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PubMed1996

[Polydipsia and water intoxication in schizophrenia patients: report of two cases].

This report describes two cases of schizophrenia inpatients with polydipsia, intermittent hyponatremia, and water intoxication. Case 1, a 38 year-old male, developed polydipsia after seven years duration of schizophrenia, with a daily intake of water of more than 10 liters as a result of auditory hallucination suggestion. Nocturnal hyponatremia, agitation and exacerbation of psychosis were noted during admission. After 12 treatments of electroconvulsive therapy, the symptoms of psychosis and polydipsia declined. Case 2, a 42 year-old male, had also been a case of schizophrenia for about twenty years, and developed polydipsia with more than 5 liters of daily water intake in a chronic psychiatric hospital for a period of 5 years schizophrenia. He claimed that he enjoyed the pleasure of drinking water. The symptom of water intoxication had been noted intermittently in the past year, leading to at least two seizures. Finally the patient was transferred to our ward due to agitated mood, self-destructive behavior, consciousness loss, and motor weakness. The clinical features, differential diagnosis and treatment concept of polydipsia and water intoxication were also discussed in context.

Adult↗
PubMed1996

["Polydipsia, intermittent hyponatremia and psychoses" syndrome: a diagnosis and therapeutic management of a case].

Polydipsia can be defined as an impulsive behavior leading to absorption of large amounts of water (4 to 20 litres a day), without any underlying organic disease. Its prevalence in a population of chronic psychiatric patients can be as high as 6 to 17%. Schizophrenia represents 80% of cases reported. Some patients with polydipsia may develop hyponatremia, leading to a PIP syndrome (Polydipsia intermittent hyponatremia and psychosis). Hyponatremia or water intoxication appears when three conditions are present: an abnormal regulation of thirst, an inappropriate ADH secretion and/or an excessive renal sensitivity to ADH, with an increased sensitivity of the central nervous system to hyponatremia. The clinician must first identify patients at risk to develop water intoxication and start treatment before any severe physical complication occurs. Pharmacological treatments aiming at an increase of renal free-water excretion--do not show a constant efficacy in the correction of hyponatremia, they have no action on polydipsia. The new atypical neuroleptics such as clozapine and risperidone seem to open new perspectives in the treatment of polydipsia. Controlled studies should be performed in this field.

Adult↗
PubMed1993

Selective serotonin re-uptake inhibitors decrease schedule-induced polydipsia in rats: a potential model for obsessive compulsive disorder.

Schedule-induced polydipsia was used to determine the effects of selective serotonin re-uptake inhibitors on adjunctive water consumption. Polydipsia was induced in food deprived rats by exposure to a fixed time feeding schedule (FT = 60 s) for 150 min per day for 22 days. Selected polydipsic rats consumed 3-4 times greater volume of water compared to food deprived control rats. Chronic administration of the selective serotonin re-uptake inhibitors fluoxetine and clomipramine (CMI) at 5 mg/kg per day and fluvoxamine at 10 mg/kg twice a day significantly decreased schedule-induced polydipsia (SIP) on day 15 and throughout the remainder of the study compared to control rats. The noradrenergic re-uptake inhibitor, desipramine (DMI), only decreased SIP behavior on day 1. The neuroleptic, haloperidol (0.03 and 0.1 mg/kg), and the benzodiazepine, diazepam (2.5 mg/kg), failed to alter SIP behavior. Since obsessive-compulsive disorder (OCD) and polydipsic behavior both involve excessive expression of a normal behavior, the polydipsia model may be relevant for the prediction of compounds useful in the treatment of OCD.

Animals↗
PubMed1993

Effects of buspirone and ipsapirone on schedule induced polydipsia: comparison with 8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT) and raclopride.

In the present experiments, the effects of the azapirone anxiolytics, buspirone and ipsapirone, on excessive drinking induced by a FT-60 schedule of food delivery (schedule induced polydipsia, SIP) were investigated. Because buspirone is known to block dopamine receptors and both buspirone and ipsapirone act as agonists at the 5-HT1A receptor, their effects on polydipsia were compared to raclopride, an antagonist at D2 receptors, and 8-OH-DPAT, an agonist at the 5-HT1A receptor, thus providing information about the relative importance of the serotonergic and/or dopaminergic systems for the maintenance of polydipsia. The effects of all four drugs were investigated both acutely, and following repeated treatment. The doses employed were as follows: buspirone, 1.0, 3.0, and 10.0 mg/kg; raclopride, 0.05, 0.15, and 0.5 mg/kg; 8-OH-DPAT, 0.1, and 1.0 mg/kg and ipsapirone, 1.0, 3.0, 10.0 mg/kg. Administered acutely, the lowest doses of buspirone and raclopride did not alter drinking, whilst the low dose of 8-OH-DPAT significantly reduced polydipsia. These effects were reversed following repeated treatment over 16 successive days. Buspirone 1.0 mg/kg and 0.05 mg/kg raclopride reduced drinking, whilst tolerance developed to the effects of 0.1 mg/kg 8-OH-DPAT. Ipsapirone, at low doses, was without effect on drinking. At high doses, all four drugs reduced drinking both acutely and chronically. Repeated treatment with buspirone (3.0, and 10.0 mg/kg) reduced licking and panel entries, but induced a selective decrease in licking at the low dose (1.0 mg/kg). Similar effects were seen following raclopride treatment, although the effects were less selective. 8-OH-DPAT and ipsapirone, in contrast reduced licking only at the highest dose, and both drugs increased panel entries as testing continued. The effects of buspirone resembled those of raclopride whereas the effects of ipsapirone resembled those of 8-OH-DPAT. Buspirone appears to act as a dopamine antagonist in this test. The effects of the drugs suggest that SIP depends upon motivational and performance factors which may be more sensitive to drug manipulation than potential underlying psychological factors such as anxiety or stress.

8-Hydroxy-2-(di-n-propylamino)tetralin↗
PubMed1997

Involvement of the alpha2-adrenergic system in polydipsia in schizophrenic patients: a pilot study.

Animal studies have suggested the involvement of the adrenergic system in drinking behavior. The present study investigated the involvement of the alpha2-adrenergic system in the polydipsia of patients with chronic schizophrenia by use of an alpha2 agonist and an antagonist. Four patients with schizophrenic disorders accompanied by intermittent hyponatremia and polydipsia were the subjects of, and completed, this study. Drinking behavior was assessed by calculating the percent of maximum weight gain [PMWG: (maximum diurnal weight - standard weight) x 100/standard weight]. Standard weight was defined as body weight after 8 h of water restriction. Clonidine (75, 150, and 225 mg/day) increased the PMWG in a dose-dependent manner in the four subjects. In contrast, in three of the subjects, mianserin (30, 60, and 90 mg/day) decreased PMWG, and the severe polydipsia disappeared almost completely. These findings indicate clearly that the alpha2-adrenergic system is involved in the drinking behavior of schizophrenic patients. Mianserin appears to be clinically useful in treating such patients with polydipsia.

Adrenergic alpha-Agonists↗
PubMed2003

Polydipsia--a study in a long-term psychiatric unit.

This is a retrospective review of the author's experience with polydipsia in a long-term unit for treatment refractory patients at a US psychiatric state hospital during a 5-year period [1996-2000]. Sixty-one patients were admitted to this long-term unit, comprising approximately 1 % of the hospital admissions. Polydipsic patients were followed with diurnal weight changes and other biological measures. This longitudinal study of 61 chronic inpatients suggests that polydipsia is no doubt present in at least 20 % of chronic psychiatric inpatients and hyponatremia in more than 10 %. Two polydipsic patients worsened when switched from clozapine to other atypical antipsychotics. Polydipsia in severe mentally ill patients continues to be a neglected subject and a challenge for psychiatrists. Polydipsic patients should not be switched to other atypical antipsychotics, unless new prospective studies prove that they are as effective as clozapine for polydipsia.

Adult↗
PubMed1994

Effects of amperozide on schedule-induced polydipsia in rats.

Schedule-induced polydipsia occurs when food-deprived rats are exposed to a fixed-interval feeding schedule (FI = 60 s) for 1 h every day. Amperozide, a novel antipsychotic drug with a strong affinity for the 5-HT2 receptor, was injected i.p. after completion of the requisite training sessions. The experimental rationale is that although the intensity of licking behavior in schedule-induced polydipsia can be taken as an index for anxiety, the drug-induced motor dysfunction should be assessed. In experiment 1, we tested the effect of amperozide on schedule-induced polydipsia at doses of 2, 4, and 8 mg/kg. The data showed that each dose significantly diminished the amount of licking and water intake. The number of presses decreased only at the dose of 8 mg/kg. During five post-treatment daily sessions for 5 days, these three measures returned to normal levels except that the number of pellets earned during the sessions did not significantly change. In addition, the number of presses showed a rebound after the termination of amperozide administration. In experiment 2, in addition to the total water intake, number of licks, pellets earned and presses, we also analyzed the postpellet temporal variation in the number of licks and presses in each schedule-induced polydipsia session. The drug was stopped for one day after each dose of 0.2, 0.4, 0.8 and 1.6 mg/kg of amperozide. The data showed that doses from 0.2 to 0.8 mg/kg did not alter any measure in drug-treated sessions and that the dose of 1.6 mg/kg decreased the number of licks and water intake.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1983

Schedule-induced polydipsia as a function of percent of body weight in the Mongolian gerbil.

Three male Mongolian gerbils displayed schedule-induced polydipsia on a fixed-time 3-min food reinforcement schedule at 85% body weight (BW). When the gerbils' body weights were gradually increased to ad lib levels, the polydipsia disappeared. When the gerbils were subsequently reduced to 85% BW again, the previous polydipsia levels of water intake were recaptured. These data replicate previous findings with rats, and suggest that schedule-induced polydipsia may be as robust in gerbils and other species, as it is with rats, once the optimal generating conditions are established.

Animals↗
PubMed1987

The differential effects of naloxone hydrochloride on the acquisition and maintenance of schedule-induced polydipsia.

Rats injected with the opiate antagonist, naloxone hydrochloride (10 mg/kg), 15 min prior to sessions in which they were given free food on a fixed time 75-sec schedule, displayed retarded acquisition of schedule-induced polydipsia relative to vehicle-injected subjects. Rats injected with naloxone after schedule-induced polydipsia had been acquired were unaffected, i.e., they continued to drink at control levels. Given that schedule-induced polydipsia has been considered non-opioid in nature, because of previous reports of its insensitivity to naloxone, the present report of differential effects of naloxone on the acquisition and maintenance of schedule-induced polydipsia suggests that some modification of this conclusion is necessary. Possible alternative mechanisms for these differential effects are discussed.

Animals↗
PubMed1989

Time-response effects of pimozide on operant behavior and schedule-induced polydipsia.

Previous research has indicated that the administration of specific doses of pimozide results in the suppression of the acquisition of schedule-induced polydipsia in rats while not affecting operant behavior. The purpose of this study was to determine if these results were due to a specific action of pimozide on schedule-induced polydipsia or if they were due to an insufficient presession time of drug administration. Pimozide at 1.0 mg/kg was administered to three groups of rats at either 30, 60 or 120 minutes presession with control subjects receiving administration of the drug vehicle also at these times. The results of the study were that both operant behavior and the acquisition of schedule-induced polydipsia were affected in a nondifferential and time-dependent manner by pimozide. It was also found that pimozide caused an alteration in the temporal pattern of both schedule-induced polydipsia and operant responding. This latter result appears to have been caused by a disruption in sensorimotor integration due to the dopamine blocking properties of pimozide.

Animals↗
PubMed1988

A study of the response to several dipsogenic treatments in rats with mammillary polydipsia and with centrally induced diabetes insipidus.

Several brain areas have been implicated in the regulation of water intake and body fluid homeostasis. Electrolytic lesions located in the mammillary area have proved to induce a strong polydipsia. The cause of this overconsumption is not understood, although other studies have indicated a possible relationship with the mechanisms involved in sodium control. In this paper, we consider whether mammillary polydipsia is related to diabetes insipidus. In this regard, animals with mammillary lesions were submitted to several dipsogenic treatments, both osmotic and volemic. These subjects showed a differential response to hypertonic NaCl compared with controls. No effect could be seen in relation to the other treatments employed, that is, sucrose and polyethylene glycol. On the other hand, this differential response to NaCl was not observed in those animals with diabetes insipidus centrally induced by means of lesions in the median eminence. Thus, mammillary polydipsia and diabetes insipidus-related water intake seem to be different phenomena. The possible relationship between mammillary polydipsia and sodium control is discussed.

Animals↗
PubMed2001

Polyuria and polydipsia. Diagnostic approach and problems associated with patient evaluation.

Primary disorders of water balance (central diabetes insipidus [DI], nephrogenic DI, and psychogenic polydipsia) should always be considered in the differential diagnosis of polyuria and polydipsia. In general, animals with these disorders have only one laboratory abnormality: a low urine specific gravity. In most instances, the more common causes of polyuria and polydipsia (e.g., hyperadrenocorticism, chronic renal failure, pyelonephritis, pyometra) have specific and obvious abnormalities associated with the complete blood cell count, the serum chemistry profile, and urinalysis. In some cases, however, a low urine specific gravity may be the only abnormality associated with these more common findings. The workup for polyuria and polydipsia can be tedious, time-consuming, expensive, confusing, and not without significant patient morbidity, especially in those cases with normal or near-normal blood work. This article focuses on the diagnostic approach and problems associated with diagnostic testing in patients with disorders of water balance.

Animals↗
PubMed1992

Pituitary-adrenal and dopaminergic modulation of schedule-induced polydipsia: behavioral and neurochemical evidence.

Five experiments investigated in rats the effects of increasing or decreasing plasma corticosterone levels on schedule-induced polydipsia and dopamine efflux in the nucleus accumbens. The results indicate that the acquisition of schedule-induced polydipsia could be decreased by adrenalectomy, blockade of corticosterone synthesis, or administration of corticosterone. Performance of established schedule-induced polydipsia was also decreased by adrenalectomy. The effects of corticosterone administration on established schedule-induced polydipsia depended on the level of performance. High levels of drinking were enhanced by a high dose of corticosterone, whereas low rates of drinking were increased by a low dose. Similar injections of corticosterone also significantly increased dopamine efflux. The relative involvement of pituitary-adrenal activity and dopamine neurotransmission in the nucleus accumbens in the acquisition and performance of SIP is discussed and related to contemporary hypotheses of schedule-induced behavior.

Animals↗
PubMed1999

MRI changes during water loading in patients with polydipsia and intermittent hyponatremia.

OBJECTIVE: Patients with polydipsia and intermittent hyponatremia have greater ventricle-brain ratios (VBRs) than matched patients without polydipsia and intermittent hyponatremia and normal subjects. Unlike previous studies, this study controlled for the impact of water loading when examining the volume of intracranial structures. METHOD: Under controlled conditions, eight male schizophrenic patients with polydipsia and intermittent hyponatremia were first assigned to either normal fluid intake or oral water loading and then the alternative condition the following day. Magnetic resonance imaging (MRI) volumetric measurements were made with the use of a standardized protocol. RESULTS: During water loading, total VBR and lateral ventricle volume significantly decreased by 13.1% and 12.6%, respectively. A strong association between change in serum sodium concentration and change in VBR was noted across conditions. CONCLUSIONS: These findings indicate that 1) water loading does not account for the diminished brain volume observed in patients with polydipsia and intermittent hyponatremia in previous studies, and 2) hyponatremia can significantly alter brain morphology on MRI.

Adult↗
PubMed1999

Urinary excretion of aquaporin-2 water channel differentiates psychogenic polydipsia from central diabetes insipidus.

The present study was undertaken to determine whether urinary excretion of aquaporin-2 (AQP-2) water channel under ad libitum water intake is of value to differentiate polyuria caused by psychogenic polydipsia from central diabetes insipidus. A 30-min urine collection was made at 0900 h in 3 groups of: 11 patients with central diabetes insipidus (22-68 yr old), 10 patients with psychogenic polydipsia (28-60 yr old), and 15 normal subjects (21-38 yr old). In the patients with central diabetes insipidus, the plasma arginine vasopressin level was low despite hyperosmolality, resulting in hypotonic urine. Urinary excretion of AQP-2 was 37 +/- 15 fmol/mg creatinine, a value one-fifth less than that in the normal subjects. In the patients with psychogenic polydipsia, plasma arginine vasopressin and urinary osmolality were as low as those in the patients with central diabetes insipidus. However, urinary excretion of AQP-2 of 187 +/- 45 fmol/mg creatinine was not decreased, and its excretion was equal to that in the normal subjects. These results indicate that urinary excretion of AQP-2, under ad libitum water drinking, participates in the differentiation of psychogenic polydipsia from central diabetes insipidus.

Adult↗
PubMed1967

Control of schedule-induced polydipsia: type, size, and spacing of meals.

Rats were given daily 1-min variable-interval sessions for several types of food delivered in various amounts per reinforcement and the concurrent, schedule-induced polydipsia was measured. Dry, solid food was neither a necessary nor sufficient condition for the development of polydipsia. Small portions of liquid Standard Monkey Diet produced polydipsia, but 45-mg dextrose or sucrose pellets did not. Within the range studied, smaller portions of both solid and liquid foods produced more drinking than larger portions per reinforcement. Two-min variable-interval sessions produced a greater polydipsic response than 1-min variable-interval, even though the number of 45-mg Noyes pellets allowed per session was held constant. Polydipsia was greatly attenuated on these schedules when the number of pellets remained constant, but were delivered two at a time. Within the ranges studied, the concurrent polydipsic response was increased by decreasing the rate of food acquisition, either by using smaller portions of food per reinforcement or by increasing the interreinforcement time.

Animals↗
PubMedDate not supplied

Use of T1-weighted MR imaging to differentiate between primary polydipsia and central diabetes insipidus.

PURPOSE: To investigate the value of MR in differentiating patients with primary polydipsia, who have an intact neurohypophyseal system, from those with central diabetes insipidus, who have impaired synthesis and/or release of vasopressin. METHODS: Eighteen patients with clinically significant hypotonic polyuria were diagnosed endocrinologically as having primary polydipsia or diabetes insipidus (central or nephrogenic). These patients, and 92 patients without sellar disease, were then imaged with 1.5-T, T1-weighted, thin sagittal sections without gadolinium contrast. RESULTS: Normal hyperintense signal of the neurohypophysis was present in 90 of 92 patients without sellar disease. The signal was also present in all six patients with primary polydipsia. In contrast, the hyperintense signal was absent in all eight patients with central diabetes insipidus. Three of the four patients with nephrogenic diabetes insipidus also had an absent hyperintense signal. CONCLUSION: T1-weighted MR may prove important in differentiating patients with central diabetes insipidus from those with primary polydipsia.

Adult↗
PubMed1990

Polyuria and polydipsia. Problems associated with patient evaluation.

Primary disorders of water balance (central diabetes insipidus, congenital nephrogenic diabetes insipidus, and psychogenic polydipsia) should always be considered in the differential diagnosis of polyuria and polydipsia. In general, animals with these disorders have only one laboratory abnormality, a low urine specific gravity. The more common causes of polyuria and polydipsia (eg, hypercalcemia, chronic renal insufficiency, pyelonephritis, hyperadrenocorticism), in most instances, have specific and obvious abnormalities associated with the complete blood count (CBC), serum chemistry profile, and urinalysis. However, in some cases, a low urine specific gravity may initially be the only abnormality in these more common ruleouts. The workup for polyuria and polydipsia, especially in those cases with normal or near normal blood work, can be tedious, time consuming, confusing, and not without significant patient morbidity. This chapter will focus on the problems associated with diagnostic testing used to evaluate animals with disorders of water balance.

Animals↗