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Intoxicated by Water

Polydipsia and Water Intoxication in a Mental Handicap Hospital

Published online by Cambridge University Press:  02 January 2018

Alexander J. Bremner  and
Adrienne Regan
Alexander J. Bremner
Affiliation:
Charing Cross Hospital, Fulham Palace Road, London W6
Adrienne Regan*
Affiliation:
Leavesden Hospital, College Road, Abbots Langley, Herts WD5 0NU
*
∗Correspondence
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Abstract

A cross-sectional survey of the drinking habits of 877 mentally handicapped in-patients revealed 31 patients (prevalence 3.5%) who, in the opinion of nurses, drank five litres or more daily. Low urine specific gravity was a less useful indicator of polydipsia. Polydipsia appeared to be significantly associated with a borderline level of handicap and with a diagnosis of schizophrenia, autism or severe personality/behaviour disorder. Of five cases of water intoxication associated with polydipsia, one was fatal. In two cases excess drinking improved with increased neuroleptic medication. Lithium and demeclocycline were used in two cases to prevent hyponatraemic episodes.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 158 , Issue 2 , February 1991 , pp. 244 - 250
Copyright
Copyright © Royal College of Psychiatrists, 1991 

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References

Ballinger, B. R. & Reid, A. H. (1987) A standardised assessment of personality disorder in mental handicap. British Journal of Psychiatry, 150, 108–109.Google Scholar
Barahal, H. S. (1938) Water intoxication in a mental case. Psychiatric Quarterly, 12, 767–771.Google Scholar
Barlow, E. D. & De Wardener, H. E. (1959) Compulsive water drinking. Quarterly Journal of Medicine, 110, 235–238.Google Scholar
Bartter, F. C. & Schwarz, W. B. (1967) The syndrome of inappropriate secretion of antidiuretic hormone. American Journal of Medicine. 42, 790–806.Google Scholar
Bewley, T. H. (1964) Acute water intoxication from compulsive water drinking. British Medical Journal, ii, 864.Google Scholar
Blum, A. Tempey, F. W. & Lynch, W. J. (1983) Somatic findings in patients with psychogenic polydipsia. Journal of Clinical Psychiatry, 44, 55–56.Google ScholarPubMed
Chin, W. Cooper, D. Crapo, L. et al (1976) Water intoxication caused by smoking in a compulsive water drinker. Clinical Research, 24, 625a.Google Scholar
Chinn, T. A. (1974) Compulsive water drinking. Journal of Nervous and Mental Diseases, 158, 78–80.Google Scholar
Delva, N. J. & Crammer, J. L. (1988) Polydipsia in chronic psychiatric patients: body weight and plasma sodium. British Journal of Psychiatry, 152, 242–245.CrossRefGoogle ScholarPubMed
Delva, N. J. Crammer, J. L. Javzylo, S. V. et al (1989) Osteopenia, pathological fractures and increased urinary calcium excretion in schizophrenic patients with polydipsia. Biological Psychiatry, 26, 781–791.Google Scholar
Ferrier, I. N. (1985) Water intoxication in patients with psychiatric illness. British Medical Journal, 291, 1594–1595.Google Scholar
Forrest, J. N. Cox, M. Hong, C. et al (1978) Superiority of demeclocycline over lithium in the treatment of chronic syndrome of inappropriate secretion of antidiuretic hormone. New England Journal of Medicine, 298, 173–177.Google Scholar
Fowler, R. C. Kronfol, Z. A. & Perry, P. J. (1977) Water intoxication, psychosis and inappropriate secretion of antidiuretic hormone. Archives of General Psychiatry, 34, 1098–1099.Google Scholar
Goldman, M. B. & Luchins, D. J. (1985) Demeclocycline improves hyponatraemia in chronic schizophrenics. Biological Psychiatry, 20, 1149–1155.Google Scholar
Goldman, M. B. Luchins, D. J. & Robertson, G. L. (1988) Mechanisms of altered water metabolism in psychotic patients with polydipsia and hyponatraemia. New England Journal of Medicine, 318, 397–403.CrossRefGoogle Scholar
Hariprasad, M. K. Elsinger, R. P. & Nadler, I. M. (1980) Hyponatraemia in psychogenic polydipsia. Archives of Internal Medicine, 140, 1639–1642.Google Scholar
Hobson, J. A. & English, J. T. (1963) Self-induced water intoxication. Annals of Internal Medicine, 58, 324–332.Google Scholar
Illowsky, B. P. & Kirch, D. G. (1988) Polydipsia and hyponatraemia in psychiatric patients. American Journal of Psychiatry, 145, 675–683.Google Scholar
Jose, C. J. & Perez-Cruet, J. (1979) Incidence and morbidity of self-induced water intoxication in state mental hospital patients. American Journal of Psychiatry, 136, 221–222.Google ScholarPubMed
Khamnei, A. K. (1984) Psychosis, inappropriate antidiuretic hormone and water intoxication. Lancet, i, 963.CrossRefGoogle ScholarPubMed
Kramer, D. S. & Drake, M. E. (1983) Acute psychosis, polydipsia and inappropriate secretion of antidiuretic hormone. American Journal of Medicine, 75, 712–714.Google Scholar
Kulkarnia, J. McLachlan, R. L. & Copolov, D. (1985) The medical and psychological investigation of psychogenic polydipsia: a case study. British Journal of Psychiatry, 146, 545–547.CrossRefGoogle Scholar
Laureno, R. (1983) Central pontine myelinolysis following rapid correction of hyponatraemia. New England Journal of Medicine, 314, 1535–1542.Google Scholar
Lee, S. Chow, C. C. & Koo, L. C. L. (1989) Altered state of consciousness in a compulsive water drinker. British Journal of Psychiatry, 154, 556–558.Google Scholar
Mann, A. H. Jenkins, R. Cutting, J. C. et al (1981) The development and use of a standardised assessment of abnormal personality. Psychological Medicine, 11, 839–847.Google Scholar
Mendelson, W. B. & Deza, P. C. (1976) Polydipsia, hyponatraemia and seizures in psychotic patients. Journal of Nervous and Mental Disease, 162, 140–143.Google Scholar
Nixon, R. A. & Chin, W. W. (1983) Water intoxication, demeclocycline and antidiuretic hormone (reply to letter). American Journal of Psychiatry, 140, 815.Google Scholar
Noonan, J. P. A. & Anath, J. (1977) Compulsive water drinking and water intoxication. Comprehensive Psychiatry, 18, 183–187.Google Scholar
Perucca, E. Garratt, A. Hebdige, S. et al (1978) Water intoxication in epileptic patients receiving carbamazepine. Journal of Neurology, Neurosurgery and Psychiatry, 41, 713–718.Google Scholar
Raskind, M. (1974) Psychosis, polydipsia and water intoxication. Report on a fatal case. Archives of General Psychiatry, 30, 112–114.Google Scholar
Raskind, M. Orenstein, H. & Christopher, T. G. (1975) Acute psychosis, increased water ingestion and inappropriate antidiuretic hormone secretion. American Journal of Psychiatry, 132, 907–910.Google Scholar
Raskind, M. & Barnes, R. F. (1984) Water metabolism in psychiatric disorders. Seminars in Nephrology, 4, 316–324.Google Scholar
Rosenbaum, J. F. Orthman, J. S. & Murray, G. B. (1979) Psychosis and water intoxication. Journal of Clinical Psychiatry, 40, 287–291.Google Scholar
Rowntree, L. G. (1923) Water intoxication. Archives of Internal Medicine, 32, 157–184.CrossRefGoogle Scholar
Sandifer, M. G. (1983) Hyponatraemia due to psychotropic drugs. Journal of Clinical Psychiatry, 44, 301–303.Google Scholar
Shen, W. W. & Sata, L. S. (1983) Hypothalamic dopamine receptor supersensitivity. Psychiatric Journal, University of Ottawa, 8, 154–158.Google ScholarPubMed
Shrier, R. W. (1985) Treatment of hyponatraemia. New England Journal of Medicine, 312, 1121–1123.Google Scholar
Shrier, R. W. (ed.) (1986) Renal and Electrolyte Disorders (3rd edn), pp. 127–131. New York: Little, Brown and Co. Google Scholar
Singh, S. Padi, M. H. Bullard, H. et al (1985) Water intoxication in psychiatric patients. British Journal of Psychiatry, 146, 127–131.Google Scholar
Sleeper, F. H. & Jellinek, E. M. (1936) A comparative physiologic, psychologic and psychiatric study of polyuric and nonpolyuric schizophrenic patients. Journal of Nervous and Mental Diseases, 83, 557–563.Google Scholar
Smith, W. O. & Clark, M. L. (1980) Self-induced water intoxication in schizophrenic patients. American Journal of Psychiatry, 137, 1055–1060.Google ScholarPubMed
Stevko, R. M. Balsley, M. & Segar, W. E. (1968) Primary polydipsia – compulsive water drinking. Journal of Paediatrics, 73, 845–851.Google Scholar
Viewig, W. V. R. Rowe, W. T. C. David, J. J. et al (1984) Evaluation of patients with self-induced water intoxication and schizophrenic disorders. Journal of Nervous and Mental Disease, 172, 552–555.Google Scholar
White, M. & Fetner, C. (1975) Treatment of the syndrome of inappropriate secretion of antidiuretic hormone with lithium carbonate. New England Journal of Medicine, 292, 390–392.Google Scholar
Zerbe, R. Stropes, L. & Robertson, G. (1980) Vasopressin function in the syndrome of inappropriate antidiuresis. Annual Reviews of Medicine, 31, 315–327.Google Scholar
Zubenko, G. S. (1987) Water homeostasis in psychiatric patients. Biological Psychiatry, 22, 121–125.Google Scholar
Zubenko, G. S. Altesman, R. I. Cassidy, J. W. et al (1984) Disturbances of thirst and water homeostasis in patients with affective illness. American Journal of Psychiatry, 141, 436–437.Google ScholarPubMed
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