hyperlipidaemia, and cardiovascular disease. The mechanisms by which schizophrenia and patients with severe mental illness are susceptible to cardiometabolic disorders are complex and include lifestyle risks and direct and indirect effects of antipsychotic drugs. An understanding of these risks might lead to effective interventions for prevention and treatment of cardiometabolic disorders in schizophrenia and severe mental illness.

Previous studies have linked vitamin D deficiency to hypertension, dyslipidemia, diabetes mellitus, and cardiovascular disease. The aim of this study was to investigate the short-term effects of vitamin D3supplementation on weight and glucose and lipid metabolism in antipsychotic-treated patients. A total of 19 schizophrenic or schizoaffective patients (BMI>27 kgm2) taking atypical antipsychotics were recruited and dispensed a 2000 IU daily dose of vitamin D3. On comparing baseline with week 8 (study end) results, we found a statistically significant increase in vitamin D3and total vitamin D levels but no statistically significant changes in weight, glucose, or lipids measurements. Patients whose vitamin D3level at week 8 was 30 ngml or more achieved a significantly greater decrease in total cholesterol levels compared with those whose week 8 vitamin D3measurement was less than 30 ngml. These results suggest that a randomized trial with a longer follow-up period would be helpful in further evaluating the effects of vitamin D3on weight, lipid metabolism, and on components of metabolic syndrome in antipsychotic-treated patients.

Introduction:Even though cognitive impairment is manifested in almost all patients with schizophrenia, the Clinical Antipsychotic Trials for Intervention Effectiveness (CATIE) study showed no significant difference between first- and second-generation psychotropic drugs in improving cognitive abilities. Discovering new drugs that can improve impaired cognition, thus, is an attractive treatment target for patients with schizophrenia.Areas covered:This article briefly reviews about donepezil, a highly selective (IC50 6.7 nM) centrally acting reversible acetylcholinesterase inhibitor that has been approved by FDA for treating cognitive deficit states such as in Alzheimer's disease and its uses in clinical trials for the treatment of schizophrenia. The literature search included PubMed and Cochrane library with the following words: donepezil, schizophrenia and cognitive impairments.Expert opinion:The results of several clinical trials utilizing donepezil as an adjunct to second-generation antipsychotic drugs targeting cognitive deficits in schizophrenia subjects have been disappointing and would not lead clinicians to consider this as a potential treatment option. While longer randomized controlled trials, increase dosage and selected groups of patients at different stage of cognitive impairment may provide a better understanding of the potential for this drug in addressing cognitive deficits, results to date have not been encouraging.

SUMMARY Although often overlooked, sleep disturbances are frequent in ADHD, affecting a sizable proportion of patients. Sleep complaints in patients with ADHD may be due to behavioral factors (e.g., limit-setting disorder), as well as objective alterations, such as delayed sleep-phase disorder, restless legs syndrome, sleep-disordered breathing and the effect of stimulants or associated comorbid disorders. We suggest to systematically screen for sleep disturbances at each visit by means of subjective tools (i.e., questionnaires and sleep diaries) and, when indicated, objective measures (i.e., polysomnography, actigraphy and the multiple sleep latency test). Empirical evidence for the treatment of sleep disturbances associated with ADHD is limited. Besides initial studies on behavioral interventions, the largest and best available evidence demonstrates the effectiveness and good tolerability of melatonin for sleep-onset delay. Further randomized controlled trials of pharmacological and nonpharmacological interventions are needed.