ArticleThe mental health clinician2026
Risperidone-induced severe hypothermia in an elderly woman with possible prior quetiapine-associated hypothermia tolerating aripiprazole: A case report and literature review.
Article in The mental health clinician, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
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.
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