2021年6月，一场破纪录的热穹笼罩加拿大温哥华，气温飙升超过摄氏39度，夜间也无法降温。急诊医师Jeff Yoo面对大量中暑患者涌入，医院冰块耗尽、病床不足，走廊挤满担架。他抢救了一名昏倒在人行道上的中年男子，该男子严重脱水、肾脏衰竭，最终靠冰敷和膀胱导管输入冷液才稳定下来。Yoo注意到，许多热穹期间送医的患者都有一个共同特征：他们患有思觉失调症。

研究显示，思觉失调症患者在极端高温中的死亡风险是其他慢性病的三倍，远超心脏病、糖尿病和气喘等疾病。其原因是多层次的：患者的多巴胺调节异常影响体温控制，交感与副交感神经系统失衡导致心血管功能受损，而抗精神病药物的抗胆碱作用会抑制排汗，进一步削弱散热能力。此外，高温本身会加剧思觉失调症状，使患者陷入恐惧与战斗逃跑反应的恶性循环。患者往往缺乏对自身健康状况的认知，可能不知道补水或降温，甚至在酷暑中穿上多层衣物。

除了生理因素，社会性风险同样致命。许多思觉失调症患者因偏执症状而回避媒体，不知道热浪即将来袭；社会污名使他们不敢前往公共降温中心；贫困导致住所缺乏空调——98%的热穹死亡发生在室内。不列颠哥伦比亚省此后投入1.48亿加元增聘急救人员、将思觉失调症列为高温高风险首位、建立照护者联系机制、推出免费冷气机计划并更新紧急警报系统。波特兰的经验也表明，在降温中心部署行为健康工作者能有效帮助犹豫不前的患者，甚至挽救生命。随著全球暖化加剧，针对这一最脆弱群体的系统性保护措施刻不容缓。

During the unprecedented 2021 heat dome that engulfed Vancouver, British Columbia, temperatures soared past 102°F for over a week, overwhelming emergency rooms with heat-related patients. ER doctor Jeff Yoo at St. Paul's Hospital witnessed the crisis firsthand as 911 calls doubled, ice supplies ran out, and hallways filled with stretcher-bound patients. Among those he treated was an unconscious man found on the sidewalk suffering severe heatstroke and kidney failure, who had to be physically restrained and cooled with ice packs and a bladder catheter. Yoo noticed a striking pattern: many of the heat dome's victims exhibited symptoms of schizophrenia, a condition affecting roughly one percent of the global population.

Subsequent research revealed that schizophrenia carries a threefold increase in the odds of heat-related death—far exceeding every other chronic condition studied, including heart disease, diabetes, and dementia. The vulnerability stems from compounding biological factors: impaired dopamine regulation disrupts thermoregulation, an imbalance between the sympathetic and parasympathetic nervous systems compromises cardiovascular function, and antipsychotic medications suppress sweating through anticholinergic effects. Heat itself can also trigger worsening psychiatric symptoms, creating a vicious feedback loop of anxiety, fear, and physiological stress. Beyond these internal factors, many patients lack insight into their deteriorating condition and may fail to hydrate or cool themselves, sometimes even adding layers of clothing in extreme heat.

Social and structural barriers compound the physiological risks dramatically. Many people with schizophrenia avoid news media due to paranoia, leaving them unaware of approaching heat waves. Stigma discourages them from visiting public cooling centers, and poverty means their homes often lack air conditioning—98 percent of heat dome deaths occurred indoors. Since 2021, British Columbia has invested $148 million in emergency services, prioritized schizophrenia in heat-risk guidelines, launched a free air conditioner program serving 40,000 people, and updated cell phone alert systems for extreme heat. Portland's experience demonstrated that stationing behavioral health workers at cooling centers can effectively reach hesitant individuals and save lives. As climate change drives increasingly frequent extreme heat events, experts emphasize that addressing stigma alongside practical interventions like cooling access and pharmacist-led medication counseling is essential to protecting this uniquely vulnerable population.