The assessment and treatment of water imbalance in patients with psychosis.
Polydipsia and episodic life-threatening water intoxication remain important clinical problems for a significant portion of persons with schizophrenia. The disorders are associated with increased morbidity and mortality from a number of causes. With a basic understanding of the pathophysiology, one can easily diagnose and assess the clinical conditions. We review here the scope and pathophysiology of disordered water imbalance, including both primary and secondary polydipsia and hyponatremia. Reversible factors and possible interventions are reviewed. Treatment options for preventing water intoxication have expanded from discontinuation of offending agents, targeted fluid restriction, and clozapine therapy to the addition of oral vasopressin antagonists. The latter, however, are extremely potent and must be carefully monitored.
Goldman
Morris B
MB
Northwestern University Feinberg School of Medicine, Department of Psychiatry, 446 East Ontario, Suite 7-100, Chicago, IL 60611, USA. m-goldman@northwestern.edu
D065092:Antidiuretic Hormone Receptor Antagonists; D018692:Antimanic Agents / Q000009:adverse effects / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001552:Benzazepines / Q000627:therapeutic use; D003024:Clozapine / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D004326:Drinking / Q000502:physiology; D006801:Humans; D007010:Hyponatremia / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D016651:Lithium Carbonate / Q000009:adverse effects / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D017483:Receptors, Vasopressin / Q000502:physiology; D012307:Risk Factors; D012559:Schizophrenia / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D012565:Schizophrenic Psychology; D049993:Sodium Chloride Symporter Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D000077602:Tolvaptan; D014868:Water Deprivation; D014869:Water Intoxication / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D014882:Water-Electrolyte Balance / Q000502:physiology
D065092:Antidiuretic Hormone Receptor Antagonists; D018692:Antimanic Agents; D014150:Antipsychotic Agents; D001552:Benzazepines; D017483:Receptors, Vasopressin; D049993:Sodium Chloride Symporter Inhibitors; D000077602:Tolvaptan; D016651:Lithium Carbonate; D003024:Clozapine