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Query: UMLS:C0036341 (schizophrenia)
 60,220 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Many mentally ill patients, particularly those with schizophrenia, have idiopathic or medication-induced disorders of water balance, which include excessive water intake, excessive water excretion, and impaired water excretion. Patients with these disorders manifest polydipsia and polyuria with or without symptomatic hyponatremia (low serum sodium concentration). Other serious sequelae include life-threatening water intoxication. The author reviews the physiology of normal water balance and the mechanism, causes, clinical presentation, and diagnosis of disorders of water balance. Interventions must first focus on identifying reversible factors. Medication-induced water imbalance can usually be reversed without compromising treatment of the underlying psychiatric disorder. A fully effective treatment for idiopathic polydipsia has not been found, although providing optimal treatment for the underlying psychiatric disorder often helps. Monitoring changes in body weight, in conjunction with measures of serum sodium, prevents water intoxication.
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PMID:A rational approach to disorders of water balance in psychiatric patients. 157 22

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.
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PMID:Polydipsia and hyponatremia in psychiatric patients: challenge to creative nursing care. 235 13

The syndrome of water intoxication may occur in psychiatric patients and various hypotheses regarding its aetiology have been postulated. Twenty-seven patients in Woodbridge Hospital were found to have this syndrome. The aim of the study was to describe the clinical and biochemical findings of this group of patients. 70.4% had schizophrenia, 25.9% had mental retardation and 3.7% had a history of alcohol dependence. Many of them were on antipsychotic medication. The symptoms of water intoxication included polyuria, nausea, tremors, weight gain, disorientation, coma and fits. A majority of the patients had hyponatraemia during the acute stages and the osmolality of urine and plasma were correspondingly low. A few patients had abnormalities in electroencephalogram and computerised axial tomography of brain. The management of patients with water intoxication is discussed briefly.
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PMID:Water intoxication in psychiatric patients in Singapore. 239 1

Nine patients (seven men and two women, mean age 36.3 +/- SD 6.7 years), six of whom had schizophrenic disorders, two of whom had bipolar disorder (manic-depressive illness), and one of whom had schizoaffective disorder, manifested psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome). Their stable pattern of hyposthenuria allowed us to predict 24-hr urinary volume on the basis of estimated daily urinary creatinine and early morning urinary creatinine concentration. Lithium and carbamazepine (Tegretol) had little, if any, effect on polyuria. Correlations of parameters of urinary excretion with serum osmolality among our nine PIP patients failed to implicate water consumption as the exclusive cause of serum hypoosmolality and attendant complications usually ascribed to "water toxicity" in the PIP syndrome. Discussed, also, is the overlap of the clinical and laboratory features of the PIP syndrome with the clinical and laboratory features of both diabetes insipidus and the syndrome of inappropriate antidiuresis.
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PMID:Correlation of parameters of urinary excretion with serum osmolality among patients with psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome). 339 94

Polydipsia and polyuria have a long association with schizophrenia. To assess the prevalence of polydipsia and polyuria in schizophrenia, urine volume was examined in medication-free chronic schizophrenic patients, normal controls, and nonschizophrenic patients. Mean urine volume was significantly higher in the schizophrenic patients (2319 +/- SD 2052 ml/24 hours) than in the other two groups (1054 +/- SD 471 ml/24 hours for nonschizophrenic patients and 1265 +/- SD 613 ml/24 hours for normals). Seven of 35 patients with schizophrenia but 0/7 nonschizophrenics had urine volumes greater than any normal control. Polyuria was associated with a good premorbid history and a positive neuroleptic response. Among polyuric patients, those with hyponatremia may represent a different, distinct subgroup. Neuroleptic treatment was associated with a further, significant increase in urine volume. Hence, polydipsia and polyuria appear to be relatively common in schizophrenia.
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PMID:Increased urine volume in chronic schizophrenic patients. 386 Aug 85

Review of 60 consecutive records of patients who died before the age of 53 years in a state mental hospital revealed that 27 of those patients (45%) had a schizophrenic disorder. Of those 27 patients, five (18.5%) died of the complications of self-induced water intoxication and schizophrenic disorders (SIWIS). Clinical, laboratory, and autopsy features of those five SIWIS patients and of an additional five SIWIS cases obtained from the literature include psychosis, polydipsia, polyuria, severe hyposthenuria (specific gravity 1.003 or less), hyponatremia, seizures, coma, and cerebral and visceral edema. SIWIS characteristically develops during Arieti's third or "preterminal" stage (5 to 15 years after onset of psychosis) of schizophrenic disorders and it must be included in the differential diagnosis of unexplained death among psychiatric patients. As there are no pathognomonic SIWIS tissue changes, the pathologist must carefully integrate clinical, laboratory, and autopsy findings to arrive at the proper diagnosis. When premortem findings of polydipsia and hyponatremia are not available, evidence of antecedent severe hyposthenuria and postmortem vitreous humor hyponatremia of less than 120 mEq/1 are strongly supportive of the diagnosis of death due to SIWIS.
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PMID:Death from self-induced water intoxication among patients with schizophrenic disorders. 397 77

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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PMID:Polydipsia and water intoxication in psychiatric patients: a review of the epidemiological literature. 801 88

1. Increased water intake and output is more common among psychiatric patients, especially those with schizophrenia, than in the general population. Animal studies suggest that polydipsia and polyuria derive, in part, from dopamine dysregulation. Stimulated by these observations this study sought to elucidate relationships among water homeostasis, monoamine metabolism, and electrolyte excretion in schizophrenic patients with and without paranoid hallucinatory symptoms (PH vs. NP), thought to reflect hyper- and hypo-dopaminergic states respectively, and to compare these with those shown by patients with obsessive compulsive disorder (OCD). 2. 24 hr-urine samples for electrolyte, monoamine and metabolite measures were taken from 14 schizophrenic patients with PH symptoms, 13 with predominantly nonparanoid (NP) symptoms, 11 OCD patients and 27 healthy controls (matched for age, weight and creatinine production). Water intake and serum electrolytes was sampled during psychological testing. 3. PH patients drank 2-3 times more than the others in a 3-4 hr test, yet 24 hr-urinary volumes were 75% larger in both PH and NP patients than in the two comparison groups. 4. Daily potassium excretion was a bit higher in PH patients, but concentrations of sodium, potassium and phosphate tended to be lower in PH and NP patients than in the others. 5. Positive associations of electrolyte with homovanillic acid excretion were consistent across groups and not directly related to medication. But associations of electrolyte excretion with noradrenergic activity in controls were absent in psychotic patients and associations with serotonin in OCD patients were absent in the other groups. 6. Increased water intake and output in PH patients along with the disturbed association with noradrenergic metabolism are consistent with altered autonomic activity in these patients. 7. The independence of measures of water homeostasis from dopaminergic medication indicates that the associations in clinically responding PH patients of polydipsia with DA function (decreased DA levels) may be pertinent to this subgroup but not to schizophrenia in general.
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PMID:Subclinical polydipsia and polyuria in young patients with schizophrenia or obsessive-compulsive disorder vs normal controls. 1063 61

A 63-year-old African-American woman was admitted to the hospital with urosepsis and altered mental status. She had a history of schizophrenia and was treated with olanzapine 5 mg/day and lithium carbonate 300 mg 3 times/day. During her hospital stay, her sodium level and serum osmolality increased and her urine osmolality decreased, whereas her lithium levels remained within normal limits. Based on these findings, the patient was diagnosed with diabetes insipidus secondary to lithium therapy and was treated successfully with amiloride. Clinicians have been aware of lithium toxicity for many years and traditionally have administered thiazide diuretics for lithium-induced polyuria and nephrogenic diabetes insipidus. Recently, amiloride, a potassium-sparing diuretic, has been reported as a successful treatment for nephrogenic diabetes insipidus.
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PMID:Treatment of lithium-induced diabetes insipidus with amiloride. 1268 Apr 86

Polydipsia, chronic or intermittent, with or without hyponatremia, frequently occurs among chronic patients with schizophrenia. The pathogenesis of polydipsia remains poorly understood. The key assumption of our hypothesis is that in some of these patients, polydipsia and hyponatremia are consequences of patients' adjustment to a prolonged intake of an insufficient diet, dominantly poor in potassium. Deficits of potassium, without significant hypokalemia, may cause impairment of the urine-concentrating ability with polyuria-polydipsia. A fall of intracellular tonicity, dominantly due to a decreased amount of K(+) and attendant anions in cells, should be accompanied with a fall of extracellular osmolality. Because of the diminished content of ions that may diffuse out of cells and because osmotic equilibrium between the ECF and ICF compartments cannot be established in a short period of time, these patients have a diminished ability to adapt to an excessive intake of fluids. These mechanisms might be related to the development of polydipsia and water intoxication in patients with different mental and somatic disorders. The experiences with the therapeutic effects of diets containing an sufficient amount of potassium in two patients with schizophrenia are described. Further investigations are needed, and we suggest a possible approach to test our hypotheses.
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PMID:A different hypothesis on hyponatremia in psychiatric patients: treatment implications and experiences. 1894 40


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