Treatment of Polydipsia and Hyponatremia in Psychiatric Patients

Abstract

Polydipsia occurs frequently in chronic schizophrenic patients, some of whom develop intermittent hyponatremia. Most therapeutic efforts have tried to control the hyponatremia. Four schizophrenic patients, followed for more than one year, showed improvement on clozapine. Case 1 was an outpatient without history of hyponatremia who improved from polydipsia and psychosis. The last three were inpatients with polydipsia, intermittent hyponatremia, and psychosis who showed minimal improvement of psychosis but significant decrease in polydipsia and water intoxication. Case 2 relapsed to polydipsia when clozapine was discontinued on two occasions. Case 3 demonstrated polyuria during 39% of days before clozapine and in 0% of days after two weeks of clozapine. In case 4, most baseline sodium levels were abnormal, but all became normal after clozapine. A time-series analysis for intervention effects showed a significant effect of clozapine (p = .017). The limited information provided by these case reports suggest the need for controlled studies of the clozapine effect on polydipsic patients.

Compulsive water drinking: a case report

“…Obsessions, compulsions, and water intake were significantly reduced during discharge. Antipsychotics were more emphasized in the treatment of psychogenic polydipsia, clozapine has been shown to be the most effective antipsychotic (7). Although excessive water drinking with fluoxetine has been reported, excessive water drinking has been reduced by fluoxetine treatment in our case.…”

“…were used. (1,(6)(7)(8). Although there are other reports in literature that fluoxetine improves water intake by causing inappropriate ADH release, in this case, fluoxetine was successful in the treatment of psychogenic polydipsia secondary to OCD.…”

Atypical antipsychotics and polydipsia: a cause or a treatment?

“…Verghese et al, 1993 hypothesized that the improvement of polydipsia with clozapine was accompanied by a significant reduction of serum PRL levels. A possible explanation of this effect is linked to its relative D2 receptors sparing and to its higher affinity for 5-HT2 than D2 receptors, coupled to a faster dissociation from the latter (de Leon et al, 1995). Among atypical antipsychotics quetiapine shows a clozapine-like preclinical profile and low potential for EPS and endocrine abnormalities, coupled to a better tolerability profile (Cheer and Wagstaff, 2004).…”

“…Elevated dopamine activity was suggested to be the mediator of thirst, but traditional neuroleptics did not prove efficacious in the management of polydipsia, and sometimes were associated to a worsening (Hirayama et al, 2001). This effect might be related, in chronic treatment, to a neuroleptic-induced dopamine supersensitivity in the hypothalamic-pituitary axis (de Leon et al, 1995), that can induce, in humans, an increased peripheral response to angiotensin II and consequently a dipsogenic activity. To avoid this eventuality, atypical antipsychotics have been used (Table 1).…”

Treatment of Catatonic Schizophrenia and Psychogenic Polydipsia with Clozapine: A Case Report

“…There are some reports which show that Clozapine can cause polydipsia and hyponatremia 7 while other reports have shown that Clozapine can ameliorate symptoms of polydipsia. 5,[8][9][10] We report a unique case of a 53 year old Caucasian man with past history of chronic schizophrenia and multiple past psychiatric hospitalizations. Patient presented with extreme stupor, mutism and polydipsia which was successfully treated with clozapine.…”