Confused, cold, and lethargic

Additionally, persons with schizophrenia might be at increased risk of developing hypothermia when exposed to a low environmental temperature.^7,8 Kudoh et al¹⁹ investigated temperature regulation during anesthesia in patients with chronic (≥7 years) schizophrenia receiving antipsychotics, and compared findings against what was seen in controls. The team reported that patients with schizophrenia had significantly lower intraoperative temperatures.

A published analysis of cases and studies of antipsychotic-induced hypothermia describes the combination of drug variables, patient variables, and environmental variables that contribute to thermal dysregulation (Table 3).^7-12,15 The recommendation for practitioners is that, when considering an antipsychotic for a patient at high risk of thermal dysregulation, your choice of an agent should take that risk into account, especially when that drug is one that has comparatively stronger serotonergic and peripheral á-adrenergic effects. You should monitor patients closely for hypothermia after starting and when increasing the dosage of the drug. In patients with schizophrenia who might have a problem with baseline thermoregulation, advise them to take measures to counteract their increased susceptibility to low ambient temperatures.

OUTCOME Readmission

Ms. K was readmitted, rewarmed, and discharged to a skilled nursing facility 4 days later, after baseline function returned to normal and temperature stabilized. Paliperidone is now listed in her electronic medical record as “drug intolerance.”

This case also highlights the importance of adequate medication reconciliation at
admission and discharge, especially when using an electronic medical record system, because what might otherwise be considered a minor mistake can have devastating consequences.

Bottom Line

Thermal dysregulation—hyperthermia and hypothermia—can occur secondary to an antipsychotic. Determining whether a patient is at increased risk of either of these adverse effects is important when deciding to use antipsychotics. Recognizing agents that can cause hypothermia is essential, because management requires prompt discontinuation of the offending drug.

Related Resource

• Espay AJ, et al. Frontal lobe syndromes. https://emedicine.medscape.com/article/1135866-overview. Updated September 17, 2012. Accessed November 3, 2012.

Drug Brand Names

Aripiprazole • Abilify                    Lamotrigine • Lamictal
Bromocriptine • Parlodel              Lorazepam • Ativan
Chlorpromazine • Thorazine         Paliperidone • Invega
Citalopram • Celexa                    Risperidone • Risperdal
Clozapine • Clozaril                     Sertraline • Zoloft
Divalproex sodium • Depakote     Thioridazine • Mellaril

Disclosure

The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.