Psychiatric patients may be more susceptible to damage from extreme heat, studies say

As the climate crisis gets worse, we know of farmers whose crops are drying up and people losing their homes to rampant forest fires.

But there is another group for whom the climate crisis is a potentially lethal threat — people with mental health problemssuch as schizophrenia, bipolar disorder or anxiety.

And this threat has already become a reality for some people. During a record heat wave in British Columbia in June 2021, 8% of people who died due to extreme heat were diagnosed with schizophrenia, according to a March study.

This made the disorder a more dangerous risk factor than all other conditions studied by the authors, including kidney disease and coronary artery disease.

“Until climate change is brought under control, things are only going to get worse, unfortunately,” said Robert Feder, a New Hampshire-based retired psychiatrist and the American Psychiatric Association representative to the Medical Society Consortium on Climate and Health.

“As the temperature continues to rise, these effects will be magnified. There will be more storms, more fires and people will be more worried about what might happen because so much more is happening.”

Rising temperatures have also been linked to suicide attempts and increased rates of mental health-related emergency department visits, according to several studies.

And long-term exposure to air pollution — which the climate crisis could worsen as add more particles from droughts or forest fires — has been associated to high anxiety and an increase in suicides.

What’s going on in the brains of people with schizophrenia or other illnesses is just one factor that makes them more vulnerable to extreme heat, air pollution and stress, experts say — and they need the support of loved ones and neighboring communities. and political authorities.

Extreme heat and mental health

What makes some psychiatric patients more susceptible to damage from extreme heat — such as heatstroke or death — starts in a part of the brain called the anterior hypothalamus.

“That’s the part of the brain that’s working to tell you — when you’re too hot or too cold — to start shivering, to start sweating,” which is the body’s cooling mechanism, said Peter Crank, an assistant professor at the department of geography and environmental management at the University of Waterloo, Canada.

Crank was the main author of a March study on associations between temperatures in Phoenix, Arizona, and hospital admissions of people with schizophrenia.

“This tells the rest of your brain that you need to take behavioral action, like drinking water or putting on a coat when it’s too cold or taking off your coat when it’s hot,” he added.

“These disorders, whether bipolar, schizophrenic or manic depressive, impair the neurotransmission of information to that part of the brain.”

The ability to regulate body temperature may also have to do with brain chemicals such as serotonin and dopamine, which are generally lower in the brains of people with these disorders, experts said.

“The hypothalamus is directly dependent on serotonin stimulation,” said Joshua Wortzel, a psychiatrist at Brown University Bradley Hospital in Rhode Island and chairman of the American Psychiatric Association’s committee on climate change and mental health.

“Serotonin levels in the brain are affected by external temperatures, so you can imagine that when we play with serotonin levels in the brain with our medications, it could alter a person’s ability to sweat.”

Some medications used to treat these disorders may increase your risk by affecting your ability to sweat or increasing your core body temperature.

Antipsychotic medications — often used to treat schizophrenia, bipolar disorder, paranoia and delusions — have the greatest effect, Feder said. These include aripiprazole, olanzapine, risperidone, quetiapine and lurasidone.

Some stimulant medications for attention deficit hyperactivity disorder, or ADHD, such as lisdexamfetamine and amphetamine/dextroamphetamine salts, and anti-anxiety medications can also cause this problem.

Lithium, a mood-stabilizing medication, can cause dehydration, Feder added.

Lifestyle habits important for managing mental health symptoms may also be impaired. Warm temperatures can also interfere with sleep, an important factor in managing mental health symptoms, experts said.

Additionally, “the nature of most mental health problems is that once diagnosed, you are at risk for recurring episodes of this illness,” Feder said. “And these episodes are often caused by some type of stress. And climate disasters are certainly a stress.”

Homelessness is also high among people with mental health problems, especially in the schizophrenic population.

“And if you’re homeless during a heat wave, that increases your risk of death because you don’t have access to air conditioning,” Feder said.

Behaviors caused by these conditions may also contribute to a greater risk of heat-related illness or death.

The psychosis that people with schizophrenia may experience, for example, may mean they are not correctly interpreting reality, so “they may not even be aware that they are overheating, or they may think that the source of their overheating is due to some bizarre reason.” or irrational and not doing something appropriate to get out of the heat or to make themselves (safer),” Feder said.

People with mental health problems are also more likely to self-medicate with medications that interfere with the body’s ability to sense and respond to heat.

How to protect yourself and others

If you are taking any of these medications and think that not taking them anymore is the solution, don’t be hasty. “That would be much worse than continuing to take the medication,” which plays a crucial role in his treatment, Wortzel said.

Talk to your doctor about whether a medication you are taking or starting makes you more vulnerable to extreme heat, as some information pamphlets about these medications may not list this risk as a potential side effect.

“These are just warnings,” he added, “to really make sure you stay in cooler environments, make sure you’re hydrated — that if climate change continues to get worse, that’s really going to be a side effect that we’re going to have to worry about more and more.” more.”

It’s not a reason to stop taking antipsychotics, Wortzel said, but it’s a good reason to take care of yourself in the heat.

Tackling the climate crisis, the root of the problem, is obviously the most important solution, Wortzel said. What’s also needed at the policy level, he added, is expanding access to cooling centers and other resources, and providing more funding for research that helps us better understand the impact of heat on mental health.

There are steps individuals and communities can take to protect vulnerable people when hot weather arrives.

“Patients need to be aware that they are vulnerable to stress,” Wortzel said. “You need to ensure you have access to air conditioning, a refrigeration center, stay hydrated and monitor the time you spend outside, not go out during the hottest times of the day, things like that.”

Wear sunscreen, hats and loose-fitting, light-colored clothing, Crank said. Taking a cool shower can also help keep your core temperature down.

“The other thing people can do is start getting involved in climate activities,” Feder said. “For anxiety associated with climate change, the best thing people can do is get involved in climate (advocacy) groups and start working towards change in the climate crisis.”

Feder also suggested that people write or talk to their legislators about the issue.

You should also let your loved ones know about your vulnerabilities so they can offer support.

If you are not someone who is at higher risk and are wondering how you can help, practice empathy and awareness by keeping bottles of water in your car to hand out to those most at risk of harm from extreme heat.

“Take the time when you see someone in distress to call some type of emergency services so they can get medical attention,” Crank said. Doing this will probably only take a few minutes out of his day.