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[Psychogenic polydipsia in a child].

At the age of 20 months a baby girl began with compulsive water drinking. The water intake reached 4,000 ml per day. The constant drinking of water created disorganization in the family life. At the age of 2 years and 9 months, the psychogenic polydipsia is confirmed, based in the patient's ability to concentrate her urine, which was demonstrated with 1-deamino-BD arginine vasopressin (DDAVP) and the water deprivation tests. Neither bacteriological, clinical, nor radiological evidences of urinary infection were found. The intravenous pyelogram revealed a unilateral and complete duplication of the collecting system. The abnormal urinary tract does not have a causal relationship with the polyuria. With progressive water deprivation, the polydispia stopped in two months. Psychogenic polydispia is rare in infants and children. The mistake and delay in diagnosis is frequency. The differential diagnosis with cranial diabetes insipidus and urological diseases may be difficult sometimes.

Child, Preschool↗
PubMed1998

Rhabdomyolysis after correction of hyponatremia due to psychogenic polydipsia possibly complicated by clozapine.

OBJECTIVE: To report a case of rhabdomyolysis related to rapid correction of hyponatremia attributable to compulsive drinking of water, possible complicated by clozapine use. CASE SUMMARY: A 42-year-old white man treated with clozapine for schizophrenia was admitted for a generalized seizure. Marked hyponatremia due to psychogenic polydipsia was present. He developed a marked elevation of creatine kinase concentrations after correction of hyponatremia with hyperosmolar sodium solution, without clinical signs of rhabdomyolysis. DISCUSSION: Rhabdomyolysis associated with hyponatremia due to water intoxication has been reported in 17 patients to date. A possible explanation may lie within the framework of the calcium-sodium exchange across the skeletal muscle cell membrane. By increasing muscle cell permeability, clozapine treatment may possibly enhance the destruction of muscle cells. CONCLUSIONS: Hyponatremia due to water intoxication and concurrent use of clozapine should be considered in the differential diagnosis of rhabdomyolysis, especially in the severely psychiatrically disabled population.

Adult↗
PubMed1985

Psychogenic polydipsia and water intoxication--concepts that have failed.

Ten patients (8 men, 2 women; mean age 38.7 +/- 8.1 years), 7 of whom had schizophrenic disorders and 3 of whom had bipolar disorder (manic-depressive illness), manifested psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome). The relationship between serum sodium and urinary water excretion among the 10 PIP patients is described in detail. The success of lithium in improving serum sodium levels and in decreasing urinary water excretion among the three PIP patients with bipolar disorder and the failure of changes in urinary water excretion to explain changes in serum sodium levels among the 10 PIP patients argue against "psychogenesis" as the explanation for the polydipsia and excessive water intake as the sole explanation for hyponatremia or complications ascribed to water intoxication.

Adult↗
PubMed1985

Psychogenic polydipsia in a patient with anorexia nervosa.

This report describes the first reported case of compulsive water drinking (CWD) in an adolescent with anorexia nervosa (AN). The CWD appears to be a bulimic behavior with potentially serious medical complications. The concurrence of AN and CWD suggests possible hypothalamic dysfunction of food and water regulation.

Adolescent↗
PubMed2001

Treatment of psychogenic polydipsia: comparison of risperidone and olanzapine, and the effects of an adjunctive angiotensin-II receptor blocking drug (irbesartan).

OBJECTIVE: Our objective was to determine the outcome of novel strategies in managing a case of severe polydipsia. CLINICAL PICTURE: The patient was a 39-year-old male with a 20-year history of paranoid schizophrenia who, despite only mild residual psychotic symptoms, had been hospitalized for the previous 10 years because of severe polydipsic behaviour complicated by water intoxication. TREATMENT: Novel antipsychotic agents, risperidone and olanzapine, as well as the specific angiotensin-II receptor blocking drug, irbesartan were employed at selected intervals in a study lasting nearly 3 years. A strict behavioural management programme was ongoing, in which diurnal weight change and the number of breaches of weight limits, requiring management in a low-stimulus environment, were documented on a daily basis. Summary measures of diurnal weight change and behavioural intervention were charted against changes in treatment. OUTCOME: Polydipsic behaviour improved on risperidone up to 4 mg daily, but was not sustained. Olanzapine was similarly successful in stabilizing polydipsia, and improvement was achieved with the addition of irbesartan. CONCLUSION: We suggest that the D2-sparing profiles of receptor binding achieved with low-dose risperidone and olanzapine may account for this beneficial effect. The benefit derived with irbesartan implicates the involvement of brain angiotensin systems centrally in helping to regulate drinking behaviour.

Adult↗
PubMed2006

The treatment of psychogenic polydipsia with risperidone in two children diagnosed with schizophrenia.

Polydipsia is a well-known phenomenon in adult psychiatry, but the literature regarding children is very limited. Just as the pathogenesis remains poorly understood, so does its management remain a clinical challenge. Data regarding the effect of risperidone on polydipsia are contradictory. We present case studies of remission of severe polydipsia with risperidone in two children.

Antipsychotic Agents↗