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Schizophreniform Disorder After Heat Injury in a Military Recruit

Received February 9, 2007; accepted May 23, 2007. From the Navy Medical Center, San Diego, CA, Department of Psychiatry. Send correspondence and reprint requests to Lt. Amy Canuso, MC USN, in care of Mr. R Wells, Psychiatry Department; 34800 Bob Wilson Dr., San Diego, CA, 92134-5000. e-mail: acanuso{at}nmcsd.med.navy.mil
© 2008 The Academy of Psychosomatic Medicine

Key Words: Schizophreniform Disorder

INTRODUCTION

TOP INTRODUCTION Case Report Discussion REFERENCES

 
Changes in body temperature have been implicated in the pathophysiology of psychosis.^1–5 Mental status changes after hyperthermia are also not uncommon.¹ We are unaware, however, of reports of persisting psychosis after heat injury. Here, we report the case of a military recruit who, after heat stroke, developed schizophrenia-like symptoms.

Case Report

TOP INTRODUCTION Case Report Discussion REFERENCES

 
The patient is a single, white man with no personal or family history of psychosis. He had an unremarkable developmental history and, other than a childhood diagnosis of attention-deficit hyperactivity disorder, which resolved, no previous contacts with mental health professionals.

He was in good physical condition, and there was no history of drug or alcohol abuse. At the age of 18, the patient enrolled in the U.S. Marine Corps and was considered to be an outstanding recruit. Forty-five days into training, he suffered a heat injury during a training hike on a warm day.

The patient’s temperature in the field was recorded as 104° F. He was flown via helicopter to the nearest emergency room, where he was hydrated, intubated, and given a head CT scan, which showed no acute intracranial process. The patient was hospitalized for 4 days, at which point he was considered to be recovered.

Approximately 4 days after returning to military training, the patient had mental-status changes. He endorsed the delusion that he was personally responsible for the unsatisfactory performances of other recruits. He expressed paranoia about his doctors and the media, whom he believed were communicating with him through the TV and newspaper. He endorsed visual hallucination of the floor moving in waves, and command auditory hallucinations.

He was admitted to inpatient psychiatric care and started on 1 mg of risperidone. An MRI scan of the brain and neurological assessment were found to be unremarkable. Symptoms improved but did not resolve during hospitalization. When symptoms persisted beyond 1 month, the patient was diagnosed with schizophreniform disorder.

Discussion

TOP INTRODUCTION Case Report Discussion REFERENCES

 
This case is an example of persisting psychosis after heat injury. It cannot be said for certain whether the hyperthermia event merely coincided with his psychotic break or his heat injury induced his symptoms.

Schizophrenia patients are known to show heat intolerance, however;² and heat-sensitive systems are known to be perturbed in these patients.^4,5 This case should spark further investigation as to whether thermoregulatory abnormalities could be precursors to psychosis, or whether heat itself can perturb brain systems, leading to psychosis.

REFERENCES

TOP INTRODUCTION Case Report Discussion REFERENCES

 

1. Dixit SN, Bushara KO, Brooks BR: Epidemic heat stroke in a midwest community: risk factors, neurological complications, and sequelae. Wisconsin Med J 1997; 96:39–41
2. Hermesh H, Shiloh R, Epstein Y, et al: Heat intolerance in patients with chronic schizophrenia maintained with antipsychotic drugs. Am J Psychiatry 2000; 157:1327–1329[Abstract/Free Full Text]
3. Heh CW, Herrera J, DeMet E, et al: Neuroleptic-induced hypothermia associated with amelioration of psychosis in schizophrenia. Neuropschopharmacology 1988; 1:149–156[CrossRef]
4. Regland B, Germgard T, Gottsfries CG, et al: Homozygous thermolabile methylenetetrahydrofolate reductase in schizophrenia-like psychosis. J Neural Trans 1997; 104:931–941[CrossRef]
5. Schwarz MJ, Riedel M, Gruber R, et al: Antibodies to heat-shock proteins in schizophrenic patients: implications for the mechanism of disease. Am J Psychiatry 1999; 156:1103–1104[Abstract/Free Full Text]

Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Email this article to a Colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via Google Scholar Articles by Canuso, A. A. Articles by Stenback, K. A. Search for Related Content PubMed Citation Articles by Canuso, A. A. Articles by Stenback, K. A. Schizophrenia Spectrum Disorders Syndromes Secondary to General Medical Disorders

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