Psychogenic polydipsia review: Etiology, differential, and treatment

Dundas, Brian; Harris, Melissa; Narasimhan, Meera

doi:10.1007/s11920-007-0025-7

Cited by 117 publications

(105 citation statements)

References 38 publications

(57 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In extremely severe acute hyponatremia the clinical picture rapidly progresses to coma and death outcome [3,10]. In presented case, the patient was particularly complicated because of a diagnosis of idiopathic epilepsy in medical history, with antiepileptic therapy prescribed.…”

Section: Discussionmentioning

confidence: 89%

“…Among the general population, the fatal outcome occurs at considerably higher sodium concentrations, usually below 120 mmol / L 10 . Possible cause for tolerance of such an extreme hyponatremia in our case is chronic water intoxication, i.e.…”

Section: Discussionmentioning

confidence: 99%

“…[4]. A special subset of polydipsia is psychogenic polydipsia, characterized by compulsive drinking of water in a population of psychiatric patients, most often those suffering from psychosis [5]. At the Department of Emergency Medicine, water intoxication can be a major diagnostic challenge, especially in the sense of differential diagnosis versus neurological conditions such as epilepsy.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Severe Hyponatremia and Water Intoxication – Diagnostic Challenge in Department of Emergency Medicine

Pupić-Bakrač

Radović

Pupić‐Bakrač

et al. 2017

Alcoholism and psychiatry research

View full text Add to dashboard Cite

-Psychogenic polydipsia is a disorder characterized by compulsive drinking of water in a population of psychiatric patients, most often those suffering from chronic psychosis. It can lead to severe dilutional hyponatremia and water intoxication, which is manifested by cerebral edema and associated neurological symptomatology. A 43 years-old patient was admitted to the Department of Emergency Medicine due to convulsions of the right hand and leg, which began one hour before arrival. During the episode, the patient was conscious, vomited once and had urinary incontinence. In the medical history he had epilepsy, chronic psychosis and moderate mental retardation. Vital parameters were stable, and physical examination did not reveal any associated pathological signs. Samples for laboratory analysis were taken and therapy with infusions of Diasepam (20 mg) included, to which patient was resistant. By heteroanamnesis it was acknowledged that in the last few days he spent more time than usual drinking water. Reviewing laboratory results it was found out that sodium concentration was 98 mmol/L. We began the gradual correction of sodium, after which the patient reached the full extent of recovery. Water intoxication is an emergency condition that is in clinical practice often mistaken for other neurological and internal emergency states, because of its non-specific symptomatology. With timely diagnosis and application of adequate treatment, recovery is complete.

show abstract

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Severe Hyponatremia and Water Intoxication – Diagnostic Challenge in Department of Emergency Medicine

Pupić-Bakrač

Radović

Pupić‐Bakrač

et al. 2017

Alcoholism and psychiatry research

View full text Add to dashboard Cite

show abstract

“…As a result, treatment options for this condition are scarce and the evidence on their efficacy is weak. 1,2 Clozapine has been proposed as a possible therapeutic alternative based on a few case reports. 1 However, in a recent study investigating the effects of clozapine and haloperidol in an animal model of psychogenic polydipsia induced by quinpirole, haloperidol showed superior efficacy in reverting polydipsia.…”

Section: Clozapine Treatment For Schizophrenia-related Polydipsiamentioning

confidence: 99%

Clozapine treatment for schizophrenia-related polydipsia

Diniz

Cordeiro

Zung

2010

Rev. Bras. Psiquiatr.

View full text Add to dashboard Cite

“…Although multiple factors have been implicated, possibly including hypothalamic dysfunction, syndrome of inappropriate secretion of ADH (SIADH), and adverse medication effects, the underlying pathophysiology of psychogenic polydipsia is still unclear [1]. The author encountered a case of cerebral edema secondary to psychogenic polydipsia possibly related to the coadministration of tandospirone with olanzapine, which seems to reduce serotonergic activity, probably via its agonistic activity toward serotonin autoreceptors.…”

mentioning

confidence: 99%

Cerebral edema secondary to psychogenic polydipsia induced by tandospirone as add-on to olanzapine therapy

Nagamine¹

2014

CNPT

View full text Add to dashboard Cite

Psychogenic polydipsia is not a rare complication in patients with schizophrenia, and has been recognized as a dangerous and potentially life-threatening disorder. Although multiple factors have been implicated, possibly including hypothalamic dysfunction, syndrome of inappropriate secretion of ADH (SIADH), and adverse medication effects, the underlying pathophysiology of psychogenic polydipsia is still unclear [1]. The author encountered a case of cerebral edema secondary to psychogenic polydipsia possibly related to the coadministration of tandospirone with olanzapine, which seems to reduce serotonergic activity, probably via its agonistic activity toward serotonin autoreceptors. A 69-year-old female inpatient with schizophrenia was found with unconsciousness and generalized tonic clonic seizures 3 days after the initiation of tandospirone as add-on to olanzapine therapy. She had been diagnosed as schizophrenic since she was in her twenties, after her first psychotic break, and had been treated with several medications with varying degrees of success. Recently, her delusions had been well controlled by olanzapine 20 mg/day. Although she had been mildly but chronically polydipsic for many years, severe hyponatremia and convulsions had not been observed. Tandospirone 20 mg/day was added to olanzapine for the treatment of psychotic depression. However, she experienced convulsions 3 days after the initiation of tandospirone. A nasogastric tube was inserted, and a large amount of clear liquid was removed from her stomach. The patient's initial serum sodium level was 112 mmol/L, representing a marked decrease from the level of 142 mmol/L 20 days earlier ( Fig.1) A non-contrast computed tomographic scan of the patient's brain revealed a loss of gray-white differentiation and sulcal effacement, consistent with cerebral edema. She was diagnosed as having acute hyponatremia, presumably secondary to psychogenic polydipsia. Based on the clinical severity of the cerebral edema, she was treated with the rapid infusion of normal saline and a loop diuretic at the rate required for sodium correction of 1.0 mmol/L/hr while her serum sodium level was closely monitored. The patient's serum sodium level rapidly increased from 112 mmol/L to 131 mmol/L in 24 hours, and she excreted 7.2 liters of urine in 24 hours. On day 3, the patient was awake and alert, and recovered her orientation to person, place and time, as her sodium level recovered to 137 mmol/L. However, after the patient's hyponatremia was corrected, she developed a substantial elevation in her creatine kinase (CK) level, indicating rhabdomyolysis, possibly due to the calcium-sodium exchange mechanism across the skeletal myocyte or the failure of cell volume regulation secondary to extracellular hypo-osmolality. Fortunately, the asymptomatic rhabdomyolysis resolved without treatment on day 9, and the patient's overall condition was good, and she did not experience any additional seizures (Fig. 1). .

show abstract

Psychogenic polydipsia review: Etiology, differential, and treatment

Cited by 117 publications

References 38 publications

Severe Hyponatremia and Water Intoxication – Diagnostic Challenge in Department of Emergency Medicine

Severe Hyponatremia and Water Intoxication – Diagnostic Challenge in Department of Emergency Medicine

Clozapine treatment for schizophrenia-related polydipsia

Cerebral edema secondary to psychogenic polydipsia induced by tandospirone as add-on to olanzapine therapy

Contact Info

Product

Resources

About