The prevalence of sleep deprivation and sleep disturbance among Hong Kong adolescents is comparable to those found in other countries. An intervention program for sleep problems in adolescents should be considered.

Objective: To determine the incidence, characteristics, and predictors of clozapine-induced fever in a sample of patients in a local psychiatric unit. Method: A retrospective review of case notes of 227 inpatients newly started on clozapine from March 2003 to December 2006 was conducted. Demographic characteristics, presence of fever, investigations carried out, fever characteristics, and complications of fever were recorded and analyzed. Patients with clozapine-induced fever were compared with their fever-free counterparts on demographic and clinical factors. Multivariate logistic regression was performed to identify predictors of clozapine-induced fever. Results: Thirty-one out of 227 patients (13.7%) developed clozapine-induced fever. The means for day of onset of clozapine-induced fever after clozapine initiation and duration of fever were 13.7 and 4.7 days, respectively. The mean highest body temperature was 38.8 °C. Fever resolved within 48 hours after clozapine discontinuation in 79% of the patients with clozapine-induced fever. One out of 7 patients (14.3%) had fever on re-challenge. Clozapine-induced fever was associated with rate of titration more than 50 mg/wk (OR 18.9; 95% CI 5.3 to 66.7; P < 0.01), concomitant use of valproate (OR 3.6; 95% CI 1.5 to 8.9; P = 0.01), and presence of physical illnesses (OR 3.2; 95% CI 1.2 to 8.3; P = 0.02). Conclusion: Clozapine-induced fever is common. Temporary withdrawal of clozapine may result in resolution of fever, and clozapine re-challenge may be considered after fever subsides. Slower rate of clozapine titration may be helpful in patients with underlying physical illness and concomitant valproate treatment.

While symptoms such as hallucinations and delusions attract the most attention from psychiatrists; sleep disturbances, although common in schizophrenia, are often overlooked or undertreated. It is estimated that 30% up to 80% of patients with schizophrenia suffer from insomnia, 15% from obstructive sleep apnea, 21% from restless leg syndrome, and 17% from a sleep-related eating disorder. Sleep disturbances have negative impact on patients’ physical health and quality of life and may aggravate neuropsychiatric symptoms in schizophrenia. This chapter serves as a concise guide for psychiatrists and other healthcare professionals to understand the assessment and management of sleep disturbances in schizophrenia spectrum and other psychotic disorders. Future research is needed to elucidate the genetic and longitudinal relationship between comorbid sleep disorders and schizophrenia, to evaluate the impact of comorbid sleep disorders and their treatment on clinical and functional outcomes, and to identify novel sleep therapies for patients with schizophrenia.

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