Antipsychotics, Hypothermia, Undressing, and Death

Abstract

One of the lesser-known adverse effects of antipsychotic medication is hypothermia, a signifi cant and protracted plunge in body temperature. Known risk factors are older age and exposure to a newfor-the-person antipsychotic drug. Hypothermia impairs cognitive function, often resulting in a delirium that can paradoxically induce the prescription of escalating doses of the offending drug. As hypothermia increases, the subjective experience of the person may be one of overwhelming heat that can lead to the person shedding protective clothing, an action that can precipitate death. Case Report Antipsychotics Case ExampleA 62-year-old male patient had, for many years, been suffering from schizophrenia and had more recently Three days later, he was found frozen to death on the sidewalk outside his residence. He was completely naked; his clothes were stacked in a neat pile beside him. Although there was no suicide note, the coroner attributed the death to suicide. Given the patient's psychiatric history, the conclusion was that he had deliberately walked out into the cold and taken off his clothes in order to freeze himself to death. Suicide while in the nude is, apparently, a known entity [2], (though purposefully freezing oneself to death has never been reported in this context). The patient's extended family and long-term clinicians stated that there was no previous history of suicidal threats or gestures; nevertheless, the care providers who had looked after him during his recent hospital stay and thought of him as "attention-seeking" considered it possible that he had deliberately staged a melodramatic ending [3] to an otherwise uneventful life. DiscussionThe death of this patient occurred twenty years ago, but it has remained a puzzle. Having known the patient for many years, I cannot believe that he committed suicide. I have wondered whether he may have been a sleepwalker. Like hypothermia, sleepwalking is a rarely recognized side effect of antipsychotic medication [4]. The naked streaking in the hospital at night may have been a form of sleepwalking, which would account for his afterwards not understanding what he had done wrong. The fi nal walk out into the street and the shedding of clothes may have been the action of a sleepwalker.The other explanatory hypothesis is hypothermia, defi ned as body temperature falling below 35°C. While malignant hyperthermia is a well-known and potentially fatal adverse effect of antipsychotics, its opposite, hypothermia, is less wellrecognized. In 2007, van Marum [5], using the World Health Organization database, reviewed 480 cases of hypothermia associated with the use of antipsychotic medication. A large number of these, 44, were linked to olanzapine.

Reversal of Clonidine-Induced Hypothermia by Decaffeinated Tea/Coffee Extract, and Their Fractions in Mice

“…Both, conventional and atypical antipsychotics cause hypothermia but atypical antipsychotics have a lower risk [25]. Hypothermia particularly in advanced age, cerebrovascular accident, hypothyroidism, sepsis, benzodiazepine use, alcohol intoxication, kidney or liver failure could be life-threatening [26]. The effects of undesired hypothermia in trauma are more in numbers and complex too [27].…”

Prevention of antipsychotic side effects in elderly populations

“…There is an association between APs and pneumonia in the elderly [38,39]. Urinary disease is also reportedly increased [40,41], as is electrolyte imbalance [42] and hypothermia [43].…”