An overview of common medical comorbidities in patients with schizophrenia.

condition is present in approximately 50% of patients with schizophrenia. Medical conditions of concern may include, but are not limited to, cardiac disease, metabolic disorders, substance use disorders, infectious disease, and neurologic disorders. Unfortunately, these medical conditions are often underrecognized and undertreated in this patient population. As a result, patients with schizophrenia are at high risk of receiving inadequate health care. The discovery of atypical antipsychotics has offered patients many benefits, including alleviation of positive and negative psychotic symptoms, cognitive deficits, and mood symptoms and a lower risk of extrapyramidal symptoms, that were not possible with conventional antipsychotics. 3 However, evidence is beginning to suggest that these agents may also help treat, or in some cases potentially exacerbate, comorbid medical conditions. In preparation for this supplement, the authors attended a roundtable to discuss common comorbid medical conditions in patients with schizophrenia and the implications of these conditions for patients, treatment, and overall outcomes. At the meeting, information on the following medical conditions was addressed: cardiovascular disease, metabolic disturbances, substance abuse, human immunodeficiency virus (HIV), and neurologic disorders. This supplement provides an in-depth review of the issues discussed at that meeting, with a particular focus on common medical comorbidities associated with schizophrenia, the role atypical antipsychotics have in these comorbidities, and pertinent clinical issues to consider in the optimal management of patients. Cardiovascular disease is the major cause of death in the United States, accounting for approximately 30% of all deaths. 4,5 For the past decade, a great deal of concern within the psychiatric community has been focused on the effect atypical antipsychotics may have on QTc prolongation and subsequent development of torsades de pointes and sudden death. Alexander H. Glassman, M.D., reviews the controversy surrounding antipsychotics and challenges the reader to reevaluate the current thinking on this complex issue. In light of new data, Dr. Glassman suggests that the issues surrounding the risk of torsades de pointes and sudden death with atypical antipsychotics may have been exaggerated. However, some atypical antipsychotics are not completely without cardiovascular side effects, such as orthostatic hypotension and, in the case of clozapine, myocarditis. Thus, screening and monitoring both the medical and psychiatric condition of the patient remains a prudent clinical practice. David C. Henderson, M.D., discusses the effects of antipsychotic treatment on the development of various metabolic disorders such as weight gain, lipid abnormalities, and diabetes mellitus. The risk of metabolic disorders in patients with schizophrenia is an important and emerging concern within psychiatry. Although evidence suggests that schizophrenia itself may be associated with some risk of metabolic disorders, the effect antipsychotic treatment has in the development of these disorders is gradually emerging. Increased awareness, early