Korean Journal of Biological Psychiatry (생물정신의학)

The Korean Society of Biological Psychiatry (대한생물정신의학회)
권호 표지

Prevalence and Risk Factors of Polydipsia and Water Intoxication in Psychiatric Inpatients

정신과 입원 환자에서의 다음증 및 물중독 유병률 및 위험인자에 관한 연구

  • Published : 2009.11.30
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives : The aims of this study are to estimate the prevalence of polydipsia and water intoxication and to identify risk factors of polydipsia and water intoxication in psychiatric inpatient. Methods : 1,108 Psychiatric inpatients at 2 mental hospitals in Yongin city were studied from September, 2008 to January, 2009. We diagnosed 'polydipsia' using staff reports(fluid intake>3L/day) or by specific gravity of urine(SPGU<1.008) and diagnosed 'at risk for water intoxication' using normalized diurnal weight gain (NDWG>4%). We attempted to identify clinical characteristics of patients by reviewing their medical records. Results : Two hundred forty seven patients(22.3%) were polydipsic. Sixty eight patients(6.1%) were at risk for water intoxication. The factors associated with polydipsia were lithium, smoking, younger age and increased smoking amounts. The factors associated with risk for water intoxication were valproic acid and polydipsia. Conclusion : Polydipsia and water intoxication in psychiatric inpatients are not rare conditions. Therefore, clinicians' attention should be paid to these conditions.

Keywords

References

  1. de Leon J, Verghese C, Tracy JI, Josiassen RC, Simpson GM. Polydipsia and water intoxication in psychiatric patients: a review of the epidemiological literature. Biol Psychiatry 1994;35:408-419. https://doi.org/10.1016/0006-3223(94)90008-6
  2. Goldman MB. A rational approach to disorders of water balance in psychiatric patients. Hosp Community Psychiatry 1991;42:488-494.
  3. Hobson JA, English JT. Self-induced water intoxication; case study of a chronically schizophrenic patient with physiological evidence of water retention due to inappropriate release of antidiuretic hormone. Ann Intern Med 1963;58:324-332. https://doi.org/10.7326/0003-4819-58-2-324
  4. Vieweg WV, David JJ, Rowe WT, Wampler GJ, Burns WJ, Spradlin WW. Death from self-induced water intoxication among patients with schizophrenic disorders. J Nerv Ment Dis 1985;173:161-165. https://doi.org/10.1097/00005053-198503000-00005
  5. de Leon J, Tracy J, McCann E, McGrory A. Polydipsia and schizophrenia in a psychiatric hospital: a replication study. Schizophr Res 2002;57:293-301. https://doi.org/10.1016/S0920-9964(01)00292-4
  6. Goldman MB, Robertson GL, Luchins DJ, Hedeker D, Pandey GN. Psychotic exacerbations and enhanced vasopressin secretion in schizophrenic patients with hyponatremia and polydipsia. Arch Gen Psychiatry 1997;54:443-449. https://doi.org/10.1001/archpsyc.1997.01830170069010
  7. de Leon J, Dadvand M, Canuso C, Odom-White A, Stanilla J, Simpson GM. Polydipsia and water intoxication in a long-term psychiatric hospital. Biol Psychiatry 1996;40:28-34. https://doi.org/10.1016/0006-3223(95)00353-3
  8. Gonzalez I, Perez N, Penas-LLedo EM, LLerena, Gonzalez I, de la Rubia A. High risk of polydipsia and water intoxication in schizophrenia patients. Schizophr Res 2008;99:377-378. https://doi.org/10.1016/j.schres.2007.05.027
  9. Mercier-Guidez E, Loas G. Polydipsia and water intoxication in 353 psychiatric inpatients: an epidemiological and psychopathological study. Eur Psychiatry 2000; 15:306-311. https://doi.org/10.1016/S0924-9338(00)00399-0
  10. Bremner AJ, Regan A. Intoxicated by water. Polydipsia and water intoxication in a mental handicap hospital. Br J Psychiatry 1991;158:244-250. https://doi.org/10.1192/bjp.158.2.244
  11. Chong SA, Tan LL, Wong MC, Woo SC, Tan CH, Ng LL. Disordered water homeostasis in Asian patients with schizophrenia. Aust N Z J Psychiatry 1997;31:869-873. https://doi.org/10.3109/00048679709065514
  12. Llerena A, De la Rubia Martlnez A, Penas-Lledo EM. [Prevalence of polydipsia and water intoxication in psychiatric inpatients.] Actas Esp Psiquiatr 2001;29:299-303.
  13. Oh DY, Suh HJ. A study on Polydipsia of Psychiatric Inpatients. J Korean Neuropsychiatr Assoc 1996;35:729-739.
  14. Kim CS, Kim HN, Paik KC. Clinical Characteristics of Chronic Schizophrenic Inpatients at Risk of Polydipsia and Water Intoxication Measured with Normalized Diurnal Weight Gain. J Korean Neuropsychiatr Assoc 1996;35:740-752.
  15. Adler LE, Olincy A, Waldo M, Harris JG, Griffith J, Stevens K, et al. Schizophrenia, sensory gating, and nicotinic receptors. Schizophr Bull 1998;24:189-202. https://doi.org/10.1093/oxfordjournals.schbul.a033320
  16. Grandjean EM, Aubry JM. Lithium: updated human knowledge using an evidence-based approach: part III: clinical safety. CNS Drugs 2009;23:397-418. https://doi.org/10.2165/00023210-200923050-00004
  17. Vieweg WV, Weiss NM, David JJ, Rowe WT, Godleski LS, Spradlin WW. Treatment of psychosis, intermittent hyponatremia, and polydipsia(PIP syndrome) using lithium and phenytoin. Biol Psychiatry 1988;23:25-30. https://doi.org/10.1016/0006-3223(88)90103-5
  18. Evenson RC, Jos CJ, Mallya AR. Prevalence of polydipsia among public psychiatric patients. Psychol Rep 1987;60:803-807. https://doi.org/10.2466/pr0.1987.60.3.803
  19. Luchins DJ, Nettles KW, Goldman MB. Anterior medial temporal lobe volumes in polydipsic schizophrenic patients with and without hypo-osmolemia: a pilot study. Biol Psychiatry 1997;42:767-770. https://doi.org/10.1016/S0006-3223(96)00491-X
  20. Illowsky BP, Kirch DG. Polydipsia and hyponatremia in psychiatric patients. Am J Psychiatry 1988;145:675-683. https://doi.org/10.1176/ajp.145.6.675
  21. Branten AJ, Wetzels JF, Weber AM, Koene RA. Hyponatremia due to sodium valproate. Ann Neurol 1998;43:265-267. https://doi.org/10.1002/ana.410430219
  22. Corda C, Beuriat P, Sgro C, Giroud M, Escousse A, Dumas R. [Hyponatremia under sodium valproate: search a drug interaction.] Therapie 1991;46:169.
  23. Ikeda K, Moriyasu H, Yasaka M, Oita J, Yamaguchi T. [Valproate related syndrome of inappropriate secretion of antidiuretic hormone(SIADH)--a case report.] Rinsho Shinkeigaku 1994;34:911-913.
  24. Miyaoka T, Seno H, Itoga M, Kishi T, Ishino H, Horiguchi J. Contribution of sodium valproate to the syndrome of inappropriate secretion of antidiuretic hormone. Int Clin Psychopharmacol 2001;16:59-61. https://doi.org/10.1097/00004850-200101000-00008
  25. Okura M, Morii S. Polydipsia, polyuria and water intoxication observed in psychiatric inpatients. Tokushima J Exp Med 1986;33:1-5.
  26. Cho SJ, Lee BJ, Cho MJ, Kim YI, Suh T, Jung IK. Length of Stay of Psychiatric Patient and Its Correlate in Mental Health-related Facilities. J Korean Neuropsychiatr Assoc 2006;45:372-381.