Vitamin D deficiency is associated with increased risk of acute respiratory infection. There is an excess of respiratory infections and deaths in schizophrenia, a condition where vitamin D deficiency is especially prevalent. This potentially offers a modifiable risk factor to reduce the risk for and the severity of respiratory infection in people with schizophrenia, although there is as yet no evidence regarding risk of Covid-19. In this narrative review, we describe the prevalence of vitamin D deficiency in schizophrenia, report the research examining the relationship between vitamin D levels and Covid-19 and discuss the associations between vitamin D deficiency and respiratory infection, including its immunomodulatory mechanism of action.

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Context Excess cardiovascular morbidity and an increased prevalence of sudden cardiac death (SCD) contributes to premature mortality in schizophrenia. Brugada syndrome (BrS) is an important but underrecognized cause of SCD. It is more commonly seen in schizophrenia than in general population controls. Methods We conducted a scoping review to describe the pathogenesis of BrS in schizophrenia and to identify the psychotropic medications that increase the risk of unmasking BrS and associated ventricular arrhythmias resulting in SCD. Findings Schizophrenia and BrS share similar calcium channel abnormalities, which may result in aberrant myocardial conductivity. It remains uncertain if there is a genetic pre-disposition for BrS in a subset of patients with schizophrenia. However, the unmasking of Brugada ECG patterns with the use of certain antipsychotics and antidepressants increases the risk of precipitating SCD, independent of QT prolongation. Conclusions and future directions Specific cardiology assessment and interventions may be required for the congenital or unmasked Brugada ECG pattern in schizophrenia. The current long-term standard of care for BrS is an implantable cardioverter defibrillator (ICD), but post-implantation psychological effects must be considered. Careful use of antipsychotic and other psychotropic medications is necessary to minimize proarrhythmic effects due to impact on cardiac sodium and calcium ion channels. When prescribing such drugs to patients with schizophrenia, clinicians should be mindful of the potentially fatal unmasking of Brugada ECG patterns and how to manage it. We present recommendations for psychiatrists managing this patient population.

Introduction There is conflicting evidence on the benefits of parathyroidectomy (PTx) in reducing the incidence of cardiovascular disease (CVD) in patients with primary hyperparathyroidism (PHPT). Aim To perform a systematic review and meta-analysis to investigate the impact of PTx in PHPT on cardiovascular outcomes. Methods A systematic review was performed as per PRISMA guidelines. Pre- and post-operative data were expressed as continuous outcomes, reported as mean differences, and expressed with 95% confidence intervals following estimation using the Mantel-Haenszel method. Results In total, there were 16 studies included in the meta-analysis with a combined total of 796 patients. Fourteen studies were prospective, one was retrospective and one was a randomised control trial. This analysis found a significant reduction in SBP post-operatively (P = 0.003). The difference in DBP was NS (P = 0.050). Fasting blood glucose levels were also significantly reduced after surgery (P < 0.0001). Echocardiographic values showed that left ventricular mass index was not significantly reduced (P = 0.070) and left ventricular ejection fraction was not affected (P = 0.680). Cholesterol levels were not impacted by surgery. Conclusion This meta-analysis shows that PTx likely improves SBP and blood glucose levels in patients with PHPT. It is unclear if this in turn has any impact on long-term outcomes.

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