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As the climate crisis worsens, we know farmers whose crops are drying up and people losing their homes to rampant wildfires.
But there is another group for whom the climate crisis could pose a deadly threat – people with mental health problems such as schizophrenia, bipolar disorder or anxiety.
And this threat is now a reality for some people. During a record heat wave in British Columbia in June 2021, 8% of those who died from the extreme heat were diagnosed with schizophrenia, according to a study in March. That was a more dangerous risk factor than the other conditions the authors studied, including kidney disease and coronary artery disease.
“Until climate change is brought under control, things will only get worse unfortunately,” said Dr. Robert Feder, a retired psychiatrist from New Hampshire and the American Psychiatric Association’s representative for the Medical Association’s Consortium on Climate and Health. “As temperatures continue to rise, these effects will increase. There will be more storms, more fires, and people will be more worried about what could happen because there are so many more things happening.”
Elevated temperatures have also been associated with suicide attempts and increased rates of mental health-related emergency department visits, several studies have found. And long-term exposure to air pollution – which could worsen the climate crisis by adding more particles from droughts or wildfires – has been linked to heightened anxiety and an increase in suicide.
What’s going on in the brains of people with schizophrenia or other conditions is just one factor that makes them more vulnerable to extreme heat, air pollution and stress, experts said – and who need the support of loved ones, surrounding communities and policy makers.
Extreme heat and mental health
Some psychiatric patients are more susceptible to extreme heat damage – such as heat stroke or death – in a part of the brain formerly known as the hypothalamus. Think of it as the body’s thermostat.
“That’s the part of the brain that’s working to tell you — when you’re too hot or too cold — to start shivering, to start sweating,” which is the body’s cooling mechanism, said Dr. Peter Crank, and assistant professor in the department of geography and environmental management at the University of Waterloo in Canada. Crank was lead author of a March study on links between temperatures in Phoenix, Arizona, and hospital admissions of people with schizophrenia.
“It tells the rest of your brain that you need to take a behavioral action, like drink water or put on a coat when it’s too cold or take off a coat when it’s hot,” he said. “These disorders, whether it’s bipolar, schizophrenia or manic depressive – all three of them impair the neurotransmission of information to that part of the brain.”
The ability to regulate body temperature may also be related to brain chemicals such as serotonin and dopamine, which are typically lower in the brains of people with these disorders, experts said.
“The hypothalamus is directly dependent on being stimulated by serotonin,” said Dr. Joshua Wortzel, a psychiatrist at Bradley Hospital at Brown University in Rhode Island and chairman of the American Psychiatric Association’s committee on climate change and mental health. “Outside temperatures affect serotonin levels in the brain, so you can imagine that when we play around with serotonin levels in the brain with our medication, that can change a person’s ability to sweat.”
Some medications used to treat these disorders can increase the risk by affecting the body’s ability to sweat or raise the core temperature.
Antipsychotic medications – often used to treat schizophrenia, bipolar disorder, paranoia and delusions – have the greatest effect, said Feder. These include aripiprazole, olanzapine, risperidone, quetiapine and lurasidone.
Some stimulant medications for attention deficit hyperactivity disorder, or ADHD, such as lisdexamfetamine and amphetamine/dextroamphetamine salts, and anti-anxiety medications can also cause this problem.
Lithium, a mood-stabilizing drug, can cause dehydration, Feder added.
Lifestyle habits that are important for managing mental health symptoms can also come into play. Hot temperatures can also disrupt sleep, an important factor in managing mental health symptoms, experts said.
Additionally, “the nature of most mental health conditions is that once you’re diagnosed, you’re at risk for recurrent episodes of that illness,” Feder said. “And these events often lead to some kind of stress. And climate disasters are certainly stressful.”
Homelessness is also high among people with mental health conditions, particularly in the schizophrenic population.
“And if you’re homeless during a heat wave, that puts you at increased risk of death, because you don’t have access to air conditioning,” Feder said.
Behavior due to these conditions can contribute to a higher risk of heat-related illness or death. For example, the psychosis that people with schizophrenia may experience, is that they are not interpreting reality correctly, so “they may not even know that they are overheated, or b ‘maybe they think it is because of the source in which they are overheated. some strange or irrational reason and not doing something appropriate to get out of the heat or make themselves (safer),” Feder said.
People with mental health problems are also more likely to self-medicate with drugs that affect their body’s ability to sense and respond to heat.
How to protect yourself and others
If you are on any of these medications and you think about not taking them anymore, your solution is, don’t be so quick. “That would be much worse than staying on the medication,” which plays a critical role in your treatment, Wortzel said.
Talk to your doctor about whether you are on or starting medication that makes you more vulnerable to extreme heat as some leaflets for these drugs may not list that risk as a possible side effect.
“These are just warnings,” he said, “to make sure you’re staying in cooler environments, making sure you’re hydrated – if climate change continues to worsen, this will in fact. an effect we will have to worry about more and more.”
It’s not a reason to stop taking antipsychotics, Wortzel said, but it’s a good reason to take care of yourself in the heat.
Tackling the climate crisis, the root of the problem, is of course the most important solution, Wortzel said. What is also necessary at a policy level, he said, is to expand access to cooling centers and other resources, and to provide more funding for research that would help us better understand the impact of heat on mental health.
There are steps that individuals and communities can take to protect vulnerable people when hot weather arrives.
“Patients need to be aware that they are at risk of stress,” Wortzel said. “You have to make sure you have access to air conditioning, a cooling center, to stay hydrated and make sure you’re monitoring how much you’re outside, (that) you’re not out in the hottest times. the day, things like that.”
Wear sunscreen, hats and light-colored, loose clothing, Crank said. Having cold showers can keep your core temperature down.
“The other thing people can do is start engaging in climate action,” Feder said. “Because of the concern about climate change, the best thing people can do is to join climate (advocacy) groups and start working on changes to the climate crisis.”
Feder also suggested people write or talk to their legislators about the issue.
You should also let your loved ones know about your vulnerabilities so they can offer support.
If you are not someone who is more at risk and are wondering how you can help, practice compassion and awareness by keeping bottles of water in your car to hand out to those who are more at risk of harm from extreme heat.
“Take the time, if you see someone in distress, call some kind of emergency services so they can get medical attention,” Crank said. This will probably only take a few minutes out of your day.
Correction: An older version of this story incorrectly stated the study authored by Dr. Peter Crank.
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