Abstract
Abstract
Introduction
Hypothermia is a rare, potentially life-threatening adverse effect of antipsychotics, including risperidone. Defined as a core temperature
Methods
An 84-year-old woman with a history of psychosis and comorbidities developed severe hypothermia (31.9°C/87.8°F) 20 days after switching from quetiapine to risperidone. Infection, endocrine abnormalities, and environmental causes were excluded. Risperidone was discontinued, and normothermia was restored within 3 days. Notably, a month prior, she had a hypothermic episode while on quetiapine in the setting of infection and prescribed opioid use despite tolerating it for 5 years. Aripiprazole was later initiated and titrated to 15 mg daily; her temperature intermittently approached 35°C/95°F without symptoms but remained stable over 4 years of follow-up without further hypothermic episodes despite experiencing infections.
Results
This case highlights diagnostic challenges and the potential for antipsychotic-induced hypothermia to recur across different agents in the same patient. Literature review suggests the phenomenon is more common than previously believed, particularly among older patients. Whereas risperidone and quetiapine are implicated in multiple reports, aripiprazole may be better tolerated in some predisposed individuals. Routine temperature monitoring during antipsychotic initiation and titration is warranted.
Discussion
Risperidone can cause severe hypothermia in older patients even at standard doses. Clinicians should consider alternative antipsychotics when hypothermia occurs and consider that it can recur even if confounding factors are resolved. This case supports the inclusion of temperature surveillance in antipsychotic treatment protocols for older adults.