Hypothermie iatrogène en psychiatrie

Introduction

Hyperthermia, in the context of Neuroleptic Malignant Syndrome, is a well-known adverse effect. However, iatrogenic hypothermia (temperature below 35 °C) due to antipsychotic drugs is less recognized. Common psychiatric treatments that can cause hypothermia include atypical neuroleptics, benzodiazepines, and certain antidepressants. Hypothermia leads to cardiovascular, respiratory, and neurological disturbances. The risk of sudden death increases with the severity of the condition.

Results and discussion

We report two cases of iatrogenic hypothermia occurring in a psychiatric hospital setting. The first patient, a 57-year-old woman, followed for schizophrenia, developed acute respiratory distress with hypothermia at 34.8 °C, 10 days after her admission. She had been treated with Clopixol and Clozapine. A pneumonia was treated with empirical antibiotic therapy. The evolution showed respiratory improvement, but hypothermia persisted (33.8 °C to 35 °C). Iatrogenic hypothermia was considered, and discontinuing Clopixol led to normalization of her temperature within 5 days. The second patient, a 60-year-old woman with a history of hypothyroidism, was hospitalized for psychotic decompensation following the discontinuation of her medications. Three days after admission, she developed hypothermia at 30 °C, along with neurological symptoms (Glasgow score 12) and sinus bradycardia with a prolonged QT interval of 470 ms, while being treated with Quetiapine and Carbamazepine (her baseline treatment prior to admission). The TSH level at 25 mU/L did not seem to explain the symptoms. She was transferred to the intensive care unit, and the hypothermia improved 24 hours after stopping the psychotropic medications. No recurrence of hypothermia was noted after Quetiapine was resumed. The cause of her hypothermia appeared to be multifactorial: the effect of psychotropics on thermoregulation, deep nocturnal sedation causing a fall and prolonged grounding, and hypothyroidism.

Conclusion

Hypothermia is a serious side effect that can compromise the patient's vital prognosis. Monitoring of body temperature after the introduction or modification of psychotropic treatments must be rigorous, especially in frail, malnourished, or elderly individuals who may have impaired thermoregulation.