Introduction Hypothermia is a rare, potentially life-threatening adverse effect of antipsychotics, including risperidone. Defined as a core temperature<35°C (95°F), it can occur even at therapeutic doses and may be underrecognized, particularly in older adults or medically complex patients. 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.
Introduction Cancer is the second leading cause of death in the United States with an incidence rate of approximately 442.3 out of 100 000. In 2021, colorectal cancer (CRC) was responsible for more than 52 000 deaths. Screening is a preventive practice that can detect CRC early. More than 70% of adults aged 45 years or older get screened at least once, yet far fewer follow recommended screening guidelines. Depression is associated with an increased risk of CRC and CRC-related mortality and a reduction in regular CRC screening, making it a significant psychosocial barrier to preventive screening. This cross-sectional study examined factors associated with adherence to CRC screening recommendations, particularly among individuals with a self-reported depression diagnosis. Methods Utilizing a representative national sample (n = 204 539) from the 2023 Behavioral Risk Factor Surveillance System (adults aged≥50), we assessed the effects of depression and key variables associated with depression and CRC screening on the likelihood of adherence. Our model included interactions between depression and race/ethnicity, education, and income among other variables. Results African Americans (AA) with depression were 60% less likely to meet recommendations than AA without depression (odds ratio = 0.40, 99% confidence interval = 0.29, 0.55). Discussion The results suggest a critical need for health care practitioners to assess patient mental health, especially among AA patients, who are at higher risk of developing CRC despite an overall higher likelihood of being screened. Targeting the highest risk individuals, particularly those with depression, may reduce costs for public health campaigns targeting CRC screening.
Introduction The purpose of this study was to evaluate the effect of substance use on sedation requirements in critically ill patients to optimize dosing in this population. Methods This was a multicenter, retrospective, observational, institutional review board–approved, cohort study. Included individuals were aged 18 years and older, required mechanical ventilation for more than 24 hours, and had a history of substance use in the intervention group, defined as documentation of using 1 or more substances within the past year. The primary outcome was the maximum number of concurrent continuous analgesic and sedative infusions required during intubation and mechanical ventilation. Results The primary outcome, maximum number of concurrent continuous analgesic and sedative infusions, was significantly higher when comparing subjects with substance use to those without substance use (3 vs 2 infusions; P < 0.001). Significantly higher doses of analgesia and sedation were also required in the substance use group, including fentanyl (150 vs 100 mcg/hr; P = 0.024), dexmedetomidine (1.2 vs 1.0 mcg/kg/hr; P = 0.040), and benzodiazepines measured in lorazepam equivalents (3 vs 1.5 mg/hr; P < 0.001). Conclusion In mechanically ventilated subjects, a statistically significantly higher number of concurrent continuous analgesic and sedative infusions were used in the substance use group, with larger doses required to sedate subjects.
