Am J Psychiatry 1988; 145:675-683
Copyright © 1988 by American Psychiatric Association
Polydipsia and hyponatremia in psychiatric patients
BP Illowsky and DG Kirch
Clinical Brain Disorders Branch, National Institute of Mental Health, St. Elizabeths Hospital, Washington, DC 20032.
Many psychiatric patients have polydipsia and polyuria without identifiable
underlying medical causes. Hyponatremia develops in some polydipsic
patients and can progress to water intoxication with such symptoms as
confusion, lethargy, psychosis, and seizures or death. This syndrome is
sometimes called "compulsive water drinking," "psychogenic polydipsia," and
"self-induced water intoxication." Although the underlying pathophysiology
of the syndrome is unclear, several factors have been implicated in
producing polydipsia and symptomatic hyponatremia. These include a possible
hypothalamic defect, the syndrome of inappropriate secretion of ADH
(SIADH), and neuroleptic medication. Evaluation of psychiatric patients
with polydipsia includes a search for other medical causes of polydipsia,
polyuria, hyponatremia, and SIADH. Treatment modalities currently available
include fluid restriction and medications.
