CNS Drugs

, Volume 7, Issue 2, pp 121–138

Polydipsia-Hyponatraemia Syndrome

Epidemiology, Clinical Features and Treatment
  • W. Victor R. Vieweg
  • Robert A. Leadbetter
Review Articles Drug Therapy

Summary

The polydipsia-hyponatraemia syndrome (PHS) occurs in about 5 to 10% of institutionalised, chronically psychotic patients, 80% of whom have schizophrenia. Major clinical features are polydipsia and dilutional hyponatraemia. Complications of PHS include delirium, generalised seizures, coma and death.

Nonpharmacological interventions are fluid restriction, diurnal bodyweight monitoring, behavioural approaches, and supplemental oral sodium chloride administration. These interventions require an experienced and dedicated multidisciplinary staff.

A number of pharmacological treatments have been assessed for PHS including the combination of lithium and phenytoin, demeclocycline, propranolol, ACE inhibitors, selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors, typical antipsychotic drugs, clozapine and risperidone. Of these agents, the most promising are the combination of lithium and phenytoin, and clozapine.

Integrated treatment requires a highly informed multidisciplinary staff, meticulous monitoring of diurnal weight gain and serum sodium level, and careful record keeping. Acute interventions of observation by trained staff, fluid restriction, water-free areas and supplemental sodium chloride administration are based on diurnal weight gain employing a monthly weight chart and a base weight method. Intravenous hypertonic saline is used briefly and administered in a highly controlled manner when patients with PHS present with generalised seizures and coma. Long term strategies include behavioural interventions and the combination of lithium and phenytoin, and clozapine.

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References

  1. 1.
    Vieweg WVR, Godleski LS, Graham P, et al. Diurnal weight gain in chronic psychosis. Schizophr Bull 1989; 15: 501–6PubMedGoogle Scholar
  2. 2.
    Bartter FC, Schwartz WB. The syndrome of inappropriate secretion of antidiuretic hormone. Am J Med 1967; 42: 790–806PubMedGoogle Scholar
  3. 3.
    Thomas A, Verbalis JG. Hyponatraemia and the syndrome of inappropriate antidiuretic hormone secretion associated with drug therapy in psychiatric patients. CNS Drugs 1995; 4: 357–69Google Scholar
  4. 4.
    Lawson WB, Karson CN, Bigelow LB. Increased urine volume in chronic schizophrenic patients. Psychiatry Res 1985; 14: 323–31PubMedGoogle Scholar
  5. 5.
    Vieweg WVR, David JJ, Glick JL, et al. Polyuria among patients with psychosis. Schizophr Bull 1986; 12: 739–43PubMedGoogle Scholar
  6. 6.
    de Leon J, Verghese C, Tracy JI, et al. Polydipsia and water intoxication in psychiatric patients: a review of the epidemiological literature. Biol Psychiatry 1994; 35: 408–19PubMedGoogle Scholar
  7. 7.
    de Leon J, Dadvand M, Canuso C, et al. Polydipsia and water intoxication in a long-term psychiatric hospital. Biol Psychiatry 1996; 40: 28–34PubMedGoogle Scholar
  8. 8.
    Siegler EL, Tamres D, Berlin JA, et al. Risk factors for the development of hyponatremia in psychiatric inpatients. Arch Intern Med 1995; 155: 953–7PubMedGoogle Scholar
  9. 9.
    Riggs AT, Dysken MW, Kim SW, et al. A review of disorders of water homeostasis in psychiatric patients. Psychosomatics 1991; 32: 133–48PubMedGoogle Scholar
  10. 10.
    Crammer JL. Drinking, thirst, and water intoxication. Br J Psychiatry 1991; 159: 83–9PubMedGoogle Scholar
  11. 11.
    Vieweg WVR, David JJ, Rowe WT, et al. Psychogenic polydipsia and water intoxication — concepts that have failed. Biol Psychiatry 1985; 20: 1308–20PubMedGoogle Scholar
  12. 12.
    Snyder SH. Drug and neurotransmitter receptors in the brain. Science 1984; 224: 22–31PubMedGoogle Scholar
  13. 13.
    Millson RC, Koczapski AB, Cook M, et al. Self-induced water intoxication: the patients speak [abstract]. Schizophr Res 1989; 2: 167Google Scholar
  14. 14.
    Millson RC, Smith AP, Koczapski AB, et al. Self-induced water intoxication treated with group psychotherapy. Am J Psychiatry 1993; 150: 825–6PubMedGoogle Scholar
  15. 15.
    Shutty MS, Leadbetter RA. Salt appetite with psychosis, intermittent hyponatremia, and polydipsia [letter]. Am J Psychiatry 1993; 150: 674–5PubMedGoogle Scholar
  16. 16.
    Goldman MB, Luchins DJ, Robertson GL. Mechanism of altered water metabolism in psychotic patients with polydipsia and hyponatremia. N Engl J Med 1988; 318: 397–403PubMedGoogle Scholar
  17. 17.
    Vieweg WVR, Godleski LS, Pulliam WR, et al. Development of water dysregulation during Arieti’s third stage of schizophrenia?. Biol Psychiatry 1989; 26: 775–80PubMedGoogle Scholar
  18. 18.
    Illowsky BP, Kirch DG. Polydipsia and hyponatremia in psychiatric patients. Am J Psychiatry 1988; 145: 675–83PubMedGoogle Scholar
  19. 19.
    Luchins DJ. A possible role of hippocampal dysfunction in schizophrenic symptomology. Biol Psychiatry 1990; 28: 87–91PubMedGoogle Scholar
  20. 20.
    Crapanzano KA, Casanova MF, Toro VE, et al. Drinking behavior as a result of a right hippocampal ictal focus. Biol Psychiatry 1993; 34: 889–92PubMedGoogle Scholar
  21. 21.
    Umbricht D. Polydipsia and hippocampal pathology. Biol Psychiatry 1994; 36: 708–10Google Scholar
  22. 22.
    Goldman MB, Blake L, Marks RC, et al. Association of non-suppression of cortisol on the DST with primary polydipsia in chronic schizophrenia. Am J Psychiatry 1993; 150: 653–5PubMedGoogle Scholar
  23. 23.
    Umbricht DSG, Saltz B, Pollack S, et al. Polydipsia and tardive dyskinesia in chronic psychiatric patients — related disorders?. Am J Psychiatry 1993; 150: 1536–8PubMedGoogle Scholar
  24. 24.
    Verghese C, deLeon J, Simpson GM. Polydipsia, tardive dyskinesia, and dopamine supersensitivity. Am J Psychiatry 1994; 151: 1716PubMedGoogle Scholar
  25. 25.
    Vieweg WVR, Robertson GL, Godleski LS, et al. Diurnal variation in water homeostasis among schizophrenic patients subject to water intoxication. Schizophr Res 1988; 1: 351–7PubMedGoogle Scholar
  26. 26.
    Vieweg WVR, Weiss NM, David JJ, et al. Treatment of psychosis, intermittent hyponatremia, and polydipsia (PIP) syndrome using lithium and phenytoin. Biol Psychiatry 1988; 23: 25–30PubMedGoogle Scholar
  27. 27.
    Emsley R, Potgieter A, Taljaard F, et al. Water excretion and plasma vasopressin in psychotic disorders. Am J Psychiatry 1989; 146: 250–3PubMedGoogle Scholar
  28. 28.
    Kishimoto T, Hirai M, Ohsawa H, et al. Manners of arginine vasopressin secretion in schizophrenic patients. With reference to the mechanism of water intoxication. Jpn J Psychiatry Neurol 1989; 43: 161–9PubMedGoogle Scholar
  29. 29.
    Zerbe R, Stropes L, Robertson G. Vasopressin function in the syndrome of inappropriate antidiuresis. Ann Rev Med 1980; 31: 315–27PubMedGoogle Scholar
  30. 30.
    Delva NJ, Crammer JL, Lawson JS, et al. Vasopressin in chronic psychiatric patients with primary polydipsia. Br J Psychiatry 1990; 157: 703–12PubMedGoogle Scholar
  31. 31.
    Vieweg V, Veldhuis J, Leadbetter R, et al. Cigarette use and hyponatremia in schizophrenic patients [letter]. Am J Psychiatry 1991; 148: 688–9Google Scholar
  32. 32.
    Vieweg WVR, Godleski LS. Hyponatremia and atrial natriuretic peptide secretion in patients with vasopressin-induced antidiuresis [letter]. Am J Med 1988; 85: 594–5PubMedGoogle Scholar
  33. 33.
    Vieweg WVR, Carey RM, Godleski LS, et al. The syndrome of psychosis, intermittent hyponatremia, and polydipsia: evidence for diurnal volume expansion. Psychiatr Med 1990; 8: 135–44PubMedGoogle Scholar
  34. 34.
    MacMillan H, Steiner M. Atrial natriuretic factor: does it have a role in psychiatry?. Biol Psychiatry 1994; 35: 272–7PubMedGoogle Scholar
  35. 35.
    Vieweg WVR, Rowe WT, David JJ, et al. Evaluation of patients with self-induced water intoxication and schizophrenic disorders (SIWIS). J Nerv Ment Dis 1984; 172: 552–5PubMedGoogle Scholar
  36. 36.
    Santy PA, Schwartz MB. Hyponatremia disguised as an acute manic episode. Hosp Community Psychiatry 1983; 34: 1156–7PubMedGoogle Scholar
  37. 37.
    Brown RP, Kocsis JH, Cohen SK. Delusional depression and inappropriate antidiuretic hormone secretion. Biol Psychiatry 1983; 18: 1059–63PubMedGoogle Scholar
  38. 38.
    Zubenko GS, Altesman RI, Cassidy JW, et al. Disturbances of thirst and water homeostasis in patients with affective illness. Am J Psychiatry 1984; 141: 436–7PubMedGoogle Scholar
  39. 39.
    White JC. The risks of excessive water drinking in epileptic patients [letter]. N Engl J Med 1985; 312: 246–7PubMedGoogle Scholar
  40. 40.
    Crammer JL. Disturbance of water and sodium in manic-depressive illness. Br J Psychiatry 1986; 149: 337–45PubMedGoogle Scholar
  41. 41.
    Cronin RE. Psychogenic polydipsia with hyponatremia: report of eleven cases. Am J Kidney Dis 1987; 9: 410–6PubMedGoogle Scholar
  42. 42.
    Finlayson AJR, Vieweg WVR, Wilkey WD, et al. Hyponatremic seizure following ECT. Can J Psychiatry 1989; 34: 463–4PubMedGoogle Scholar
  43. 43.
    Ripley TL, Millson RC, Koczapski AB. Self-induced water intoxication and alcohol abuse. Am J Psychiatry 1989; 146: 102–3PubMedGoogle Scholar
  44. 44.
    Vieweg WVR, Godleski LS, Shannon C, et al. Diurnal weight gain among patients with mental retardation. Am J Ment Retard 1989; 93: 558–65PubMedGoogle Scholar
  45. 45.
    MacMillan HL, Gibson JC, Steiner M. Hyponatremia and depression. J Nerv Ment Dis 1990; 178: 720–2PubMedGoogle Scholar
  46. 46.
    Vieweg WVR, Godleski LS, Graham P, et al. Abnormal diurnal weight gain among institutionalized patients with manic-depressive spectrum disorders. Psychiatr Med 1990; 8: 129–34PubMedGoogle Scholar
  47. 47.
    Bremner AJ, Regan A. Intoxication by water: polydipsia and water intoxication in a mental handicap hospital. Br J Psychiatry 1991; 158: 244–50PubMedGoogle Scholar
  48. 48.
    El-Mallakh RS, Cearnal LR, Kirch DG. Stereotypic behavior and hyponatremia. Biol Psychiatry 1990; 28: 1077–8PubMedGoogle Scholar
  49. 49.
    Vieweg V, Lombana A, Lewis R. Hyper- and hyponatremia among geropsychiatric inpatients. J Geriatr Psychiatry Neurol 1994; 7: 148–52PubMedGoogle Scholar
  50. 50.
    Vieweg WVR, David JJ, Rowe WT, et al. Death from self-induced water intoxication and schizophrenic disorders. J Nerv Ment Dis 1985; 173: 161–5PubMedGoogle Scholar
  51. 51.
    Delva NJ, Crammer JL, Jarzylo SV, et al. Osteopenia, pathological fractures, increased urinary calcium excretion in schizophrenic patients with polydipsia. Biol Psychiatry 1989; 26: 781–93PubMedGoogle Scholar
  52. 52.
    Vieweg WVR, David JJ, Rowe WT, et al. Hypocalcemia: an additional complication of the syndrome of self-induced water intoxication and psychosis (SIWIP). Psychiatr Med 1986; 4: 291–7PubMedGoogle Scholar
  53. 53.
    Harrison RB, Ramchandani P, Allen JT. Psychogenic polydipsia: unusual cause for hydronephrosis. Am J Radiol 1979; 133: 327–8Google Scholar
  54. 54.
    Blum A, Friedland GW. Urinary tract abnormalities due to chronic psychogenic polydipsia. Am J Psychiatry 1983; 140: 915–6PubMedGoogle Scholar
  55. 55.
    Moskowitz DW. Functional obstructive uropathy: a significant factor in the hyponatremia of psychogenic polydipsia. J Urol 1992; 147: 1611–3PubMedGoogle Scholar
  56. 56.
    Zubenko GS. Water homeostasis in psychiatric patients. Biol Psychiatry 1987; 22: 121–5PubMedGoogle Scholar
  57. 57.
    Godleski LS, Vieweg WVR, Leadbetter RA, et al. Day-to-day care of chronic schizophrenic patients subject to water intoxication. Ann Clin Psychiatry 1989; 1: 179–85Google Scholar
  58. 58.
    Lapierre E, Berthot BD, Gurvitch M, et al. Polydipsia and hyponatremia in psychiatric patients: challenge to creative nursing care. Arch Psychiatr Nursing 1990; 4: 87–92Google Scholar
  59. 59.
    Goldman MB. A rational approach to disorders of water balance in psychiatric patients. Hosp Community Psychiatry 1991; 42: 488–94PubMedGoogle Scholar
  60. 60.
    Pavalonis D, Shutty M, Hundley P, et al. Behavioral intervention to reduce water intake in the syndrome of psychosis, intermittent hyponatremia, and polydipsia. J Behav Ther Exp Psychiatry 1992; 23: 51–7PubMedGoogle Scholar
  61. 61.
    Vieweg WVR. Behavioral approaches to polydipsia. Biol Psychiatry 1993; 34: 125–7PubMedGoogle Scholar
  62. 62.
    Leadbetter RA, Shutty MS, Higgins PB, et al. Multidisciplinary approach to psychosis, intermittent hyponatremia, and polydipsia. Schizophr Bull 1994; 20: 375–85PubMedGoogle Scholar
  63. 63.
    Vieweg V, Pandurangi A, Levenson J, et al. The consulting psychiatrist and the polydipsia-hyponatremia syndrome in schizophrenia. Int J Psychiatry Med 1994; 24: 275–303PubMedGoogle Scholar
  64. 64.
    Vieweg WVR. Treatment strategies in the polydipsia-hyponatremia syndrome. J Clin Psychiatry 1994; 55: 154–60PubMedGoogle Scholar
  65. 65.
    Vieweg WVR, Karp BI. Severe hyponatremia in the polydipsia-hyponatremia syndrome. J Clin Psychiatry 1994; 55: 355–61PubMedGoogle Scholar
  66. 66.
    Goldman MB, Luchins DJ. Prevention of episodic water intoxication with target weight procedure. Am J Psychiatry 1987; 144: 365–6PubMedGoogle Scholar
  67. 67.
    Vieweg W, Godleski L, Yank G. Diurnal weight gain as an index of polyuria and hyponatremia among chronically psychotic patients. Neuroendocrinol Lett 1987; 9: 218Google Scholar
  68. 68.
    Koczapski A, Ibraheem S, Paredes J, et al. Diurnal variations in hyponatremia and body weight in chronic schizophrenics with self-induced water intoxication [abstract]. J Clin Invest Med 1985; 8: A86Google Scholar
  69. 69.
    Leadbetter RA, Shutty MS, Hammersburg J, et al. Water balance in schizophrenia. In: Schnur DB, Kirch DG, editors. Management of polydipsia and hyponatremia. Washington, D.C.: American Psychiatric Press, 1996: 181–200Google Scholar
  70. 70.
    Klonoff EA, Moore DJ. Compulsive polydipsia presenting as diabetes insipidus: a behavioral approach. J Behav Ther Exp Psychiatry 1984; 15: 353–8PubMedGoogle Scholar
  71. 71.
    McNally RJ, Calamari JE, Hansen PM, et al. Behavioral treatment of psychogenic polydipsia. J Behav Ther Exp Psychiatry 1988; 19: 57–61PubMedGoogle Scholar
  72. 72.
    Bentz JE, Bergeron JA. Polydipsia and hyponatremia. Am J Psychiatry 1989; 146: 405–6Google Scholar
  73. 73.
    Baldwin LJ, Beck NC, Menditto AA, et al. Decreasing excessive water drinking by chronically mentally ill forensic patients. Hosp Community Psychiatry 1992; 43: 507–9PubMedGoogle Scholar
  74. 74.
    Vieweg V, Rowe W, David J, et al. Hyposthenuria as a marker for self-induced water intoxication and schizophrenic disorders. Am J Psychiatry 1984; 141: 1258–60PubMedGoogle Scholar
  75. 75.
    Rowntree LG. Water intoxication. Arch Intern Med 1923; 32: 157–74Google Scholar
  76. 76.
    Helwig FC, Schutz CB, Kuhn HP. Water intoxication. Moribund patient cured by administration of hypertonic salt solution. JAMA 1938; 110: 644–5Google Scholar
  77. 77.
    Berl T. Treating hyponatremia: damned if we do and damned if we don’t. Kidney Int 1990; 37: 1006–18PubMedGoogle Scholar
  78. 78.
    Berl T. Treating hyponatremia: what is all the controversy about?. Ann Intern Med 1990; 113: 417–8PubMedGoogle Scholar
  79. 79.
    Cluitmans FHM, Meinders AE. Management of severe hyponatremia: rapid or slow correction?. Am J Med 1990; 88: 161–6PubMedGoogle Scholar
  80. 80.
    Vieweg WVR, Rowe WT, David JJ, et al. Oral sodium chloride in the management of schizophrenic patients with self-induced water intoxication. J Clin Psychiatry 1985; 46: 16–9PubMedGoogle Scholar
  81. 81.
    Vieweg WVR, Godleski LS, Hundley PL, et al. Lithium, polyuria, and abnormal diurnal weight gain in psychosis. Acta Psychiatr Scand 1988; 78: 510–4PubMedGoogle Scholar
  82. 82.
    Vieweg WVR, David JJ, Rowe WT, et al. Lack of changes in urinary excretion among patients with psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome) while receiving lithium and phenytoin. Psychiatric Hosp 1986; 17: 127–31Google Scholar
  83. 83.
    Nixon RA, Rothman JS, Chin W. Demeclocycline in the prophylaxis of self-induced water intoxication. Am J Psychiatry 1982; 139: 828–30PubMedGoogle Scholar
  84. 84.
    Goldman MB, Luchins DJ. Effect of demeclocycline on serum sodium in hyponatremic chronic schizophrenics. Biol Psychiatry 1985; 20: 1149–55PubMedGoogle Scholar
  85. 85.
    Khamnei AK. Psychosis, inappropriate antidiuretic hormone secretion, and water intoxication. Lancet 1984; I: 963Google Scholar
  86. 86.
    Kathol RG, Wilcox JA, Turner RD, et al. Pharmacologic approaches to psychogenic polydipsia: case reports. Prog Neuropsychopharmacol Biol Psychiatry 1986; 10: 95–100PubMedGoogle Scholar
  87. 87.
    Vieweg WVR, Wilkinson EC, David JJ, et al. The use of demeclocycline in the treatment of patients with psychosis, intermittent hyponatremia, and polydipsia (PIP) syndrome. Psychiatr Q 1988; 59: 62–8PubMedGoogle Scholar
  88. 88.
    Alexander RC, Karp BI, Thompson S, et al. A double blind, placebo-controlled trial of demeclocycline treatment of polydipsia-hyponatremia in chronically psychotic patients. Biol Psychiatry 1991; 30: 417–20PubMedGoogle Scholar
  89. 89.
    Shevitz SA, Jameison RC, Pétrie WM, et al. Compulsive water drinking treated with high dose propranolol. J Nerv Ment Dis 1980; 168: 246–8PubMedGoogle Scholar
  90. 90.
    Goldstein MB, Folsom T. The successful treatment of psychogenic polydipsia and water intoxication with propranolol: a case report. Minn Med 1991; 74: 29–32PubMedGoogle Scholar
  91. 91.
    Goldstein JA. Captopril in the treatment of psychogenic polydipsia [letter]. J Clin Psychiatry 1986; 47: 99PubMedGoogle Scholar
  92. 92.
    Tueth MJ, Broderick-Cantwell J. Successful treatment with captopril of an elderly man with polydipsia and hyponatremia. J Geriatr Psychiatry Neurol 1993; 6: 112–4PubMedGoogle Scholar
  93. 93.
    Sebastian CS, Bernardin AS. Comparison of enalapril and captopril in the management of self-induced water intoxication. Biol Psychiatry 1990; 27: 787–90PubMedGoogle Scholar
  94. 94.
    Al-Mufti HI, Arieff AI. Captopril-induced hyponatremia with irreversible neurologic damage. Am J Med 1985; 79: 769–71PubMedGoogle Scholar
  95. 95.
    Vieweg WVR, Leadbetter RA. Water intoxication treatment [letter]. Biol Psychiatry 1990; 28: 829–30PubMedGoogle Scholar
  96. 96.
    Goldman MB, Janecek HM. Is compulsive drinking a compulsive behavior? A pilot study. Biol Psychiatry 1991; 29: 503–5Google Scholar
  97. 97.
    Hwang AS, Magraw RM. Syndrome of inappropriate secretion of antidiuretic hormone due to fluoxetine. Am J Psychiatry 1989; 146: 399PubMedGoogle Scholar
  98. 98.
    Cohen BJ, Mahelsky M, Adler L. More cases of SIADH with fluoxetine [letter]. Am J Psychiatry 1990; 147: 948–9PubMedGoogle Scholar
  99. 99.
    Staab JP, Yerkes SA, Cheney EM, et al. Transient SIADH associated with fluoxetine [letter]. Am J Psychiatry 1990; 147: 1569–70PubMedGoogle Scholar
  100. 100.
    Vishwanath BM, Navalgund A, Cusano W, et al. Fluoxetine as acause of SIADH [letter]. Am J Psychiatry 1991; 148: 542–3PubMedGoogle Scholar
  101. 101.
    Crews JR, Potts NLS, Schreiber J, et al. Hyponatremia in a patient treated with sertraline [letter]. Am J Psychiatry 1993; 150: 1564PubMedGoogle Scholar
  102. 102.
    Ball CJ, Herzberg J. Hyponatremia and selective serotonin reuptake inhibitors. Int J Geriatr Psychiatry 1994; 9: 819–22Google Scholar
  103. 103.
    Bluff D, Oji N. SIADH in a patient receiving sertraline [letter]. Ann Intern Med 1995; 123: 811PubMedGoogle Scholar
  104. 104.
    Leung M, Remick R. Sertraline-associated hyponatremia [letter]. Can J Psychiatry 1995; 40: 497–8PubMedGoogle Scholar
  105. 105.
    Flint AJ, Crosby J, Genik JL. Recurrent hyponatremia associated with fluoxetine and paroxetine [letter]. Am J Psychiatry 1996; 153: 134PubMedGoogle Scholar
  106. 106.
    Leadbetter RA, Shutty MS. Differential effect of neuroleptics and clozapine on polydipsia and intermittent hyponatremia. J Clin Psychiatry 1994; 55 Suppl. B: 110–3PubMedGoogle Scholar
  107. 107.
    Rendell M, McGrane D, Cuesta M. Fatal compulsive water drinking. JAMA 1978; 240: 2557–9PubMedGoogle Scholar
  108. 108.
    Smith WO, Clark ML. Self-induced water intoxication in schizophrenic patients. Am J Psychiatry 1980; 137: 1055–60PubMedGoogle Scholar
  109. 109.
    Hariprasad MK, Eisinger RP, Nadler IM, et al. Hyponatremia in psychogenic polydipsia. Arch Intern Med 1980; 140: 1639–42PubMedGoogle Scholar
  110. 110.
    Sletten IW, Gershon S. The effect of chlorpromazine on water and electrolyte balance. J Nerv Ment Dis 1966; 142: 25–31PubMedGoogle Scholar
  111. 111.
    Tildesley HD, Toth E, Crockford PM. Syndrome of inappropriate secretion of antidiuretic hormone in association with chlorpromazine ingestion. Can J Psychiatry 1983; 28: 487–8PubMedGoogle Scholar
  112. 112.
    Ananth J, Lin KM. SIADH: a serious side effect of psychotropic drugs. Int J Psychiatry Med 1987; 16: 401–7Google Scholar
  113. 113.
    Glusac E, Patel H, Josef NC, et al. Polydipsia and hyponatremia induced by multiple neuroleptics but not molindone. Can J Psychiatry 1990; 35: 268PubMedGoogle Scholar
  114. 114.
    Matuk F, Kalyanaraman K. Syndrome of inappropriate secretion of antidiuretic hormone in patients with psychotherapeutic drugs. Arch Neurol 1977; 34: 374–5PubMedGoogle Scholar
  115. 115.
    Rivera JL de. Inappropriate secretion of antidiuretic hormone from fluphenazine therapy [letter]. Ann Intern Med 1975; 82: 811–2PubMedGoogle Scholar
  116. 116.
    Gleadhill IC, Smith TA, Yium JJ. Hyponatremia in patients with schizophrenia. South Med J 1982; 75: 426–8PubMedGoogle Scholar
  117. 117.
    Ajlouni K, Kern MW, Tures JE, et al. Thiothixene-induced hyponatremia. Arch Intern Med 1974; 134: 1103–5PubMedGoogle Scholar
  118. 118.
    Koi de H. Three cases of hyponatremia during administration of pimozide. No To Hattatsu 1991; 23: 502–5Google Scholar
  119. 119.
    Peck K, Shenkman L. Haloperidol-induced syndrome of inappropriate secretion of antidiuretic hormone. Clin Pharmacol Ther 1979; 26: 442–4PubMedGoogle Scholar
  120. 120.
    Kramer DS, Drake ME. Acute psychosis, polydipsia, and inappropriate secretion of antidiuretic hormone. Am J Med 1983; 75: 712–4PubMedGoogle Scholar
  121. 121.
    Ellinas PA, Rosner F, Jaume JC. Symptomatic hyponatremia associated with psychosis, medications, and smoking. J Natl Med Assoc 1993; 85: 135–41PubMedGoogle Scholar
  122. 122.
    Nishikawa T, Tsuda A, Tanaka M, et al. Evidence for a direct adverse reaction of neuroleptics in self-induced water intoxication of psychiatric patients. Kurume Med J 1991; 38: 307–10PubMedGoogle Scholar
  123. 123.
    Sandifer MG. Hyponatremia due to psychotropic drugs. J Clin Psychiatry 1983; 44: 301–3PubMedGoogle Scholar
  124. 124.
    Raskind MA, Courtney N, Murburg MM, et al. Antipsychotic drugs and plasma vasopressin in normals and acute schizophrenic patients. Biol Psychiatry 1987; 22: 453–62PubMedGoogle Scholar
  125. 125.
    Rider JM, Mauger TF, Jameson JP, et al. Water handling in patients receiving haloperidol decanoate. Ann Pharmacother 1995; 29: 663–6PubMedGoogle Scholar
  126. 126.
    Vieweg V, Godleski L, Hundley P, et al. Antipsychotic drugs, lithium, carbamazepine, and abnormal diurnal weight gain in psychosis. Neuropsychopharmacology 1989; 2: 39–43PubMedGoogle Scholar
  127. 127.
    Shen WW, Sata LS. Hypothalamic dopamine receptor super-sensitivity? A pilot study of self-induced water intoxication. Psychiatric J Univ Ott 1983; 8: 154–8Google Scholar
  128. 128.
    Shah DK, Wig NN, Chaudury RR. Antidiuretic hormone levels in patients with weight gain after chlorpromazine therapy. Indian J Med Res 1973; 61: 771–6PubMedGoogle Scholar
  129. 129.
    Verghese C, deLeon J, Simpson GM. Neuroendocrine factors influencing polydipsia in psychiatric patients: an hypothesis. Neuropsychopharmacology 1993; 9: 157–66PubMedGoogle Scholar
  130. 130.
    Dourish CT. Dopaminergic involvement in the control of drinking behaviour: a brief review. Prog Neuropsychopharmacol Biol Psychiatry 1983; 7: 487–93PubMedGoogle Scholar
  131. 131.
    Lee HS, Kwon K, Alphs LD, et al. Effect of clozapine on psychogenic polydipsia in chronic schizophrenia. J Clin Psychopharmacol 1991; 11: 222–3PubMedGoogle Scholar
  132. 132.
    Verghese C, deLeon J, Simpson GM. Clozapine treatment of polydipsia: a prolactin connection?. J Clin Psychopharmacol 1992; 12: 218–9PubMedGoogle Scholar
  133. 133.
    Spears NM, Leadbetter RA, Shutty MS. Influence of clozapine on water dysregulation [letter]. Am J Psychiatry 1993; 150: 1430–1PubMedGoogle Scholar
  134. 134.
    de Leon J, Verghese C, Stanilla J, et al. Treatment of polydipsia and hyponatremia in psychiatric patients: can clozapine be a new option?. Neuropsychopharmacology 1995; 12: 133–8PubMedGoogle Scholar
  135. 135.
    Munn NA. Resolution of polydipsia and hyponatremia in schizophrenic patients after clozapine treatment [letter]. J Clin Psychiatry 1993; 54: 439PubMedGoogle Scholar
  136. 136.
    Lyster C, Miller AL, Seidel D, et al. Polydipsia and clozapine. Hosp Community Psychiatry 1994; 45: 610–1PubMedGoogle Scholar
  137. 137.
    Henderson DC, Goff DC. Clozapine for polydipsia and hyponatremia in chronic schizophrenics. Biol Psychiatry 1994; 36: 768–70PubMedGoogle Scholar
  138. 138.
    Ogilvie AD, Croy MF. Clozapine and hyponatraemia [letter]. Lancet 1992; 340: 672PubMedGoogle Scholar
  139. 139.
    Spears N, Leadbetter RA, Shutty M. Clozapine treatment in polydipsia and intermittent hyponatremia. J Clin Psychiatry 1996; 57: 123–8PubMedGoogle Scholar
  140. 140.
    Khreis IY, Slaugher JR. Risperidone for primary psychogenic polydipsia [poster session NR 496]. American Psychiatric Association 148th Annual Meeting: 1995 May 15-20; MiamiGoogle Scholar
  141. 141.
    Landry P. Effect of risperidone on polydipsia and hyponatremia in schizophrenia [letter]. Can J Psychiatry 1995; 40: 566–7PubMedGoogle Scholar
  142. 142.
    Michell RH, Kirk CJ, Billah MM. Hormonal stimulation of phosphatidylinositol breakdown, with particular reference to the hepatic effects of vasopressin. Biochem Soc Trans 1979; 7: 861–5PubMedGoogle Scholar
  143. 143.
    Ohnishi A, Orita Y, Okahara R, et al. Potent aquaretic agent. A novel nonpeptide selective vasopressin 2 antagonist (OPC-31260) in men. J Clin Invest 1993; 92: 2653–9PubMedGoogle Scholar
  144. 144.
    Ohnishi A, Orita Y, Takagi N, et al. Aquaretic effect of a potent, orally active, nonpeptide V2 antagonist in men. J Pharmacol Exp Ther 1995; 272: 546–51PubMedGoogle Scholar
  145. 145.
    Reece PA, Sedman AJ, Rose S, et al. Diuretic effects, pharmacokinetics, and safety of a new centrally acting kappa-opioid agonist (CI-977) in humans. J Clin Pharmacol 1994; 34: 1126–32PubMedGoogle Scholar
  146. 146.
    Vieweg WVR, Godleski LS, Graham P, et al. Abnormal diurnal weight gain among long-term patients with schizophrenic disorders. Schizophr Res 1988; 1: 67–71PubMedGoogle Scholar
  147. 147.
    Godleski LS, Vieweg WVR, Yank GR. Prevalence of polyuria among chronically psychotic men. Psychiatr Med 1988; 6: 114–20PubMedGoogle Scholar
  148. 148.
    Hantman D, Rossier B, Zohlman R, et al. Rapid correction of hyponatremia in the syndrome of inappropriate secretion of antidiuretic hormone: an alternative treatment to hypertonic saline. Ann Intern Med 1973; 78: 870–5PubMedGoogle Scholar
  149. 149.
    Black RM. Diagnosis and management of hyponatremia. J Intensive Care Med 1989; 4: 205–20Google Scholar

Copyright information

© Adis International Limited 1997

Authors and Affiliations

  • W. Victor R. Vieweg
    • 1
  • Robert A. Leadbetter
    • 2
    • 3
  1. 1.Department of Psychiatry, Medical College of VirginiaVirginia Commonwealth UniversityRichmondUSA
  2. 2.University of Virginia School of MedicineCharlottesvilleUSA
  3. 3.Clinical Studies Unit, Western State HospitalStauntonUSA

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