Increased rates of respiratory disease in schizophrenia: A systematic review and meta-analysis including 619,214 individuals with schizophrenia and 52,159,551 controls.

INTRODUCTION: Despite respiratory disease being a major cause of excess mortality in people with schizophrenia, the prevalence of respiratory conditions in this population is poorly defined. A systematic review and meta-analysis were conducted to establish the prevalence and association of respiratory diseases in people with schizophrenia. MATERIAL AND METHODS: Major electronic databases were searched from inception to 27 April 2020 for articles reporting respiratory disease (asthma, chronic obstructive pulmonary disease [COPD], pneumonia, and tuberculosis) in people with schizophrenia and, where possible, a control group. A random-effects meta-analysis was conducted. The study was registered with PROSPERO (CRD42018115137). RESULTS: Of 1569 citations, 21 studies consisting of 619,214 individuals with schizophrenia and 52,159,551 controls were included in the meta-analysis. Compared to the general population, people with schizophrenia had significantly higher rates of COPD (odds ratio [OR]: 1.82, 95% CI: 1.28-2.57), asthma (OR: 1.70, 95% CI: 1.02-2.83), and pneumonia (OR: 2.62, 95% CI: 1.10-6.23). In people with schizophrenia, the prevalence of COPD was 7.7% (95% CI: 4.0-14.4), asthma 7.5% (95% CI: 4.9-11.3), pneumonia 10.3% (95% CI 5.4-18.6), and tuberculosis 0.3% (95% CI 0.1 -0.8). After adjusting for publication bias, the prevalence of COPD increased to 19.9% (95% CI: 9.6-36.7). DISCUSSION: All respiratory diseases examined were significantly more prevalent in people with schizophrenia compared with the general population. Future studies should focus on improving the prevention and management of respiratory disease in this group to reduce associated excess mortality.

A systematic review and meta-analysis of the association between clozapine and norclozapine serum levels and peripheral adverse drug reactions.

RATIONALE: Clozapine is the most effective antipsychotic for treatment-refractory schizophrenia for reducing positive psychotic symptoms. It is associated with a reduction in hospitalisation and overall mortality. In spite of this, clozapine remains underutilised due to its complex adverse drug reaction (ADR) profile. OBJECTIVE: This systematic review aims to investigate the association of clozapine and norclozapine serum levels, and peripheral ADRs. METHODS: Studies were searched from four electronic databases (PubMed, EMBASE, PsycINFO and CINAHL) from inception to 12 June 2020. Studies were included if they had adult patients, provided data on steady-state trough clozapine or norclozapine levels and reported on clozapine-associated ADRs. Pregnant women, case reports and series were excluded. RESULTS: A statistically significant correlation was found for clozapine serum levels and triglycerides (n = 70; r = 0.303, 95% CI 0.0119-0.546, p = 0.042), heart rate (n = 137; r = 0.269, 95% CI 0.0918-0.486, p = 0.035), and overall combined ADRs (n = 160; r = 0.264, 95% CI 0.110-0.405, p = 0.001), but not for absolute neutrophil count (n = 223; r = - 0.164, 95% CI - 0.529-0.253, p = 0.444) or total white cell count (n = 18; r = 0.0176, 95% CI - 0.203-0.237, p = 0.878). Interestingly, norclozapine serum levels were found to be statistically correlated to triglycerides (n = 120; r = 0.211, 95% CI 0.0305-0.378, p = 0.022), total cholesterol (n = 120; r = 0.272, 95% CI 0.0948-0.432, p = 0.003) and weight gain (n = 118; r = 0.208, 95% CI 0.0261-0.377, p = 0.025). CONCLUSIONS: Heart rate, triglycerides and combined ADRs are significantly correlated with clozapine levels, and triglycerides, total cholesterol and weight gain with norclozapine levels. Future prospective, randomised controlled studies are needed to identify the cause-effect relationship between clozapine levels and peripheral ADRs.

Canadian student leaders' perspective on interprofessional education: A consensus statement.

The purpose of this article is to report on the outcomes of an interprofessional education (IPE) consensus-building exercise amongst student leaders enrolled in health science-related degree programs. The 12 participants included undergraduate and graduate students from eight different universities situated in five Canadian provinces. Their areas of study spanned a broad range of professions and disciplines including child and youth care, health promotion, nursing, kinesiology, medicine, physical education, psychology, and social work. A consensus statement regarding IPE and, more specifically, "what we know," "what we don't know," and "where do we go from here" is presented. These insights are unique, and a willingness to embrace them may be critical in building the next generation of improved IPE offerings across the country.