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


CONCLUSIONS
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.
1Department of Psychiatry,Chang Gung Memorial Hospital,Taoyuan,Taiwan.
Chin-Pang
CP
Lee
1Department of Psychiatry,Chang Gung Memorial Hospital,Taoyuan,Taiwan.
Pei-Jung
PJ
Chen
1Department of Psychiatry,Chang Gung Memorial Hospital,Taoyuan,Taiwan.
Chia-Ming
CM
Chang
D000077582:Amisulpride; D000978:Antiparkinson Agents / Q000008:administration & dosage* / Q000009:adverse effects; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001569:Benzodiazepines / Q000008:administration & dosage / Q000009:adverse effects; D001833:Body Temperature Regulation / Q000187:drug effects; D003422:Critical Care; D003937:Diagnosis, Differential; D004347:Drug Interactions; D018883:Heat Stroke / Q000139:chemically induced / Q000209:etiology* / Q000517:prevention & control / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077152:Olanzapine; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology*; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D013406:Suicide, Attempted; D013469:Sulpiride / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D014196:Trazodone / Q000008:administration & dosage / Q000009:adverse effects; D014282:Trihexyphenidyl / Q000008:administration & dosage / Q000009:adverse effects
D000077582:Amisulpride; D000978:Antiparkinson Agents; D014150:Antipsychotic Agents; D001569:Benzodiazepines; D000077152:Olanzapine; D017367:Selective Serotonin Reuptake Inhibitors; D013469:Sulpiride; D014196:Trazodone; D014282:Trihexyphenidyl
anticholinergic; heat stroke; olanzapine; schizophrenia; trazodone