Skip to main content Accessibility help
×
Home

Heat stroke during treatment with olanzapine, trihexyphenidyl, and trazodone in a patient with schizophrenia

  • Chin-Pang Lee (a1), Pei-Jung Chen (a1) and Chia-Ming Chang (a1) (a2)

Abstract

Objective

Heat stroke is a medical emergency. Psychiatric patients are particularly susceptible to heat stroke. Therefore, awareness and preventive measures of heat stroke are important for both clinicians and patients.

Case description

A 49-year-old man with schizophrenia, who was under maintenance treatment with olanzapine 20 mg/day, trihexyphenidyl 4 mg/day, and trazodone 50 mg/day, suffered from heat stroke in a heat wave and required intensive care. He recovered with the medical treatment provided.

Discussion

Several factors could have contributed to the impaired thermoregulation and the occurrence of heat stroke in this case: schizophrenia, the psychotropic regimen, and lack of preventive measures. Possible differential diagnoses of heat stroke in this case include infection, neuroleptic malignant syndrome, and serotonin syndrome.

Conclusion

Heat stroke can occur during the maintenance treatment of olanzapine, trihexyphenidyl, and trazodone for schizophrenia. Clinicians should be proactive to reduce the risk of heat stroke in psychiatric patients.

Copyright

Corresponding author

Chia-Ming Chang, Department of Psychiatry, Chang Gung Memorial Hospital, Linkou branch No. 5, Fusing Street, Gueishan, Taoyuan 33305, Taiwan. Tel: +886 3 3281200, ext. 3836; Fax: +886 3 3280267; E-mail: cmchang58@cgmh.org.tw

References

Hide All
1. Bouchama, A, Knochel, J. Heat stroke. N Engl J Med 2002;346:19781988.
2. Duthie, D. Heat-related illness. Lancet 1998;352:13291330.
3. Shahid, M, Hatle, L, Mansour, H, Mimish, L. Echocardiographic and Doppler study of patients with heatstroke and heat exhaustion. Int J Cardiac Imaging 1999;15:279285.
4. Reilly, TH, Kirk, MA. Atypical antipsychotics and newer antidepressants. Emerg Med Clin North Am 2007;25:477497.
5. Hermesh, H, Shiloh, R, Epstein, Y, Manaim, H, Weizman, A, Munitz, H. Heat intolerance in patients with chronic schizophrenia maintained with antipsychotic drugs. Am J Psychiatry 2000;157:13271329.
6. Chong, TWH, Castle, DJ. Layer upon layer: thermoregulation in schizophrenia. Schizophr Res 2004;69:149157.
7. Shiloh, R, Weizman, A, Stryjer, R, Kahan, N, Waitman, DA. Altered thermoregulation in ambulatory schizophrenia patients: a naturalistic study. World J Biol Psychiatry 2009;10:163170.
8. Bark, N. Deaths of psychiatric patients during heat waves. Psychiatr Serv 1998;49:1088 1090.
9. Ramos, MJG, Valverde, FMG, Álvarez, CS, Katnich, LO, Quirante, FP. Fatal heat stroke in a schizophrenic patient. Case Rep Crit Care 2012;2012:15.
10. Kao, RL, Kelly, LM. Fatal exertional heat stroke in a patient receiving zuclopenthixol, quetiapine and benztropine. Can J Clin Pharmacol 2007;14:e322e325.
11. Kerwin, RW, Osborne, S, Sainz-Fuertes, R. Heat stroke in schizophrenia during clozapine treatment: rapid recognition and management. J Psychopharmacol 2004;18:121123.
12. Thara, R. Heat stroke and schizophrenia. Indian J Psychiatry 1998;40:395396.
13. Clapham, JC. Central control of thermogenesis. Neuropharmacology 2012;63:111123.
14. Hayes, BD, Martinez, JP, Barrueto, F Jr. Drug-induced hyperthermic syndromes. Emerg Med Clin North Am 2013;31:10191033.
15. Boulant, JA. Role of the preoptic-anterior hypothalamus in thermoregulation and fever. Clin Infect Dis 2000;31:S157S161.
16. Balthazar, CH, Leite, LH, Ribeiro, RM, Soares, DD, Coimbra, CC. Effects of blockade of central dopamine D1 and D2 receptors on thermoregulation, metabolic rate and running performance. Pharmacol Rep 2010;62:5461.
17. Balthazar, CH, Leite, LH, Rodrigues, AG, Coimbra, CC. Performance-enhancing and thermoregulatory effects of intracerebroventricular dopamine in running rats. Pharmacol Biochem Behav 2009;93:465469.
18. Bhanushali, M, Tuite, P. The evaluation and management of patients with neuroleptic malignant syndrome. Neurol Clin 2004;22:389411.
19. Central Weather Bureau. Monthly Data for 2012/07. Ministry of Transportation and Communication R.O.C, 2012. Retrieved 29 September 2014 from http://www.cwb.gov.tw/V7e/climate/monthlyData/mD.htm.
20. Intergovernmental Panel on Climate Change. Climate change 2007. In: Solomon S, Qin D, Manning M, Chen Z, Marquis M, Averyt K, et al., editors. The physical science basis (English). Cambridge, UK: Cambridge University Press, 2007. 996 pp.
21. Kilbourne, EM, Choi, K, Jones, TS, Thacker, SB. The Field Investigation Team. Risk factors for heatstroke: a case control study. JAMA 1982;247:33323336.
22. Bouchama, A, Dehbi, M, Mohamed, G, Matthies, F, Shoukri, M, Menne, B. Prognostic factors in heat wave-related deaths. Arch Intern Med 2007;167:21702176.
23. Naranjo, CA, Busto, U, Sellers, EM et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981;30:239245.
24. Stahl, S. Stahl’s essential psychopharmacology: neuroscientific basis and practical applications. Cambridge Medicine. ISBN: 9781107025981. Cambridge University Press, 2013.
25. Kreuzer, P, Landgrebe, M, Wittmann, M et al. Hypothermia associated with antipsychotic drug use: a clinical case series and review of current literature. J Clin Pharmacol 2012;52:10901097.
26. Longmore, J, Banjar, W, Szabadi, E, Bradshaw, CM. Antagonism of phenylephrine-evoked sweating by trazodone and amitriptyline in humans in vivo. Br J Clin Pharmacol 1987;23:245246.
27. Kassahun, K, Mattiuz, E, Nyhart, JE. Disposition and biotransformation of the antipsychotic agent olanzapine in humans. Drug Metab Dispos 1997;25:8193.
28. Bergemann, N, Frick, A, Parzer, P, Kopitz, J. Olanzapine plasma concentration, average daily dose, and interaction with co-medication in schizophrenic patients. Pharmacopsychiatry 2004;37:6368.
29. Jafferany, M, Lowry, J. Case report of olanzapine-associated elevation of serum creatine kinase in a 16-year-old boy with heat stroke. Prim Care Companion J Clin Psychiatry 2008;10:250252.
30. Kontaxakis, VP, Havaki-Kontaxaki, BJ, Christodoulou, NG, Paplos, KG. Olanzapine-associated neuroleptic malignant syndrome. Prog Neuropsychopharmacol Biol Psychiatry 2002;26:897902.
31. Levenson, JL. Neuroleptic malignant syndrome. Am J Psychiatry 1985;142:11371145.
32. Kuo, CJ, Yang, SY, Liao, YT et al. Second-generation antipsychotic medications and risk of pneumonia in schizophrenia. Schizophr Bull 2013;39:648657.
33. Maddalena, AS, Fox, M, Hofmann, M, Hock, C. Esophageal dysfunction on psychotropic medication. Pharmacopsychiatry 2004;37:134138.

Keywords

Type Description Title
EXCEL
Supplementary materials

Lee supplementary material
Table

 Excel (45 KB)
45 KB

Heat stroke during treatment with olanzapine, trihexyphenidyl, and trazodone in a patient with schizophrenia

  • Chin-Pang Lee (a1), Pei-Jung Chen (a1) and Chia-Ming Chang (a1) (a2)

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed