Vasopressin in chronic psychiatric patients with primary polydipsia

Article Abstract:

Twelve chronic psychiatric in-patients (nine men and three women, average age 41 years) with primary polydipsia (excessive and persistent thirst) were studied during free drinking periods and during periods of fluid deprivation, to assess plasma and urinary arginine vasopressin (AVP) levels. AVP is an antidiuretic hormone, which stimulates the reabsorption of water, which in turn leads to urine concentration. Ten of the patients were taking neuroleptics (antipsychotic medications). During the first 24 hours of the study, patients were allowed to drink freely. Weight and urine volume were recorded hourly. Urine for each four-hour period was pooled and samples taken for estimations of concentration (osmolality), creatinine, and AVP. Blood samples for estimations of AVP, sodium and osmolality were also collected every four hours. Samples were collected over the next few days. First, fluid intake was restricted to a state of normal fluid intake, and then nothing was permitted by mouth for 12 hours. During the first day of the study, urinary creatinine excretion was high, although osmolar excretion was within normal limits. During the maximum hydration period, plasma AVP levels were sufficient to cause the water retention. In addition, patients showed a decrease of kidney sensitivity to high levels of AVP. Although they were able to respond to fluid deprivation with increased vasopressin secretion and urine concentration, many patients demonstrated inappropriate secretion of antidiuretic hormone (SIADH). The majority of patients had SIADH Type I, in which there is no relationship between plasma osmolality and plasma AVP. Since the patients did not exhibit drug-induced hypotension, the assumption was made that neuroleptic treatment was unlikely to have caused the SIADH. SIADH appears to contribute to the development of water retention and severity of polydipsia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Drinking (Physiology), Vasopressin, Vasopressins

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Systemic lupus erythematosus in a woman with mental handicap

Article Abstract:

A case report is presented of a young woman of Irish descent who was institutionalized for 15 years before being diagnosed with systemic lupus erythematosus (SLE). SLE is a progressive connective tissue disorder with a slow, insidious onset marked by fatigue and low-grade fevers. Anemia, high blood pressure, and skin rashes or lesions are common later developments. Neurological symptoms, including epileptic-type seizures and mental disorders such as psychoses, depression, and personality changes, have been reported in 60 percent of SLE cases. The young woman appeared to be normal until age two, when her mother felt she was developing somewhat slowly. She had academic difficulties, and at age 20 she became confused, aggressive and distressed. The patient was diagnosed with epilepsy and brain damage. One year later, she was placed in a mental institution where she remained for 15 years. Her mental and physical states fluctuated a great deal, and she demonstrated a great deal of distractibility. The woman was finally moved to another facility, and after a multidisciplinary review of her history, was tentatively diagnosed with SLE. Clinical notes described years of intermittent rashes and infections of the skin and chest. Lupus antibody tests were positive and, in addition to antipsychotic, anticonvulsive and antianxiety medications, she was started on prednisolone to treat the SLE. When antipsychotic and anticonvulsant drugs were discontinued, the patient's mental state improved, although her ability to concentrate remained poor. While some of her behavior remained bizarre, her aggression and violent mood swings abated. This case demonstrates the necessity of monitoring mentally handicapped patients for concurrent physiological disorders to avoid unnecessary lengthy institutionalization and complications. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Diagnostic errors, Systemic lupus erythematosus, Mentally disabled persons, Psychiatric errors

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Intoxicated by water: polydipsia and water intoxication in a mental handicap hospital

Article Abstract:

Compulsive water drinking, or polydipsia, refers to the drinking of large amounts of water regardless of need or thirst. This can lead to water intoxication, which can cause such symptoms as restlessness, confusion, lethargy, nausea, diarrhea, or vomiting. Even death may result occasionally. Some of the long-term medical effects include kidney failure, expansion of the bladder, dementia, and possibly spinal fracture due to excessive loss of calcium. Out of 877 persons in a hospital for the mentally handicapped, 31 patients were identified as 'drinkers,' 21 men and 10 women out of a total population that was half men and half women. Average age was 42 years, which was seven years younger than the average age of the population. Drinkers were likely to suffer from schizophrenia, severe personality disorders, or autism. Of 18 able to discuss their drinking, 12 admitted it, six reported drinking secondary to thirst, and six complained of a dry mouth. Observations showed that many of the patients with polydipsia were anxious while exhibiting the behavior. It is suggested that polydipsia is a learned behavior based on availability of fluid, persistent anxiety, a sense of relief gained from drinking, and a lack of other, more effective measures to relieve anxiety. Cases are presented in support of this analysis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Compulsive behavior, Water intoxication, Overhydration

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