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      The Catastrophic Effects of Psychogenic Polydipsia: A Case Report

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      Author(s): 1 , , 2 , 3 , 4 , 5
      Editor(s): ,
      Publication date (Electronic, pub):
      Publication date (Electronic, collection):
      Journal: Cureus
      Publisher: Cureus
      Keywords: water intoxication, delirium, schizophrenia, hyponatremia, psychogenic polydipsia

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          Abstract

          Patients with hyponatremia are at risk of severe complications including seizures, coma, and death. Psychiatric patients are particularly susceptible to death from hyponatremia due to the association between psychiatric conditions and psychogenic polydipsia, characterized by water intoxication. We report a case of a schizophrenic patient who presented with altered mental status, leading to a differential diagnosis narrowed through clinical investigations to include hypovolemic hyponatremia, syndrome of inappropriate antidiuretic hormone secretion (SIADH), and psychogenic polydipsia. This case underscores the need to inquire about schizophrenic patients' water intake, advocating for a standardized approach. The timely diagnosis of disorders causing electrolyte abnormalities can prevent severe complications and aid in the management of psychiatric patients.

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          Lithium side effects and toxicity: prevalence and management strategies

          Michael Gitlin (2016)
          Despite its virtually universal acceptance as the gold standard in treating bipolar disorder, prescription rates for lithium have been decreasing recently. Although this observation is multifactorial, one obvious potential contributor is the side effect and toxicity burden associated with lithium. Additionally, side effect concerns assuredly play some role in lithium nonadherence. This paper summarizes the knowledge base on side effects and toxicity and suggests optimal management of these problems. Thirst and excessive urination, nausea and diarrhea and tremor are rather common side effects that are typically no more than annoying even though they are rather prevalent. A simple set of management strategies that involve the timing of the lithium dose, minimizing lithium levels within the therapeutic range and, in some situations, the prescription of side effect antidotes will minimize the side effect burden for patients. In contrast, weight gain and cognitive impairment from lithium tend to be more distressing to patients, more difficult to manage and more likely to be associated with lithium nonadherence. Lithium has adverse effects on the kidneys, thyroid gland and parathyroid glands, necessitating monitoring of these organ functions through periodic blood tests. In most cases, lithium-associated renal effects are relatively mild. A small but measurable percentage of lithium-treated patients will show progressive renal impairment. Infrequently, lithium will need to be discontinued because of the progressive renal insufficiency. Lithium-induced hypothyroidism is relatively common but easily diagnosed and treated. Hyperparathyroidism from lithium is a relatively more recently recognized phenomenon.
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            Polydipsia and water intoxication in psychiatric patients: a review of the epidemiological literature.

            José de León, Cherian Verghese, Joseph Tracy … (1994)
            Polydipsia among chronic psychiatric patients is poorly understood and underdiagnosed. It may have three stages: simple polydipsia, polydipsia with water intoxication, and physical complications. Epidemiological surveys have used staff reports and polyuria measures to identify polydipsic patients. Water intoxication has been screened by chart review, weight, or serum sodium data. According to these surveys, polydipsia, not explained by medically induced polyuria, may be present in more than 20% of chronic inpatients. Up to 5% of chronic inpatients had episodes of water intoxication although mild cases may have been missed. Single time point surveys show that 29% of polydipsic patients had presented water intoxication. Methodologically limited clinical studies suggest that polydipsia with water intoxication rather than simple polydipsia may be associated with poor prognosis in schizophrenia. Epidemiological surveys found polydipsia with water intoxication to be associated with chronicity, schizophrenia, smoking, some medications, male gender, and white race. New pathophysiological models need to elucidate these findings.
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              Psychogenic polydipsia review: etiology, differential, and treatment.

              Brian Dundas, Melissa Harris, Meera Narasimhan (2007)
              Psychogenic polydipsia (PPD), a clinical disorder characterized by polyuria and polydipsia, is a common occurrence in inpatients with psychiatric disorders. The underlying pathophysiology of this syndrome is unclear, and multiple factors have been implicated, including a hypothalamic defect and adverse medication effects. Hyponatremia in PPD can progress to water intoxication and is characterized by symptoms of confusion, lethargy, and psychosis, and seizures or death. Evaluation of psychiatric patients with polydipsia warrants a comprehensive evaluation for other medical causes of polydipsia, polyuria, hyponatremia, and the syndrome of inappropriate secretion of antidiuretic hormone. The management strategy in psychiatric patients should include fluid restriction and behavioral and pharmacologic modalities.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 6 September 2023
                Publication date (Electronic, collection): September 2023
                Volume: 15
                Issue: 9
                Electronic Location Identifier: e44766
                Affiliations
                [1 ] Division of Diagnostic Radiology, Drexel University College of Medicine, Wyomissing, USA
                [2 ] Psychiatry, West Virginia School of Osteopathic Medicine, Lewisburg, USA
                [3 ] Psychiatry, Drexel University College of Medicine, Philadelphia, USA
                [4 ] Psychiatry, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
                [5 ] Psychiatry, Reading Hospital - Tower Health, West Reading, USA
                Author notes
                Davin J. Evanson dje46@ 123456drexel.edu
                Article
                DOI: 10.7759/cureus.44766
                PMC ID: 10557044
                PubMed ID: 37809219
                SO-VID: 430c60c2-d691-4f96-aadd-3ee5faa5a7df
                Copyright © Copyright © 2023, Evanson et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date accepted : 6 September 2023
                Categories
                Subject: Neurology
                Subject: Psychiatry
                Subject: Nephrology

                Keywords: water intoxication,delirium,schizophrenia,hyponatremia,psychogenic polydipsia
                Data availability:
                Keywords: water intoxication, delirium, schizophrenia, hyponatremia, psychogenic polydipsia

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