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

Published online by Cambridge University Press:  27 October 2015

Chin-Pang Lee ,
Pei-Jung Chen  and
Chia-Ming Chang
Chin-Pang Lee
Affiliation:
Department of Psychiatry, Chang Gung Memorial Hospital, Taoyuan, Taiwan
Pei-Jung Chen
Affiliation:
Department of Psychiatry, Chang Gung Memorial Hospital, Taoyuan, Taiwan
Chia-Ming Chang*
Affiliation:
Department of Psychiatry, Chang Gung Memorial Hospital, Taoyuan, Taiwan School of Medicine, Chang Gung University, Taoyuan, Taiwan
*
Chia-Ming Chang, Department of Psychiatry, Chang Gung Memorial Hospital, Linkou branch No. 5, Fusing Street, Gueishan, Taoyuan 33305, Taiwan. Tel: +886 3 3281200, ext. 3836; Fax: +886 3 3280267; E-mail: cmchang58@cgmh.org.tw
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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

anticholinergicheat strokeolanzapineschizophreniatrazodone
Type
Case Report
Information
Acta Neuropsychiatrica , Volume 27 , Supplement 6 , December 2015 , pp. 380 - 385
Copyright
© Scandinavian College of Neuropsychopharmacology 2015 

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