A case of severe hypothermia following antipsychotic medication

T. Scherl; B. Langguth; P. M. Kreuzer

doi:10.1055/s-0038-1627419

Nervenheilkunde, Table of Contents

Nervenheilkunde 2015; 34(06): 461-465
DOI: 10.1055/s-0038-1627419

Kasuistik

Schattauer GmbH

Hypothermie unter antipsychotischer Medikation

Ein Fallbericht mit LiteraturübersichtA case of severe hypothermia following antipsychotic medicationA case report

T. Scherl

¹Abteilung für Innere Medizin, Asklepios Klinik Burglengenfeld, Burglengenfeld

,

B. Langguth

²Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Regensburg am Bezirksklinikum, Regensburg

,

P. M. Kreuzer

²Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Regensburg am Bezirksklinikum, Regensburg

› Author Affiliations

Abstract

Zusammenfassung

Veränderungen der Körpertemperatur nach Applikation antipsychotisch wirksamer Substanzen werden im klinischen Alltag seit jeher beobachtet. Die Entwicklung von Fieber im Sinne einer unerwünschten Arzneimittelwirkung von antipsychotisch wirksamen Substanzen (isoliert vorliegend bzw. im Rahmen des malignen neuroleptischen Syndroms) ist jedem Medizinstudenten bekannt. Weitaus geringere Beachtung finden dagegen gegenläufige Störungen der Thermoregulation im Sinne einer Erniedrigung der Körpertemperatur nach Applikation von antipsychotisch wirksamen Substanzen. Dies verwundert umso mehr, da bereits vor der Entdeckung des antipsychotischen Effekts des ersten Neuroleptikums Chlorpromazin im Jahr 1952 dessen temperatursenkende Wirkung in der Anästhesiologie gut bekannt war und sogar therapeutischen Nutzen fand.

Hier stellen wir den Fall einer 93-jährigen Patientin mit demenziellem Syndrom vor, die unter einer psychopharmakologischen Polymedikation mit Risperidon, Doxepin und Buspiron eine Hypothermie von 29,5°C entwickelte. Eine Literaturübersicht zeigt, dass Antipsychotika bei individueller Disposition und in Kombination mit unabhängigen Risikofaktoren wie Umgebungstemperatur, somatischer Begleiterkrankung, endokrinen Störungen (z. B. Hypothyreose) oder organischer ZNS-Vorschädigung sowohl zu Hypo- wie auch zu Hyperthermie führen können. Ursächlich verantwortlich erscheint ein komplexes Zusammenspiel dopaminerger Regulationsmechanismen im ventralen Hypothalamus mit peripherer vasomotorischer Dysregulation.

Summary

Thermoregulatory dysfunction is a well-known side effect of central acting drugs. Particularly there is a high awareness that fever can develop in patients receiving antipsychotic medication. It may occur either unescorted or in the context of the malignant neuroleptic syndrome (NMS). However, in comparison to neuroleptics induced hyperthermia, a neuroleptics induced reduction of body temperature draws only minor attention. This is especially surprising as even before the discovery of the antipsychotic effect of the first neuroleptic drug (chlorpromazine) in the year 1952, anaesthesiologists have already tried to use its hypothermia-inducing effects for therapeutic reasons. Here we present the case of a 93-year-old lady with dementia developing a hypothermic episode of 29.5°C receiving a poly-psychopharmacological therapy consisting of risperidone, doxepin, and buspirone. A literature search illustrated that antipsychotic drugs may lead to both hypo- and hyperthermia, which is additionally based on individual predisposition and independent risk factors such as environmental temperature, somatic comorbidity, endocrinological dysfunction and structural brain damage. A complex interaction between dopaminergic regulatory mechanisms concerning the ventral hypothalamus, and peripheral vasomotoric dysregulation may play a vital pathophysiological role.

Schlüsselwörter

Hypothermie - Neuroleptika - Antipsychotika - Thermoregulation - Hypothalamus

Keywords

Hypothermia - antipsychotic medication - neuroleptics - thermoregulation - hypothalamus

Full Text

References

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