Drug-induced Hyperthermic Syndromes in Psychiatry

Abstract

Hyperthermia, or extreme elevations in body temperature, can be life-threatening and may be caused by prescription drugs or illegal substances acting at a number of different levels of the neuraxis. Several psychotropic drug classes and combinations have been associated with a classic clinical syndrome of hyperthermia, skeletal muscle hypermetabolism, rigidity or rhabdomyolysis, autonomic dysfunction and altered mental status ranging from catatonic stupor to coma. It is critical for clinicians to have a high index of suspicion for these relatively uncommon drug-induced adverse effects and to become familiar with their management to prevent serious morbidity and mortality. Although these syndromes look alike, they are triggered by quite different mechanisms, and apart from the need to withdraw or restore potential triggering drugs and provide intensive medical care, specific treatments may vary. Clinical similarities have led to theoretical speculations about common mechanisms and shared genetic predispositions underlying these syndromes, suggesting that there may be a common “thermic stress syndrome” triggered in humans and animal models by a variety of pharmacological or environmental challenges.

Overview of Movement Disorders Secondary to Drugs

“…In this context, several potentially life-threatening conditions can present with hypokinetic movement disorders. Parkinsonism-hyperpyrexia disorder, serotonin syndrome, and neuroleptic malignant syndrome should be ruled out in the acute–subacute onset of drug-induced parkinsonism ( Table 6 ) [ 64 ].…”

Current clinical application of dantrolene sodium

“…DS is also used for treating drug-induced fever, such as neuroleptic malignant syndrome [ 6 ], overdose of 2,4-dinitrophenol (a banned "fat burner" medication that interrupts ATP synthesis and causes hyperthermia) [ 88 , 89 ], lysergic acid diethylamide (LSD), and MDMA (3,4-methylene-dioxy-meth-amphetamine, ‘Ecstasy’) toxicity [ 10 , 36 , 90 ]. It can also be used to treat the serotonin syndrome, anticholinergic poisoning, sympathomimetic poisoning [ 91 , 92 ].…”

Postoperative rhabdomyolysis due to neuroleptic malignant syndrome associated with droperidol and metoclopramide

“…Dear Editor, Neuroleptic malignant syndrome (NMS) is a rare, idiosyncratic, and po tentially fatal complication of neuro leptic use, with a prevalence of 0.02-2.4% [1]. NMS is an important diffe rential dia gnosis of hyperthermia in the periope rative period, with a morta lity rate of 5-20% [2]. Early recognition is essential for proper management, impacting morbidity and mortality [2].…”