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PubMed1989

[Primary/secondary characteristics of polydipsia induced by electrolytic lesion of the mammillary bodies].

Rats with mammillary electrolytic lesions show a strong polydipsia and polyuria. This over-consumption may be primary or secondary to the polyuric effect. In this regard, mammillary lesioned rats excrete a greater amount of urine compared with control animals when matched in daily water consumption (partial water deprivation). Moreover, this abnormal water intake is significantly reversed by treatment with Pitressin, a vasopressin analogue. These results suggest that the polydipsia may be determined by the urinary water loss. However, when subjected to the bilateral ureter ligation, the experimental animals still outdrink the control ones, thus also suggesting a primary component of the polydipsia under study. The possible explanation of these components in relation to the mammillary polydipsia is discussed.

Animals↗

PubMed1996

Clozapine treatment in polydipsia and intermittent hyponatremia.

BACKGROUND: Recent case reports indicate that clozapine treatment diminishes excessive diurnal weight gain and alleviates hyponatremia observed in some chronically psychotic patients. We examined the influence of clozapine on sodium metabolism and water regulation across a group of patients with the syndrome of polydipsia and intermittent hyponatremia. METHOD: Eleven patients with treatment-resistant DSM-III-R schizophrenia or schizoaffective disorder were studied. Each had a history of repeated diurnal weight gains of greater than 10% with at least one documented bout of hyponatremia in the 6 months before clozapine treatment. We utilized a target weight protocol and serial laboratory measures to compare changes in sodium metabolism and water regulation during 26 weeks of standard antipsychotic medication and 26 weeks of clozapine treatment. RESULTS: Across patients, we found significant improvement in routinely monitored 6 a.m. and 4 p.m. serum sodium, reflecting normalization of sodium metabolism. We also found that the frequency (as reflected by diurnal weight gain), severity (lowest serum sodium), and estimated quantity (calculated urine volume) of polydipsia improved across patients. Improvement in polydipsia and hyponatremia was associated with decreased necessity for monitoring and restrictive interventions, and tended to be associated with psychiatric improvement. CONCLUSION: We found a corrective and stabilizing effect of clozapine on polydipsia and intermittent hyponatremia. Future studies need to examine the relationship of psychiatric improvement and alterations in the regulation of sodium and water physiology to our findings.

Adult↗

PubMedDate not supplied

[Polydipsia: review of the literature].

Polydipsia, unrelated to organic polyuria is present in 20% of the patients hospitalised in psychiatry on a long term basis. It seems that about a third of them have presented at some point an episode of water intoxication. Most patients with psychogenic polydipsia excrete all the water they absorb. In a subgroup of them, at risk for water intoxication, the capacity to excrete water is deficient. This is usually due to an inappropriate secretion of antidiuretic hormone. The first two steps in the treatment of patients with psychogenic polydipsia consist in making the diagnosis and in evaluating the risk of water intoxication. To do this, one must monitor throughout the day their weight and the serum sodium plasma level if necessary, then reduce the risk factors and prescribe water restriction during the high risk periods. Behavioural therapy is sometimes used; prospects for chemotherapy are being studied. It is probable that there is not a single type of patient with psychogenic polydipsia but several subtypes, the etiology being multifactorial.

Drinking↗

PubMed1985

Effects of naloxone, beta-endorphin and ACTH on acquisition of schedule-induced polydipsia.

A series of three experiments examined the possible involvement of endogenous opioid peptides in the development of schedule-induced polydipsia in rats. Repeated pretraining treatment with 2 mg/kg naloxone impaired acquisition of schedule-induced polydipsia, whereas the same treatment injected after training increased drinking. This later effect was time dependent, since a 30-min delay in the injection of naloxone resulted in a disappearance of its effect. Post-training injections of 10 micrograms/kg beta-endorphin or ACTH delayed the development of drinking. These findings are consistent with the hypothesis that endogenous opioid peptides modulate the development of schedule-induced polydipsia.

Adrenocorticotropic Hormone↗

PubMed1995

Association between stereotypic behavior and polydipsia in chronic schizophrenic patients.

We assessed temporal associations between polydipsia and motor stereotypies in chronic schizophrenia. Subjects included: (a) a polydipsic patient with marked stereotypies; (b) a polydipsic patient with no history of stereotypy; (c) a nonpolydipsic patient. Stereotyped grooming and pacing were significantly associated with drinking for polydipsic patients only (polydipsic patients evidenced a 87% and 66% concordance between excessive grooming and drinking versus 12% in the control). Our findings provide the first empirical demonstration that polydipsia is temporally associated with other repetitive behaviors. The use of behavioral assessment to examine etiological theories suggesting that polydipsia stems from interacting environmental, biological, and pharmacological variables is discussed.

Adult↗

PubMed1989

Osteopenia, pathological fractures, and increased urinary calcium excretion in schizophrenic patients with polydipsia.

Ten male chronic schizophrenic patients with polydipsia and 10 nonpolydipsic controls, matched for gender, diagnosis, duration of illness, age, and race, were studied by dual- and single-photon absorptiometry to estimate bone density of the lumbar spine and radius and by 24-hr urine collections to estimate urinary electrolyte excretion. Bone density was normal in the control group, but was abnormally low in the polydipsic group, which had a markedly increased incidence of fractures. Electrolyte excretion was normal in the control group and in the polydipsic group when water intake was restricted to normal amounts; increased urinary sodium and calcium excretion occurred in proportion to polydipsia. As polydipsia is associated with a number of physiological changes, the cause of the osteopenia is unclear; we suggest that a negative calcium balance caused by increased urinary calcium excretion induced by extracellular space expansion may play an important role in the causation of the skeletal changes.

Adult↗

PubMed1996

Polydipsia and water intoxication in a long-term psychiatric hospital.

This cross-sectional survey attempts to establish the prevalence of polydipsia and water intoxication at a state hospital (N = 360) using staff diagnosis, specific gravity of the urine (SPGU), weight changes, and chart review. There were 150 [42%, 95% confidence interval (CI) 37-47%] patients diagnosed as polydipsic by the staff or by SPGU. At least 93 (26%, CI 21-30%) had primary polydipsia not explained by other causes. Chart review identified 17 (5%, CI 3-7%) patients with a history of water intoxication. Using a case-control study design, schizophrenia, extended duration of hospitalization, and heavy smoking were associated with primary polydipsia in a logistic regression analysis (respective odds ratios were 1.6, 1.8, and 3.6). All patients with a history of water intoxication were Caucasian (versus 83% in those without a history) and had significantly more extended hospitalizations (94 vs. 49%). Future case-control studies should combine longitudinal identification of true cases and controls and exhaustive collections of clinical information in a standardized way.

Adolescent↗

PubMed1976

Acquisition of schedule-induced polydipsia in rats with no prior drinking experience.

Three litters of 10 rat pups each were reared on Purina laboratory chow and either (1) continuous access to water, (2) access to both water and lettuce until weaning at 21 days and then only lettuce, or (3) continuous access to lettuce. At 100 days all rats were reduced to 80% free feeding weight and tested for polydipsia. During 15 sessions of polydipsia testing, excessive postpellet drinking developed in all groups to 45 mg Noyes pellets delivered on a fixed-time 1 min schedule. No significant differences in water intake over sessions were found among groups. It was concluded that schedule-induced polydipsia does not represent an exaggeration of a learned prandial drinking pattern, but rather an exaggeration of an inborn prandial drinking reflex.

Animals↗

PubMed1985

Schedule-induced polydipsia: another look at water-intake volume regulation.

Experiment 1 found that rats regulated the number of drinks per session during schedule-induced polydipsia, rather than volume intake when water was obtained from different sized water dipper cups. However, when water availability was manipulated during polydipsia sessions by changing the aperture size of the water bottle tube (Experiment 2), the rats regulated total water-intake volume per session. Experiment 3 demonstrated that this volume regulation was more precise during schedule-induced drinking than during water deprivation induced drinking. Also, it was shown that the different sized apertures were effective in manipulating the rates of water availability and ingestion. These experiments demonstrated that volume regulation during schedule-induced polydipsia occurs only when water is freely available via drinking tubes.

Animals↗

PubMed1988

The propensity for schedule-induced polydipsia is related to differences in conditioned avoidance behaviour and in defense reactions in a defeat test.

In line with previous research showing that animals predisposed to develop schedule-induced polydipsia when submitted to intermittent distribution of food show differential behavioural and neurochemical characteristics, the present experiments investigated the nature of defense reactions to aversive situations in rats that do or do not develop schedule-induced polydipsia. It was found that rats that engage in excessive drinking during intermittent feeding display more rapid active avoidance learning in a 2-way shuttle-box and show less freezing when confronted with an aggressive resident male in a defeat test than those that do not develop schedule-induced polydipsia. These results are consistent with the hypothesis that individual differences in the propensity to exhibit oral consummatory activities in conditions of mild stress are related to the ability to shift behavioural programmes in response to external stimulation.

Aggression↗

PubMed1988

Schedule-induced polydipsia: attenuating effects of decreased size of food granulations.

The effect of food texture on the development of schedule-induced polydipsia was examined in six groups of rats (n = 8), each receiving one of six grades of food granulation. A seventh group received pellets. By the end of 15 sessions of FT 60-sec food delivery, rats receiving pellets and the coarser granulations had developed polydipsia. The volume of water drunk at asymptote by the remaining groups declined with decreased coarseness of the food. Ethological analyses of the behavioral repertoire of the rats during the fifteenth session showed that the polydipsic groups sustained their drinking throughout the session, rather than turning from ingestive to exploratory behaviors near the end of the session, as was the case with animals receiving finer granulations. The enhanced drinking induced by the coarser food texture was reciprocally related to the amount of time the animal spent with its head in the feeder hole during the period of maximum drinking. The results support the conclusion that the schedule-induced polydipsia traditionally demonstrated with pellets as the reinforcer is critically dependent on the fact that pellets are coarse in texture.

Animals↗

PubMed1981

Cross-tolerance to phenobarbital following chronic ethanol polydipsia.

Using contingent food pellet delivery, rats were trained on a discriminative motor control task requiring that a force transducer be held steadily within a force band. Motor performance following pre-task doses of phenobarbital (40, 60 or 80 mg/kg) both before and after 4 months fo chronic ethanol polydipsia (mean intake = 11.1 g/kg/kay)indicated the development of cross-tolerance from ethanol to phenobarbital. Days on which saline control injections were given in place of phenobarbital injections (on injection days ethanol was withdrawn 5 hr pre-injection) revealed the development of a mild physical dependence on ethanol at this level of ethanol polydipsia. Chronic ethanol polydipsia did not alter the time course of phenobarbital elimination from the serum, indicating that the cross-tolerance probably was due to central nervous system changes.

Alcoholism↗

PubMed1990

Polydipsia and hyponatremia in psychiatric patients: challenge to creative nursing care.

Among patients with psychiatric disorders, especially schizophrenia, a pattern of extreme polydipsia and polyuria sometimes emerges, usually without readily identifiable medical causes. Hyponatremia may develop and progress to water intoxication, with symptoms including restlessness, confusion, seizures, or even death. We review the clinical features and pathophysiology of this syndrome and discuss nursing roles in identifying and managing patients with polydipsia and hyponatremia. While the causes of polydipsia and hyponatremia are unclear, relevant factors seem to include a possible dysfunction in central nervous system (CNS) thirst and osmoregulatory centers, the inappropriate secretion of or sensitivity to antidiuretic hormone (ADH), and psychoactive drugs. Management techniques for affected patients concentrate on careful observation, fluid restriction, and the minimization of possible exacerbating factors such as high neuroleptic dosage and cigarette consumption.

Humans↗

PubMed2006

Successful treatment of polydipsia, water intoxication, and delusional jealousy in an alcohol dependent patient with clozapine.

The beneficial effect of clozapine on polydipsia and water intoxication in patients with schizophrenia has been demonstrated many times. The authors report a successful clozapine treatment of polydipsia, intermittent water intoxication, and delusional jealousy of an alcoholic. This is a rare case of clozapine treatment of a non-schizophrenic patient affected by polydipsia.

Adult↗

PubMed1987

Psychogenic polydipsia with hyponatremia: report of eleven cases.

Psychogenic polydipsia is an uncommon clinical disorder characterized by excessive water-drinking in the absence of a physiologic stimulus to drink. The excessive water-drinking is well tolerated unless hyponatremia supervenes. This report describes 11 patients with psychogenic polydipsia and hyponatremia (ten men and one woman) who were collectively hospitalized a total of 70 times for treatment of complications of this disorder. This group differs from the classical patient with psychogenic polydipsia, ie, a hospitalized schizophrenic, in that none was institutionalized and there was a high incidence of chronic alcoholism (10), intractable hiccups (7), self-induced vomiting (6), and laboratory evidence for rhabdomyolysis (5).

Adult↗

PubMed1993

Neuroendocrine factors influencing polydipsia in psychiatric patients: an hypothesis.

Polydipsia and water intoxication cause considerable morbidity and mortality in chronic psychiatric patients. The pathophysiology of the disorder is unknown, and there is no effective treatment. Angiotensin II is an important dipsogen in animals; in humans, some conditions with abnormal thirst are associated with increased angiotensin function. Chronic D2 dopamine receptor blockade increases angiotensin II-induced thirst in animals; in humans, increased peripheral response to angiotensin II is documented. Chronic D2 blockade with typical neuroleptics may increase sensitivity to angiotensin II and induce thirst. Clozapine, which has negligible D2 blocking action may improve polydipsia. Recent case reports demonstrate improvement of polydipsia during clozapine therapy. Angiotensin II releases vasopressin; this could explain water intoxication, which occurs later in the syndrome. This paper suggests an etiological model and a treatment modality for this disorder.

Antipsychotic Agents↗

PubMed2004

Polydipsia screening tool.

Polydipsia is a condition whereby individuals consume excessive amounts of liquids, which is common in patients with schizophrenia. A 17-item Polydipsia Screening Tool (PST; Copyright 2000 by Sheila Reynolds) was evaluated for psychometric properties. Five nurses and 70 psychiatric residents in a 92-bed nursing home comprised the samples. The interrater reliability (mean intraclass correlation coefficient) was 0.84. The average test-retest agreement was 92.4% with agreement ranging from 75% to 100%. Internal consistency of the tool was 0.79. Sensitivity and specificity were 80% and 68%, respectively. Additionally, validity of the PST was supported using a medical record history of polydipsia, low serum sodium, and low specific gravity.

Drinking Behavior↗

PubMed1988

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

Water intoxication is a serious problem in many patients with chronic psychiatric illness. In an effort to determine the mechanism of this disorder, we investigated the osmoregulation of water intake and antidiuretic function in psychiatric patients with polydipsia and hyponatremia and in matched controls with psychiatric illness but neither polydipsia nor hyponatremia. We found that a water load suppressed plasma osmolality and vasopressin and urine osmolality in both groups, but that urinary dilution and free water clearance were impaired in the patients with hyponatremia, even though plasma levels of vasopressin and solute clearance were similar in the two groups. Moreover, during water loading and infusion of hypertonic saline, the plasma level of vasopressin was higher at any given plasma osmolality in the test patients than in the controls, indicating a downward resetting of the osmostat. Patients' estimates of the amount of water they desired were shown to correlate significantly with the amount of water consumed and, at any given level of plasma osmolality, appeared to be higher in the test patients than in the controls. We conclude that psychiatric patients with polydipsia and hyponatremia have unexplained defects in urinary dilution, the osmoregulation of water intake, and the secretion of vasopressin.

Adult↗