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Psychogenic Polydipsia
Psychogenic polydipsia is excessive thirst and compulsive water drinking occurring in patients with psychiatric disorders. It may result in hyponatremia due to low plasma osmolality. Treatment involves correcting any hyponatremia, fluid restriction, and treating the underlying psychiatric illness. Behavioral therapy focuses on restricting water intake through stimulus control and coping skills. Pharmacological treatments include atypical antipsychotics or lithium.
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Presentation by Anish Dhakal introducing the management of psychogenic polydipsia.
Contents include Primary Polydipsia, Psychogenic Polydipsia, Diagnosis, and Management.
Excessive thirst leading to increased fluid intake; affects plasma osmolarity, sodium, and AVP secretion.
Further insights into Primary Polydipsia, elaborating on its conditions.
Compulsive drinking in psychiatric patients, often in anxious middle-aged women. May cause PPHS.
Illness progresses: polydipsia and polyuria, hyponatremia, and water intoxication.
Placeholder for diagnosis details of polydipsia.
History, psychiatric evaluation, differentiating chronic schizophrenia, effects of anticholinergic drugs.
Managing underlying conditions, monitoring electrolytes; correcting hyponatremia, fluid restriction.
Monitoring symptoms of hyponatremia; treatments when sodium levels are critically low.
Rapid correction with hypertonic saline infusion; adjustment goals for sodium levels.
Focus on fluid restriction to 1.5L/day, use of loop diuretics for water excretion.
Non-pharmacological approaches including therapeutic fluid restriction and behavior modification.
Tracking fluid intake, coping mechanisms to reduce water consumption, therapist feedback.
Use of atypical antipsychotics, like Clozapine and Risperidone for appropriate psychiatric management.
Emphasizes the complex nature of psychogenic polydipsia and key treatment goals like correcting hyponatremia.
Sources for further reading on the management and understanding of psychogenic polydipsia.
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Psychogenic Polydipsia
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- 3. Primary Polydipsia Polydipsia meansexcessive thirst and increase intake of fluid Abnormality in cognition or thirst causes excessive intake of fluids and increases in body water that reduces: ◦ Plasma osmolarity or sodium ◦ AVP secretion ◦ Urinary concentration
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- 5. Psychogenic Polydipsia Excessive thirst+ Compulsive water drinking Clinical disorder characterized by polyuria and polydipsia, patients with psychiatric disorders. Underlying pathophysiology unclear (Multifactorial) Anxious, middle-aged women and in patients with psychiatric illnesses, schizophrenia, OCD May results in Primary Polydipsia Hyponatremia Syndrome (PPHS)
- 6. In patients withprimary polydipsia the illness generally develops in three phases, beginning with 1) polydipsia and polyuria, followed by 2) hyponatremia and finally 3) water intoxication
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- 8. Diagnosis History + Rulingout other causes + Psychiatric evaluation Polydipsia in psychiatry patients is seen in patients with chronic schizophrenia, compulsive behavior Rarely associated:psychosis with onset during childhood, mental retardation, stress/anxiety, psychogenic or primary polydipsia, 6-20% of the psychiatric patients. in psychiatric patients taking anticholinergic drugs elevated levels of dopamine may be stimulating the thirst center
- 9. Management Main aim: To treatthe primary condition causing the polydipsia and monitoring electrolytes ◦ Hyponatremia present, must be corrected ◦ Fluid restriction and diuretics ◦ Non-pharmacological behavior therapy ◦ Pharmacological therapy
- 10. Management Hyponatremia (10-20% ofpatients) ◦ Neurological symptoms: when sodium levels below 125 mmol/L (<125 mEq/L) ◦ Restlessness, Psychosis, Ataxia, Stupor, Coma ◦ Use of hypertonic saline (3%) infusions with serum sodium monitoring
- 11. Management Severe Hyponatremia (<125mEq/L) ◦ Rapid correction with hypertonic saline (3%) infusion @ 1ml/kg/hr. to 6ml/kg/hr. ◦ Infusion continue until patient is asymptomatic and sodium level is > 118-120 mEq/L ◦ Maximum correction: 8 mEq/L in 24 hrs.
- 12. Management Fluid restriction and diuretics ◦1 to 1.5 litres per day ◦ Loop diuretics to enhance water excretion
- 13. Management Non-Pharmacological and Behavioural Therapy ◦Therapeuticfluid restriction, but high rates of non-compliance in patients with mental illness ◦Implementation of behavioral programme to restrict water intake (the focus is on stimulus- control )
- 14. ◦ Maintain logof the time, fluid amount, and mitigating situation for each beverage ◦ The patient uses coping skills (substituting ice cubes for drinks, taking small sips, engaging in distracting activities) and positive feedback from the therapist
- 15. Management Psychopharmacological Therapy ◦ Atypicalanti-psychotics ( Schizophrenia, Bipolar disorder, Major depressive disorder) ◦ Clozapine ◦ Risperidone and Olanzapine ◦ Demeclocycline: Nocturnal enuresis ◦ Lithium: Rarely used.
- 16. Summary Psychogenic polydipsia isexcessive thirst and compulsive water drinking occuring in patient with psychatric disorder May result in plasma hypoosmoalrity (Hyponatremia) and SIADH Correction of hyponatremia, fluid restriction and treatment of underlying illnesses; main stay of treatment
- 17. References http://bestpractice.bmj.com/best- practice/monograph/865/treatment/step-by-step.html, Accessed on: 25thJanuary, 2018 https://www.ncbi.nlm.nih.gov/pubmed/17521521, Accessed on: 24th January, 2018 Kasper et al, Harrison’s Principles of Internal Medicine, 19th Edition