Commentary

Extreme heat and mental health: Protecting patients


 

  • Increased emergency department and hospitalization for patients with preexisting psychiatric illness during heat waves.10,11
  • Preexisting mental illness alone increases the risk of mortality during extreme heat events by 2 to 3 times.12,13
  • Patients with schizophrenia might have underlying impairments in thermoregulation that are intrinsic to the disease. Such impairments would explain the perplexing sight of psychotic patients bundled up in layers on hot days.14
  • Psychiatric medications (antipsychotics, anticholinergics, and antidepressants) have the potential to impair the body’s heat regulatory functioning; lithium affects fluid homeostasis.15
Dr. Robin Cooper is in private practice and is affiliated with the department of psychiatry at the University of California, San Francisco. She is a Distinguished Life Fellow of the American Psychiatric Association.

Dr. Robin Cooper

The negative effects of climate change are not equally distributed, and people with mental illness are among the most vulnerable. Given the predictable future of extreme heat waves (potentially increasing the population exposure by four- to sixfold by midcentury),1 we must do everything we can to educate our patients so that they take preventive measures to protect themselves from the adverse effects of extreme heat.

References

1. Nature Climate Change. 2015 May 18;5:652-5.

2. National Oceanic and Atmospheric Administration Global Climate Report. May 2018.

3. “Climate Change and Extreme Heat Events.” Centers for Disease Control and Prevention.

4. Science. 2013 Sep 13;341(6151).

5. Personal communication.

6. Int J Hyperthermia. 2003 May-Jun;19(3):355-72.

7. J Physiol Anthropol. 2012 May 31;31(14).

8. Br J Psychiatry. 2007 Aug;191:106-12.

9. U.S. Global Change Research Program, 2016. “The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment.” Chapters 8 and 9.

10. J Affect Disord. 2014 Feb;155:154-61.

11. Environ Health Perspect. 2008 Oct;116(10):1369-75.

12. Psychiatr Serv. 1998 Aug;49(8):1088-90.

13. Arch Intern Med. 2007 Nov. 12;167(20):2170-6.

14. Schizophr Res. 2004 Aug 1;69(2-3):149-57.

15. Eur Psychiatry. 2007 Sep;22(6):335-8.

Strategies for patients, communities

Part of the job of mental health professionals is psychoeducation, or teaching patients and families about the health risks tied to the psychological and physical impacts of heat exposure. Also, we should provide advice about effective management of psychiatric medications – such as monitoring lithium levels and considering medication dose adjustments – to reduce risks. Another key step is engaging caregivers, case managers, visiting nurses, and family members so that they closely monitor vulnerable populations. Providing information about the availability of respite care and cooling centers is another concrete step clinicians can take to help minimize the impact of extreme heat on patients.

Information that can be shared with patients about the threat include:

Dr. Cooper is in private practice and is affiliated with the department of psychiatry at the University of California, San Francisco. She is a Distinguished Life Fellow of the American Psychiatric Association.

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