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

Acta Neuropsychiatr. 2015 Dec;27(6):380-5. doi: 10.1017/neu.2015.29.

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.

Keywords: anticholinergic; heat stroke; olanzapine; schizophrenia; trazodone.

Publication types

  • Case Reports

MeSH terms

  • Amisulpride
  • Antiparkinson Agents / administration & dosage*
  • Antiparkinson Agents / adverse effects
  • Antipsychotic Agents / administration & dosage*
  • Antipsychotic Agents / adverse effects
  • Benzodiazepines / administration & dosage
  • Benzodiazepines / adverse effects
  • Body Temperature Regulation / drug effects
  • Critical Care
  • Diagnosis, Differential
  • Drug Interactions
  • Heat Stroke / chemically induced
  • Heat Stroke / etiology*
  • Heat Stroke / prevention & control
  • Heat Stroke / psychology
  • Humans
  • Male
  • Middle Aged
  • Olanzapine
  • Schizophrenia / diagnosis
  • Schizophrenia / drug therapy*
  • Schizophrenia / physiopathology*
  • Selective Serotonin Reuptake Inhibitors / administration & dosage*
  • Selective Serotonin Reuptake Inhibitors / adverse effects
  • Suicide, Attempted
  • Sulpiride / administration & dosage
  • Sulpiride / adverse effects
  • Sulpiride / analogs & derivatives
  • Trazodone / administration & dosage
  • Trazodone / adverse effects
  • Trihexyphenidyl / administration & dosage
  • Trihexyphenidyl / adverse effects

Substances

  • Antiparkinson Agents
  • Antipsychotic Agents
  • Serotonin Uptake Inhibitors
  • Benzodiazepines
  • Trihexyphenidyl
  • Sulpiride
  • Amisulpride
  • Olanzapine
  • Trazodone