By Meredith Lee, DO, DFAPA
Associate Professor – Dept of Psychiatry
University of Virginia
Climate change has led to rising environmental temperatures around the planet. Higher temperatures have a significant impact on physical and mental health. With summer approaching, I want to highlight some of the effects of heat and some strategies to mitigate risk for heat-related illnesses. As described in the Handbook of Climate Psychiatry and Psychotherapy: A Manual for Clinicians by Dr. Elizabeth Haase, there are multiple implications of rising temperatures for Psychiatry and our patients including:
- Higher temperatures increase suicide, violent behavior, and violent conflict
- The neurotransmitter, receptor, and brain systems involved in thermoregulation overlap with those central to neuropsychiatry. Medications and substances can have an impact on serotonin, norepinephrine, dopamine, GABA and glutamate which are involved in thermoregulation. Therefore, several medications and substances impact heat tolerance:
- Antipsychotics and cocaine may affect thermoregulatory mechanisms such as sweating
- Benzodiazepines and alcohol may impair the ability to notice and respond to heat related symptoms
- Certain substances (e.g. cocaine) or medications may raise body temperature by increasing physical activity and agitation
- Some medications (i.e. lithium) are affected by heat-related changes in the body; dehydration can lead to lithium toxicity
- Heat events can lead to a variety of heat-related illnesses from sunburn and heat edema to heatstroke and heat exhaustion
- Extreme heat can lead to death. Risk factors for heat-related morbidity and mortality include:
- Overexposure to high temperatures
- Being young (children) or older age (elderly)
- Being obese
- Having medical conditions that increase cardiovascular or pulmonary risk
- Not leaving home daily or being bedbound
- Having conditions that impair autonomic function (e.g. diabetes or Parkinson’s disease)
- Additional risk factors: urban residence, poverty, low education, homelessness, substance use and abuse, having a mental illness
It is important for us to educate our patients on how heat may impact their physical and mental health, and how they can reduce the risk for heat illnesses. Some practical tips for patients include:
- Acclimatization to heat can reduce risk for heat illnesses. The CDC has recommendations for this here: Acclimatization | Heat | CDC
- Limit time outdoors, especially midday
- Save high-exertion work for the morning and evening
- Use a buddy system for emergency notification
- Install air conditioning
- Use fans
- Ventilate laundry and stove outside
- Check heart rate on wearable devices
- Wear vests, neckbands, and hard hats with inserted frozen material if working outside
- Have a cooler and cooling blankets at job sites if working outside
- Increase ventilation
- Install shade awnings around the home
Climate Psychiatry Alliance (CPA) has several resources on their website for patients and clinicians like the one below. Heat Wave Resources — Climate Psychiatry Alliance.
