The Syndrome of Self‐Induced Water Intoxication in Psychiatric Patients

Abstract

This is a report on six psychiatric patients who indulged in excessive ingestion of water and subsequently developed tonic‐clonic seizures in the course of the underlying mental disorders. On the basis of the DSM‐III criteria, they were diagnosed as follows: schizophrenic disorder, 4; schizoaffective disorder, 1; borderline personality disorder, 1. The levels of serum electrolytes were estimated during five episodes of seizures in three patients. Hyponatremia was a consistent finding (serum sodium: mean = 120.6 mEq/liter). Plasma osmolality and plasma levels of arginine vasopressin (AVP) were determined during two episodes in two patients. The inappropriately high circulating levels of AVP relative to plasma hypoosmolality were documented. However, the response to the overnight fluid deprivation and acute water load during the period of no seizures in two patients revealed no evidence of the persistent SIADH, suggesting the temporal association of hyponatremic encephalopathy with inappropriate AVP secretion. It is not conclusive whether the transient SIADH is the cause or the consequence of hyponatremic encephalopathy, although a delusion or an auditory hallucination could play a critical role in drinking water excessively in three patients.

A review on hyponatremia associated with SSRIs, reboxetine and venlafaxine

“…In sporadic cases of antidepressant-induced hyponatremia elevated vasopressin levels have been observed [96].…”

Psychogenic Polydipsia leading to Hyponatremia induced Seizure in Schizophrenia.

“…Primary symptoms of hyponatremia are drowsiness, restlessness, myoclonic jerks and generalized convulsions and it leads coma and death if not treated properly, it occurs in indoor settings or outpatient psychiatric patients (2). Clinical picture PPD seen 6 to 20 percent of psychiatric patient mainly schizophrenia, where patients are having sensation of excessive thirst and compulsive drinking, without a clear underlying pathophysiology (3,4) lead to over-hydration, resulting in disruption of fluid and electrolyte balance with potentially fatal consequences (5).…”

Über selbstinduzierte Wasserintoxikation bei schizophrenen Patienten

“…Von den 3 Patienten ohne SIADH ist bei einem die Medikation nicht bekannt, 1 Patient erhielt Amitriptylin und 1 Patient Hydrochlorothiazid. Möglicherweise läßt sich der Umstand, daß nicht alle schizophrenen Patienten mit Wasserint,)xikation ein SIADH aufweisen, durch ein nur temporäres Vorhandensein dieses Syndroms erklären(26). Jedenfalls scheinen Zusammenhänge zwischen psychischer bzw.…”