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Ann Marie T. Sullivan, M.D., Acting Commissioner
Governor Andrew M. Cuomo

Medical Alert - Increased Risk of Heat Illness
to Persons Taking Antipsychotic Medications

Office of Mental Health Letterhead

To: OMH Facility Directors, Clinical Directors, Chief Nursing Officers,
Directors of OMH Licensed Programs
From: Lloyd I. Sederer, M.D.
Medical Director
Subject: Medical Alert - Increased Risk Of Heat Illness To Persons Taking Antipsychotic Medications
Date: April 16, 2013

Hot summer temperatures have been associated with an increase in heat-related symptoms and even deaths. Pattern and trend reviews of OMH incident reports have confirmed these findings. Individuals receiving antipsychotic medications are at particular risk of heat stroke and neuroleptic malignant syndrome (NMS) during periods of extreme heat, which is more likely in poorly ventilated rooms. Children and the elderly are at increased risk. In addition to monitoring individuals at risk, including any people placed in seclusion or restraints during and after such episodes, prevention is paramount.

These conditions may best be prevented by:

  • heightened attention to the state of hydration of patients, particularly those at high risk (those on antipsychotic medications, the elderly, children and those with poor fluid intake);
  • helping high risk patients remain in cooler areas;
  • monitoring patients for temperature elevations;
  • avoiding direct exposure to sunlight or minimizing exposure;
  • wearing protective clothing and using sunscreen
  • minimizing anticholinergic medications which may interfere with sweating; this includes switching to antipsychotics with less intrinsic anticholinergic activity and/or treating extrapyramidal side effects with amantadine instead of anticholinergics (such as benztropine or trihexyphenidyl).

For patients experiencing significant temperature elevations, where heat stroke or NMS are a consideration, antipsychotic medications should be held until the diagnosis is clear. If the diagnosis of NMS is confirmed, the antipsychotic medication must then be discontinued.

Patient friendly informational materials can be found at the links below. To order the brochures or posters fax your order to (315) 735-5041 or e-mail the OMH Design Center. Please include the item requested, the number of copies, and shipping address.

Please use the handouts to assist you and your staff in preventing and treating heat-related problems. Please ensure that these materials are widely circulated in your facilities and are discussed with patients and their families, in preparation for the hot weather ahead.


Kristin Woodlock, OMH Acting Commisioner.
OMH Executive Team, Catherine Benham, Gregory Miller, Grace Lee, Matthew Perkins, Jay Carruthers, OMH Field Office Directors

Printing directions for the brochures and posters below.

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