Hypothermia Associated With Antipsychotic Drug Use: A Clinical Case Series and Review of Current Literature

Abstract

Hypothermia as an adverse reaction of antipsychotic drug use represents a potentially life-threatening complication. However, the mechanisms by which antipsychotic drugs alter thermoregulatory processes in the human body are far from being fully understood. Here we present a case series of 5 patients developing severe hypothermia after administration of olanzapine and benperidol. Controlled by a network of neural structures, body temperature is physiologically regulated in far more narrow boundaries than are other vital functions, and its homeostasis is critical for survival. The preoptic region in the ventral hypothalamus is assumed to act as a coordinating center that is endowed with thermosensory units that constantly compare actual body temperature with target values and initiate regulatory and compensatory mechanisms in case of mismatch. Hypothermia risk seems to increase in the first days after initiation of antipsychotic drug therapy or increases in the daily dose. Schizophrenic patients bear a higher risk than nonschizophrenic patients treated with antipsychotic drugs (such as patients with dementia or depression). Antipsychotic drugs with strong 5-HT2 antagonism seem to be more frequently associated with hypothermia. These cases demonstrate the clinical relevance of hypothermia as an adverse reaction to antipsychotic treatment and the importance of careful monitoring of body temperature.

De Novo delayed onset hypothermia secondary to therapeutic doses of risperidone in bipolar affective disorder

“…Moreover, the patient in this case report was diagnosed as having bipolar affective disorder as opposed to schizophrenia, which was the most common psychiatric disorder associated with previously reported hypothermia [van Marum et al 2007]. Finally the occurrence of this side effect in a patient living in a country with a warm climate also highlights the importance of this case as in comparison with previous reports [Kreuzer et al 2012;Schwaninger et al 1998]. …”

The protective effect of thymoquinone over olanzapine-induced side effects in liver, and metabolic side effects

“…The increased energy storage induced by OLZ was extensively considered a result of both increased energy intake (such as hyperphagia) (30, 31) and reduced energy expenditure (such as decreased thermogenesis) (32)(33)(34). In a study performed by Ader et al showed that dogs treated with OLZ for 4-6 weeks and assessed parameters related to weight gain, adiposity and insulin resistance (35,36).…”

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

“…Patients with a previous history of NMS and/or a personal or family history of catatonia are also at higher risk 867. Antipsychotics may also impact thermoregulation, with case studies indicating the potential for both heat‐related illnesses868 and hypothermia869; thus, patients should be made aware and monitored for these risks during periods of extreme temperatures.…”