Polydipsia and water intoxication in psychiatric patients: A review of the epidemiological literature

doi:10.1016/0006-3223(94)90008-6

Biological Psychiatry

Volume 35, Issue 6, 15 March 1994, Pages 408-419

https://doi.org/10.1016/0006-3223(94)90008-6 Get rights and content

Abstract

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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Diabetes insipidus: Diabetes insipidus is an uncommon disturbance in water metabolism resulting from a deficiency in the action of the antidiuretic hormone caused either by neurohypophyseal disorder difficulty its secretion (central diabetes insipidus) or by impaired renal response (nephrogenic diabetes insipidus). Clinically is characterized by polydipsia and polyuria. Water deprivation test, which assesses the ability of the kidney to concentrate urine, is the confirmatory diagnostic test. Differential diagnosis includes: primary polydipsia (hypotonic urination secondary to excessive fluid intake) and osmotic diuresis. In order to distinguish between central and nephrogenic diabetes insipidus, vasopressin levels and desmopressin response have to be assessed. Desmopressin is the treatment of central diabetes insipidus. On the other hand, and in order to facilitate kidney urine concentration, diuretic drugs (mainly thiazide diuretics) appear as the treatment of nephrogenic diabetes insipidus.
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Review articlePolydipsia and water intoxication in psychiatric patients: A review of the epidemiological literature

Abstract

Am J Med

Gen Hosp Psychiatry

Biol Psychiatry

Am J Med Sci

Psychiatry Res

Prog Neuropsychopharmacol Biol Psychiatry

Biol Psychiatry

J Urol

Biol Psychiatry

Psychosomatics

Biol Psychiatry

Biol Psychiatry

Schizophr Res

Biol Psychiatry

Biol Psychiatry

Role of cigarette use in hyponatremia in schizophrenic patients

Am J Psychiatry

Compulsive water drinking

Q J Med

The possible role of tobacco smoking in hyponatremia of long-term psychiatric patients

JAMA

Somatic findings in patients withd psychogenic polydipsia

J Clin Psychiatry

Polydipsia and water intoxication in a mental handicap hospital

Br J Psychiatry

Polydipsia in chronic psychiatric patients body weight and plasma sodium

Br J Psychiatry

Inappropriate antidiuretic state in long-term psychiatric inpatients

South African Med J

Prevalence of polydipsia among public psychiatric patients

Psychol Rep

Water intoxication in patients with psychiatric illness

Br Med J

Sex differences result in increased morbidity from hyponatremia in female rats

Am J Physiol

Hyponatremia in patients with schizophrenia

South Med J

Prevalence of polyuria among chronically psychotic men

Psychiatr Med

A rational approach to disorders of water balance in psychiatric patients

Hosp Comm Psychiatry

Neuroleptics do not worsen hyponatremia in hyponatremic psychotics

Schizophr Res

Prevention of episodic water intoxication with target weight procedure

Am J Psychiatry

Mechanisms of altered water metabolism in psychotic patients with polydipsia and hyponatremia

N Engl J Med

Review article
Polydipsia and water intoxication in psychiatric patients: A review of the epidemiological literature