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Evanson DJ, Espiridion ED. The Catastrophic Effects of Psychogenic Polydipsia: A Case Report. Cureus 2023; 15:e44766. [PMID: 37809219 PMCID: PMC10557044 DOI: 10.7759/cureus.44766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
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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Affiliation(s)
- Davin J Evanson
- Division of Diagnostic Radiology, Drexel University College of Medicine, Wyomissing, USA
| | - Eduardo D Espiridion
- Psychiatry, West Virginia School of Osteopathic Medicine, Lewisburg, USA
- Psychiatry, Drexel University College of Medicine, Philadelphia, USA
- Psychiatry, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
- Psychiatry, Reading Hospital - Tower Health, West Reading, USA
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Komatsu H, Ono T, Onouchi Y, Onoguchi G, Maita Y, Ishida Y, Maki T, Oba A, Tomita H, Kakuto Y. Polydipsia and autistic traits in patients with schizophrenia spectrum disorders. Front Psychiatry 2023; 14:1205138. [PMID: 37484674 PMCID: PMC10359144 DOI: 10.3389/fpsyt.2023.1205138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Polydipsia, prevalent in 6%-20% of patients with schizophrenia, results in seclusion and prolonged hospitalization. It is also observed in autistic individuals, with previous studies reporting that autism accounted for 20% of all hospitalized patients with polydipsia. The current study investigated the association between polydipsia and autistic traits in patients with schizophrenia spectrum disorders (SSDs) based on the hypothesis that higher autistic traits would be observed in schizophrenic patients with polydipsia. Methods In the first study (study A), the autism-spectrum quotient [(AQ); Japanese version] scores of long-stay inpatients with and without polydipsia were compared. Furthermore, the association between polydipsia and autistic traits was also examined in short-stay inpatients and outpatients with SSDs (study B). Results Study A showed that patients with polydipsia scored significantly higher on the three AQ subscales (attention switching; communication; and imagination) compared to those without. Study B also showed that patients with polydipsia had significantly higher AQ scores overall and for several subscales compared to those without polydipsia. Binary logistic regression analysis of the combined sample showed that male gender and higher autistic traits were significant predictors of polydipsia. Discussion The study highlights the importance of focusing on such traits to understand the pathogenesis of polydipsia in SSD patients.
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Affiliation(s)
- Hiroshi Komatsu
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan
- Department of Psychiatry, Graduate School of Medicine, Tohoku University, Sendai, Japan
- Miyagi Psychiatric Center, Natori, Japan
| | | | | | - Goh Onoguchi
- Department of Psychiatry, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | | | | | | | - Akiko Oba
- Miyagi Psychiatric Center, Natori, Japan
| | - Hiroaki Tomita
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan
- Department of Psychiatry, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Yoshihisa Kakuto
- Miyagi Psychiatric Center, Natori, Japan
- Department of Community Psychiatry, Graduate School of Medicine, Tohoku University, Sendai, Japan
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Interoception abnormalities in schizophrenia: A review of preliminary evidence and an integration with Bayesian accounts of psychosis. Neurosci Biobehav Rev 2021; 132:757-773. [PMID: 34823914 DOI: 10.1016/j.neubiorev.2021.11.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/31/2021] [Accepted: 11/13/2021] [Indexed: 01/07/2023]
Abstract
Schizophrenia research has traditionally focused almost exclusively on how the brain interprets the outside world. However, our internal bodily milieu is also central to how we interpret the world and construct our reality: signals from within the body are critical for not only basic survival, but also a wide range of brain functions from basic perception, emotion, and motivation, to sense of self. In this article, we propose that interoception-the processing of bodily signals-may have implications for a wide range of clinical symptoms in schizophrenia and may thus provide key insights into illness mechanisms. We start with an overview of interoception pathways. Then we provide a review of direct and indirect findings in various interoceptive systems in schizophrenia and interpret these findings in the context of computational frameworks that model interoception as hierarchical Bayesian inference. Finally, we propose a conceptual model of how altered interoceptive inference may contribute to specific schizophrenia symptoms-negative symptoms in particular-and suggest directions for future research, including potential new avenues of treatment.
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Havens TH, Innamorato G, Nemec EC. Non-antipsychotic pharmacotherapy of psychogenic polydipsia: A systematic review. J Psychosom Res 2021; 152:110674. [PMID: 34856427 DOI: 10.1016/j.jpsychores.2021.110674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 10/29/2021] [Accepted: 11/09/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Polydipsia is defined at the intake of excessive fluid (>3 L daily). Psychogenic polydipsia (PPD) presents without an identifiable medical cause and is often seen in patients with diagnoses of schizophrenia, OCD, anxiety, alcohol use disorder, and other psychotic disorders. The purpose of this systematic review is to assess the therapeutic effect of various non-antipsychotic medications on patients with a stable psychotic illness and concurrent PPD. METHODS A systematic search was conducted using the following databases: PubMed, MEDLINE with Full Text, CINAHL complete, Cochrane database of systematic reviews, Cochrane methodology register, MasterFILE Premier, APA PsychArticles, APA PsychInfo, APA PsycBooks, APA PsycTests, TRIP, Nursing and Allied Health. The quality of each retained study was assessed using appropriate risk of bias tools based on study design. RESULTS The initial search resulted in 1422 articles from which 22 articles were included for qualitative synthesis. Study designs ranged from case reports to double blind, placebo controlled randomized trials and was interpreted uniquely based on study design. Acetazolamide was effective in improving some PPD outcomes. Fluoxetine at high doses was effective in reducing fluid intake and polydipsia. Other medications included in this review performed equivocally for reduction of numerous parameters evaluating PPD. CONCLUSION No one drug appeared to be the most efficacious; however, some did show promise in specific populations. Those in need of pharmacotherapeutic options for PPD may consider one of the included agents to assist with co-morbid state. Further high-quality research is needed to provide better treatment guidance for PPD.
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Affiliation(s)
- Thomas H Havens
- Sacred Heart University, College of Health Professions, 5151 Park Ave, Fairfield, CT 06825, United States of America.
| | - Gaetano Innamorato
- Sacred Heart University, College of Health Professions, 5151 Park Ave, Fairfield, CT 06825, United States of America.
| | - Eric C Nemec
- Sacred Heart University, College of Health Professions, 5151 Park Ave, Fairfield, CT 06825, United States of America.
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Low-Dose Lurasidone-Induced Polydipsia Complicated by Hyponatremia in a Patient With Bipolar Disorder. Clin Neuropharmacol 2021; 44:243-244. [PMID: 34561339 DOI: 10.1097/wnf.0000000000000481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Atypical antipsychotic-induced hyponatremia has been reported in patients with psychiatric disorders. To date, hyponatremia due to lurasidone, an atypical antipsychotic approved for the treatment of schizophrenia and bipolar depression, has never been reported. CASE REPORT A female patient with bipolar depression and a history of subdural hematoma experienced a rapid onset of hyponatremia after the initiation of low-dose lurasidone. The hyponatremia worsened after the dose of lurasidone was increased and resolved only after lurasidone was ceased. According to the Naranjo Adverse Drug Reaction Probability Scale, this case report scores 6 as a possible drug reaction between lurasidone and hyponatremia. RESULTS Based on laboratory results, the syndrome of inappropriate antidiuretic hormone secretion and thyroid or adrenal dysfunction as differential diagnoses were excluded. Lurasidone-induced polydipsia complicated by hyponatremia was confirmed. Lurasidone was subsequently discontinued. The sodium level returned to normal within 1 week without any sodium supplementation. CONCLUSIONS This case report highlighted that low-dose lurasidone may induce polydipsia complicated by hyponatremia. Physicians should be aware of the adverse reactions of hyponatremia associated with lurasidone, particularly in patients with a history of intracranial hemorrhage.
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Akbas Aliyev ES, Günal Okumuş H, Karakus Y, Ersoz Alan B, Cak HT. Letter to the Editor: Olanzapine Treatment and Polyuria-Polydipsia in Two Children with Autism Spectrum Disorder. J Child Adolesc Psychopharmacol 2021; 31:513. [PMID: 34076494 DOI: 10.1089/cap.2020.0164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ecem Selin Akbas Aliyev
- Department of Child and Adolescent Psychiatry, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Hande Günal Okumuş
- Department of Child and Adolescent Psychiatry, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Yagmur Karakus
- Department of Child and Adolescent Psychiatry, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Burcu Ersoz Alan
- Department of Child and Adolescent Psychiatry, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Halime Tuna Cak
- Department of Child and Adolescent Psychiatry, School of Medicine, Hacettepe University, Ankara, Turkey
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Takeda K, Kobayashi C, Nakai T, Oishi T, Okada A. Analysis of the Frequency and Onset Time of Hyponatremia/Syndrome of Inappropriate Antidiuretic Hormone Induced by Antidepressants or Antipsychotics. Ann Pharmacother 2021; 56:303-308. [PMID: 34210184 DOI: 10.1177/10600280211030270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hyponatremia and syndrome of inappropriate antidiuretic hormone (SIADH) is a potentially fatal adverse effect of antidepressants (ADs) and antipsychotics (APs), although its frequency and onset time have not been well documented. OBJECTIVE To analyze the frequency and onset time of AD- or AP-induced hyponatremia/SIADH. METHODS We used plural data-mining techniques to search the US Food and Drug Administration Adverse Event Reporting System (FAERS) database for reports on hyponatremia/SIADH induced by psychotropic drugs from January 2004 to June 2020. For each item, we assessed the reporting odds ratio, 95% CI, median onset time, and Weibull distribution parameters. RESULTS We identified 36 422 reports related to hyponatremia/SIADH. Signals were detected for all psychotropic drugs that we analyzed, except for clozapine. The median onset time of total AD-induced hyponatremia/SIADH was shorter than that of AP. For all ADs and APs except clozapine, hazards were considered to be the early failure type. In contrast, the hazard of clozapine was considered to be the random failure type. The limitations of this study included several reporting biases and the presence of confounding variables, particularly age. CONCLUSION AND RELEVANCE Most ADs and APs were found to be associated with a risk for hyponatremia/SIADH. In addition, sufficient attention should be paid to signs of hyponatremia/SIADH in the early phase when most ADs and APs are administered. These data are potentially useful for determining AD- or AP-induced hyponatremia/SIADH in the early stage and for preventing its further aggravation into a serious condition.
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Affiliation(s)
- Koki Takeda
- Mie Prefectural Shima Hospital, Shima, Mie, Japan
| | | | - Taketo Nakai
- Mie Prefectural Shima Hospital, Shima, Mie, Japan
| | - Teruki Oishi
- Mie Prefectural Shima Hospital, Shima, Mie, Japan
| | - Akira Okada
- Musashino University, Nishitokyo-shi, Tokyo, Japan
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Development of diagnostic criteria and severity scale for polydipsia: A systematic literature review and well-experienced clinicians' consensus. Psychiatry Res 2021; 297:113708. [PMID: 33461119 DOI: 10.1016/j.psychres.2021.113708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 12/31/2020] [Indexed: 11/21/2022]
Abstract
Despite the clinical importance of polydipsia, no diagnostic criteria or severity scales that comprehensively assess this condition are available. Thus, we aimed to develop diagnostic criteria and a severity scale for polydipsia based on a systematic review and well-experienced clinicians' consensus. We performed a systematic review, identified 27 studies related to diagnostic criteria or severity classification for polydipsia, and extracted items used to assess polydipsia in these studies. Ten well-experienced clinicians-5 psychiatrists and 5 nurses-participated in the Delphi method. They evaluated 39 items extracted based on the results of the systematic review regarding (1) their necessity in diagnosing and assessing the severity of polydipsia, and (2) their relative importance rated on 7-point scale among the items included in the severity scale. The Polydipsia Diagnostic Criteria (PDC) included 4 essential items-excessive drinking, low serum sodium level or low serum osmolality, abnormal normalized diurnal weight gain, and low urine specific gravity-based on consensus reached using the Delphi method. The Polydipsia Severity Scale (PSS) included 13 items with a maximum score of 59. The first diagnostic criteria and symptom scale for polydipsia were developed based on the findings of a systematic review and well-experienced clinicians' consensus.
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Psychogenic Polydipsia Complicated to Hyponatremia Induced Seizure in Schizophrenia: A Case Report from Nepal. Case Rep Psychiatry 2019; 2019:6021316. [PMID: 31827965 PMCID: PMC6885238 DOI: 10.1155/2019/6021316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/09/2019] [Indexed: 11/17/2022] Open
Abstract
Psychogenic polydipsia is one of the common cooccurrences with Schizophrenia and if not addressed can lead to fatal consequences. There are some evidences for pharmacological management of this condition but nonpharmacological management starting from psycho-education to behavioural modification therapy involving family members can be a very effective strategy. We report a case from Nepal where psychogenic polydipsia was complicated to hyponatremia and lead to seizure episodes. We emphasize on asking a routine question about polydipsia in every patient of Schizophrenia in clinics.
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