SUMMARY We report a patient in whom extreme hyperthermia, rhabdomyolysis, acute renal failure and a residual pancerebellar syndrome occurred while taking a combination of perphenazine and amitriptyline. We postulate that impaired thermoregulation due to psychotropic drugs was responsible for the development of heat stroke and that the cerebellar syndrome resulted directly from the elevated temperature.Residual neurological deficits after recovery from hyperthermia, particularly heat stroke, are well known' and probably result directly from elevated body temperature.2 Impaired thermoregulation in patients taking neuroleptic drugs may lead to hyperthermia. We present a case in which hyperthermia with rhabdomyolysis, renal failure, and a persistent cerebellar syndrome developed during therapy with perphenazine and amitriptyline.Case report A 50-year-old woman was found in her home one hour after having collapsed. When discovered, she was alert, sweating, and unable to walk without assistance. She repeatedly became sweaty and subsequently collapsed again without losing consciousness, but was confused and was admitted to hospital. She had been taking a perphenazine and amitriptyline combination 4-25 and diazepam 10 mg each four times a day for seven years. On physical examination rectal temperature was 42-5C and *Present address:
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