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Der Nervenarzt

, Volume 83, Issue 5, pp 630–637 | Cite as

Hypothermie unter Olanzapin

Eine Fallserie mit Literaturübersicht
  • P. KreuzerEmail author
  • M. Landgrebe
  • M. Wittmann
  • G. Hajak
  • M. Schecklmann
  • T.B. Poeppl
  • B. Langguth
Originalien

Zusammenfassung

Hintergrund

Hypothermien unter Antipsychotikabehandlung sind seit Jahrzehnten bekannt, finden jedoch im klinischen Alltag nur geringe Beachtung.

Material und Methoden

Die vorliegende Arbeit beschreibt eine Serie von 3 Fällen ausgeprägter Hypothermie nach Applikation von Olanzapin. Risikofaktoren und Pathomechanismen der neuroleptikainduzierten Hypothermie werden anhand der vorgestellten Fälle und einer Literaturübersicht zum Thema diskutiert.

Ergebnisse

Eine 51-jährige Frau mit katatoner Schizophrenie und Hypothyreose entwickelte bei kachektischem Ernährungszustand unter antipsychotischer Medikation mit 30 mg Olanzapin pro Tag eine Hypothermie von 30,0°C Körperkerntemperatur unter Komedikation mit Lorazepam und L-Thyroxin. Bei einer 48-jährigen Patientin mit ebenfalls katatoner Schizophrenie kam es nach Einmalgabe von 10 mg Olanzapin per os und 3 mg Lorazepam auf 3 Einzeldosen verteilt zu einer Hypothermie auf 31,0°C. Die dritte kasuistische Darstellung berichtet von einem 69-jährigen Patienten mit akuter schizophreniformer Störung, welcher nach Einmalgabe von 5 mg Olanzapin ohne weitere Komedikation eine Hypothermie von 33,0°C in Verbindung mit einem reversiblen AV-Block 3. Grades entwickelte.

Schlussfolgerung

Antipsychotika können bei individueller Disposition und in Kombination mit unabhängigen Risikofaktoren wie Umgebungstemperatur, somatischer Begleiterkrankung, endokrinologischen Störungen (z. B. Hypothyreose) oder organischer ZNS-Vorschädigung sowohl zu Hypo- als auch zu Hyperthermie führen. Ursächlich hierfür erscheint ein komplexes Zusammenspiel dopaminerger Regulationsmechanismen im ventralen Hypothalamus mit Veränderungen der Thermoregulation im Bereich der Vasomotorik von Hautgefäßen. Im klinischen Alltag sollte an die antipsychotikaassoziierte Hypothermie gedacht werden, da sie eine hochrelevante unerwünschte Arzneimittelwirkung mit potenziell lebensbedrohlichem Charakter darstellt.

Schlüsselwörter

Hypothermie Neuroleptika Antipsychotika Thermoregulation Hypothalamus 

Hypothermia under olanzapine treatment

Clinical case series and review of current literature

Summary

Background

Antipsychotic drugs may lead to hypothermia as well as hyperthermia. Although known for decades and clinically highly relevant, the mechanisms by which antipsychotic drugs alter thermoregulatory processes in the human body are still far from being fully understood. In clinical practice, much attention is paid to antipsychotic drug-induced elevation of body core temperature as observed in the neuroleptic malignant syndrome (NMS). But also hypothermia is a clinically highly relevant adverse reaction to antipsychotic drugs.

Material and methods

Here we report a case series of three patients who developed severe hypothermia after administration of olanzapine. A review of the current literature is given with a focus on risk factors for the development of antipsychotic drug-induced hypothermia and its pathophysiologic mechanisms.

Results

A 51-year-old female patient suffering from catatonic schizophrenia, cachectic nutritional condition and hypothyroidism developed severe hypothermia of 30.0°C body core temperature after administration of 30 mg olanzapine per day under comedication with lorazepam and L-thyroxine. A 48-year-old female patient with catatonic schizophrenia showed hypothermia of 31.0°C (rectal measurement) after single-dose administration of olanzapine 10 mg orally and a total of 3 mg lorazepam (1–1–1 mg). The third case report describes a 69-year-old male patient with acute delusional disorder exhibiting hypothermia of 33.0°C (rectal measurement) in combination with a reversible atrioventricular block grade III without any further comedication.

Conclusion

A review of the current literature reveals that thermoregulatory disturbances as sequelae of antipsychotic drug administration depend on individual disposition as well as various independent risk factors such as environmental temperature, somatic comorbidities, endocrinological abnormalities (e.g. hypothyroidism) and structural damage of the brain. A complex interaction of dopaminergic regulatory mechanisms in the ventral hypothalamus and peripheral vaso- and sudomotor adjustments seems to be causative. Hypothermia following antipsychotic drug administration represents a serious adverse drug reaction and a potentially life-threatening event.

Keywords

Hypothermia Neuroleptics Antipsychotics Thermoregulation Hypothalamus 

Notes

Danksagung

Wir danken Herrn Prof. Dr. Dr. Haen, Universität Regensburg, für den Beitrag der Fallvignette Nr. 3 aus der AGATE-Datenbank zur Arzneimittelvigilanz in der Psychiatrie.

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • P. Kreuzer
    • 1
    Email author
  • M. Landgrebe
    • 1
  • M. Wittmann
    • 1
  • G. Hajak
    • 1
  • M. Schecklmann
    • 1
  • T.B. Poeppl
    • 1
  • B. Langguth
    • 1
  1. 1.Klinik und Poliklinik für Psychiatrie, Psychosomatik und PsychotherapieUniversität Regensburg am BezirksklinikumRegensburgDeutschland

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