Heat Stroke and Schizophrenia

indicate the degree of initial response that may be expected in potential responders and nonresponders, when the same diagnostic criteria, selection criteria, treatment criteria and response criteria are applied. REFERENCES Andrade, C. (1990) Psychobiological frontiers of electroconvulsive therapy in depression : Evaluation of strategies for rational prescription and reduction in morbidity. Tilak Venkoba Rao Oration. Clinical prediction of rate of response of endogenous depression to electroconvulsive therapy. (1989) Initial response to ECT as a predictor of outcome in endogenous depression. (1990) Further characterization of mania as a side effect of ECT. Antidepressant and cognitive effects of twice-versus three-times-weekly ECT. (1993) Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. (1995) Onset and time course of antidepressant action : psychopharmacological implications of a controlled trial of electroconvulsive therapy. The coastal city of Chennai faced one of the worst summers in 40 years in the months of May and June 1998. The average day time temperature in the last week of May/first week of June was about 42°C with a humidity of over 70%. Several cases of heat stroke were recorded during this period and admissions for this accounted for over 50% of all general hospital admissions. At the Schizophrenia Research Foundation, we had three inpatient deaths due to heat related problems and nearly 7 outpatients succumbed to this over a period of two to three months. Information on the latter group trickled to us slowly from the families. I present below a case report of a patient who suffered from schizophrenia and died of heat stroke. She was a forty year old woman who had been suffering from schizophrenia for 22 years and was admitted in the residential rehabilitation facility of SCARF in 1991. Initially considered treatment non-responsive, she began improving with clozapine which was started in 1996. Her positive symptoms, general irritability and episodes of aggression had all improved and she was considered stabilized at a dosage of 300 mgms of clozapine Regular blood tests were all normal. In the first week of June, she developed high fever with rectal temperature going upto 104° F which did not respond to antipyretics. She had no localising signs of infection or any other physical signs or symptoms. She was transferred to a private nursing home, where she was investigated extensively. She tested negative for malaria, enteric fever and urinary infection. All tests of hepatic and …