Highlights & Basics
- Psychogenic polydipsia is commonly encountered in patients with psychiatric disorders, particularly in those with schizophrenia.
- Patients present with water-seeking and excessive drinking, sometimes accompanied by hyponatremia and water intoxication.
- Neuropsychiatric manifestations of hyponatremia include headache, nausea, cramping, hyporeflexia, dysarthric speech, lethargy, confusion, seizures, and delirium. Coma and sudden death can ensue.
- Complications of psychogenic polydipsia include incontinence and enuresis, bladder dilation and hydronephrosis, renal and congestive heart failure, and osteoporosis and associated pathologic fractures.
- Diagnosis is one of exclusion. Other medical causes of polydipsia, polyuria, and/or hyponatremia need to be ruled out.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
Ahmadi L, Goldman MB. Primary polydipsia: update. Best Pract Res Clin Endocrinol Metab. 2020 Sep;34(5):101469.[Abstract][Full Text]
Sterns RH. Disorders of plasma sodium - causes, consequences, and correction. N Engl J Med. 2015 Jan 1;372(1):55-65.[Abstract]
1. Verghese C, De Leon J, Josiassen RC. Problems and progress in the diagnosis and treatment of polydipsia and hyponatremia. Schizophr Bull. 1996;22(3):455-64.[Abstract][Full Text]
2. de Leon J. Polydipsia: a study in a long-term psychiatric unit. Eur Arch Psychiatry Clin Neurosci. 2003 Feb;253(1):37-9.[Abstract]
3. Illowsky BP, Kirch DG. Polydipsia and hyponatremia in psychiatric patients. Am J Psychiatry. 1988 Jun;145(6):675-83.[Abstract]
4. Jose CJ, Perez-Cruet J. Incidence and morbidity of self-induced water intoxication in state mental hospital patients. Am J Psychiatry. 1979 Feb;136(2):221-2.[Abstract]
5. Blum A, Tempey FW, Lynch WJ. Somatic findings in patients with psychogenic polydipsia. J Clin Psychiatry. 1983 Feb;44(2):55-6.[Abstract]
6. Meulendijks D, Mannesse CK, Jansen PA, et al. Antipsychotic-induced hyponatraemia: a systematic review of the published evidence. Drug Saf. 2010 Feb 1;33(2):101-14.[Abstract]
7. Mannesse CK, van Puijenbroek EP, Jansen PA, et al. Hyponatraemia as an adverse drug reaction of antipsychotic drugs: a case-control study in VigiBase. Drug Saf. 2010 Jul 1;33(7):569-78.[Abstract]
8. Hariprasad MK, Eisinger RP, Nadler IM, et al. Hyponatremia in psychogenic polydipsia. Arch Intern Med. 1980 Dec;140(12):1639-42.[Abstract]
9. Jose CJ, Barton JL, Perez-Cruet J. Hyponatremic seizures in psychiatric patients. Biol Psychiatry. 1979 Oct;14(5):839-43.[Abstract]
10. Ahmadi L, Goldman MB. Primary polydipsia: update. Best Pract Res Clin Endocrinol Metab. 2020 Sep;34(5):101469.[Abstract][Full Text]
11. Janicic N, Verbalis JG. Evaluation and management of hypo-osmolality in hospitalized patients. Endocrinol Metab Clin North Am. 2003 Jun;32(2):459-81, vii.[Abstract]
12. Gleadhill IC, Smith TA, Yium JJ. Hyponatremia in patients with schizophrenia. South Med J. 1982 Apr;75(4):426-8.[Abstract]
13. Torosyan N, Spencer D, Penev S, et al. Psychogenic polydipsia in a woman with anorexia nervosa: case report and recommendations. Prim Care Companion CNS Disord. 2018 Feb 8;20(1):17l02120.[Abstract][Full Text]
14. Nauwynck E, Van De Maele K, Vanbesien J, et al. Psychogenic polydipsia in a female adolescent without a psychiatric background: a case report. Clin Case Rep. 2021 Apr;9(4):1937-42.[Abstract][Full Text]
15. Bremner AJ, Regan A. Intoxicated by water: polydipsia and water intoxication in a mental handicap hospital. Br J Psychiatry. 1991 Feb;158:244-50.[Abstract]
16. Deb S, Bramble D, Drybala G, et al. Polydipsia amongst adults with a learning disability in an institution. J Intellect Disabil Res. 1994 Aug;38 ( Pt 4):359-67.[Abstract]
17. Millson RC, Koczapski AB, Cook MI, et al. A survey of patient attitudes toward self-induced water intoxication. Can J Psychiatry. 1992 Feb;37(1):46-7.[Abstract]
18. Sklar AH, Schrier RW. Central nervous system mediators of vasopressin release. Physiol Rev. 1983 Oct;63(4):1243-80.[Abstract]
19. Jose CJ, Evenson RC. Antecedents of self-induced water intoxication: a preliminary report. J Nerv Ment Dis. 1980 Aug;168(8):498-500.[Abstract]
20. Blum A. The possible role of tobacco cigarette smoking in hyponatremia of long-term psychiatric patients. JAMA. 1984 Nov 23-30;252(20):2864-5.[Abstract]
21. Thompson CJ, Selby P, Baylis PH. Reproducibility of osmotic and nonosmotic tests of vasopressin secretion in men. Am J Physiol. 1991 Mar;260(3 Pt 2):R533-9.[Abstract]
22. Gillum DM, Linas SL. Water intoxication in a psychotic patient with normal renal water excretion. Am J Med. 1984 Oct;77(4):773-4.[Abstract]
23. Thompson CJ, Edwards CR, Baylis PH. Osmotic and non-osmotic regulation of thirst and vasopressin secretion in patients with compulsive water drinking. Clin Endocrinol (Oxf). 1991 Sep;35(3):221-8.[Abstract]
24. Siegel AJ. Hyponatremia in psychiatric patients: update on evaluation and management. Harv Rev Psychiatry. 2008;16(1):13-24.[Abstract]
25. Goldman MB. The mechanism of life-threatening water imbalance in schizophrenia and its relationship to the underlying psychiatric illness. Brain Res Rev. 2009 Oct;61(2):210-20.[Abstract]
26. Rangan GK, Dorani N, Zhang MM, et al. Clinical characteristics and outcomes of hyponatraemia associated with oral water intake in adults: a systematic review. BMJ Open. 2021 Dec 9;11(12):e046539.[Abstract][Full Text]
27. Ripley TL, Millson RC, Koczapski AB. Self-induced water intoxication and alcohol abuse. Am J Psychiatry. 1989 Jan;146(1):102-3.[Abstract]
28. Poirier S, Legris G, Tremblay P, et al. Schizophrenia patients with polydipsia and water intoxication are characterized by greater severity of psychotic illness and a more frequent history of alcohol abuse. Schizophr Res. 2010 May;118(1-3):285-91.[Abstract]
29. Dundas B, Harris M, Narasimhan M. Psychogenic polydipsia review: etiology, differential, and treatment. Curr Psychiatry Rep. 2007 Jun;9(3):236-41.[Abstract]
30. Verghese C, De Leon J, Josiassen RC. Problems and progress in the diagnosis and treatment of polydipsia and hyponatremia. Schizophr Bull. 1996;22:455-464.[Abstract][Full Text]
31. de Leon J. Polydipsia: a study in a long-term psychiatric unit. Eur Arch Psychiatry Clin Neurosci. 2003;253:37-39.[Abstract]
32. Illowsky BP, Kirch DG. Polydipsia and hyponatremia in psychiatric patients. Am J Psychiatry. 1988;145:675-683.[Abstract]
33. Jose CJ, Perez-Cruet J. Incidence and morbidity of self-induced water intoxication in state mental hospital patients. Am J Psychiatry. 1979;136:221-222.[Abstract]
34. Blum A, Tempey FW, Lynch WJ. Somatic findings in patients with psychogenic polydipsia. J Clin Psychiatry. 1983;44:55-56.[Abstract]
35. Meulendijks D, Mannesse CK, Jansen PA, et al. Antipsychotic-induced hyponatraemia: a systematic review of the published evidence. Drug Saf. 2010;33:101-114.[Abstract]
36. Mannesse CK, van Puijenbroek EP, Jansen PA, et al. Hyponatraemia as an adverse drug reaction of antipsychotic drugs: a case-control study in VigiBase. Drug Saf. 2010;33:569-578.[Abstract][Full Text]
37. Bremner AJ, Regan A. Intoxicated by water: polydipsia and water intoxication in a mental handicap hospital. Br J Psychiatry. 1991;158:244-250.[Abstract]
38. Deb S, Bramble D, Drybala G, et al. Polydipsia amongst adults with a learning disability in an institution. J Intellect Disabil Res. 1994;38:359-367.[Abstract]
39. Vieweg WV, Godleski LS, Graham P, et al. Abnormal diurnal weight gain among long-term patients with schizophrenic disorders. Schizophr Res. 1988;1:67-71.[Abstract]
40. Lawson WB, Karson CN, Bigelow LB. Increased urine volume in chronic schizophrenic patients. Psychiatry Res. 1985 Apr;14(4):323-31.[Abstract]
41. Gleadhill IC, Smith TA, Yium JJ. Hyponatremia in patients with schizophrenia. South Med J. 1982;75:426-428.[Abstract]
42. Koczapski AB, Millson RC. Individual differences in serum sodium levels in schizophrenic men with self-induced water intoxication. Am J Psychiatry. 1989;146:1614-1615.[Abstract]
43. Douglas I. Hyponatremia: why it matters, how it presents, how we can manage it. Cleve Clin J Med. 2006 Sep;73 Suppl 3:S4-12.[Abstract][Full Text]
44. Sterns RH. Disorders of plasma sodium - causes, consequences, and correction. N Engl J Med. 2015 Jan 1;372(1):55-65.[Abstract]
45. Tomiyama J, Kametani H, Kumagai Y, et al. Water intoxication and rhabdomyolysis. Jpn J Med. 1990 Jan-Feb;29(1):52-5.[Abstract][Full Text]
46. Wicki J, Rutschmann OT, Burri H, et al. Rhabdomyolysis after correction of hyponatremia due to psychogenic polydipsia possibly complicated by clozapine. Ann Pharmacother. 1998 Sep;32(9):892-5.[Abstract]
47. Goldman MB, Robertson GL, Luchins DJ, et al. The influence of polydipsia on water excretion in hyponatremic, polydipsic, schizophrenic patients. J Clin Endocrinol Metab. 1996 Apr;81(4):1465-70.[Abstract]
48. Rose BD, Post TW. Clinical physiology of acid-base and electrolyte disorders. 5th ed. New York, NY: McGraw-Hill; 2001:748-57,767-72.
49. Baylis PH, Cheetham T. Diabetes insipidus. Arch Dis Child. 1998 Jul;79(1):84-9.[Abstract][Full Text]
50. Zerbe RL, Robertson GL. A comparison of plasma vasopressin measurements with a standard indirect test in the differential diagnosis of polyuria. N Engl J Med. 1981 Dec 24;305(26):1539-46.[Abstract]
51. Costanzo ES, Antes LM, Christensen AJ. Behavioral and medical treatment of chronic polydipsia in a patient with schizophrenia and diabetes insipidus. Psychosom Med. 2004 Mar-Apr;66(2):283-6.[Abstract]
52. Moses AM, Clayton B. Impairment of osmotically stimulated AVP release in patients with primary polydipsia. Am J Physiol. 1993 Dec;265(6 Pt 2):R1247-52.[Abstract]
53. Dashe AM, Cramm RE, Crist CA, et al. A water deprivation test for the differential diagnosis of polyuria. JAMA. 1963 Aug 31;185:699-703.[Abstract]
54. Tierney LM Jr, McPhee ST, Papadakis MA. Current medical diagnosis & treatment. 42nd ed. New York, NY: McGraw-Hill; 2002:840-5,1076-7.
55. Harrigan MR. Cerebral salt wasting syndrome: a review. Neurosurgery. 1996 Jan;38(1):152-60.[Abstract]
56. Schrier RW, ed. Atlas of diseases of the kidney. Philadelphia, PA: Current Medicine; 1999.
57. Spital A. Diuretic-induced hyponatremia. Am J Nephrol. 1999;19(4):447-52.[Abstract]
58. Twardowschy CA, Bertolucci CB, Gracia Cde M, et al. Severe hyponatremia and syndrome of inappropriate secretion of antidiuretic hormone (SIADH) associated with fluoxetine: case report. Arq Neuropsiquiatr. 2006 Mar;64(1):142-5.[Abstract][Full Text]
59. Sachdeo RC, Wasserstein AG, D'Souza J. Oxcarbazepine (Trileptal) effect on serum sodium. Abstract 2.074. Paper presented at: Annual Meeting of the American Epilepsy Society. 3-8 Dec 1999. Orlando, FL. Epilepsia. 1999;40(suppl 7):103.[Full Text]
60. Flegel KM, Cole CH. Inappropriate antidiuresis during carbamazepine treatment. Ann Intern Med. 1977 Dec;87(6):722-3.[Abstract]
61. Liamis GL, Milionis HJ, Rizos EC, et al. Mechanisms of hyponatraemia in alcohol patients. Alcohol Alcohol. 2000 Nov-Dec;35(6):612-6.[Abstract][Full Text]
62. Wilkins B. Cerebral oedema after MDMA ("ecstasy") and unrestricted water intake: hyponatraemia must be treated with low water input. BMJ. 1996 Sep 14;313(7058):689-90.[Abstract][Full Text]
63. Holden R, Jackson MA. Near-fatal hyponatremic coma due to vasopressin over-secretion after "ecstasy" (3,4-MDMA). Lancet. 1996 Apr 13;347(9007):1052.[Abstract]
64. Rogers G, Elston J, Garside R, et al. The harmful health effects of recreational ecstasy: a systematic review of observational evidence. Health Technol Assess. 2009 Jan;13(6):iii-iv, ix-xii, 1-315.[Abstract][Full Text]
65. Thaler SM, Teitelbaum I, Berl T. "Beer potomania" in non-beer drinkers: effect of low dietary solute intake. Am J Kidney Dis. 1998 Jun;31(6):1028-31.[Abstract]
66. Sakuma M, Misawa F, Maeda M, et al. Development of diagnostic criteria and severity scale for polydipsia: a systematic literature review and well-experienced clinicians' consensus. Psychiatry Res. 2021 Mar;297:113708.[Abstract]
67. Han DS, Cho BS. Therapeutic approach to hyponatremia. Nephron. 2002;92 Suppl 1:9-13.[Abstract]
68. Offenstadt G, Das V. Hyponatremia, hypernatremia: a physiological approach. Minerva Anestesiol. 2006 Jun;72(6):353-6.[Abstract]
69. Koczapski AB, Millson RC. Individual differences in serum sodium levels in schizophrenic men with self-induced water intoxication. Am J Psychiatry. 1989 Dec;146(12):1614-5.[Abstract]
70. Adrogué HJ, Madias NE. Hyponatremia. N Engl J Med. 2000 May 25;342(21):1581-9.[Abstract]
71. Vieweg WV, Godleski LS, Graham P, et al. Abnormal diurnal weight gain among long-term patients with schizophrenic disorders. Schizophr Res. 1988 Jan-Feb;1(1):67-71.[Abstract]
72. Ko AR, Kim SJ, Jung MK, et al. Hypotonic hyponatremia by primary polydipsia caused brain death in a 10-year-old boy. Ann Pediatr Endocrinol Metab. 2015 Sep;20(3):166-9.[Abstract][Full Text]
73. Millson RC, Smith AP, Koczapski AB, et al. Self-induced water intoxication treated with group psychotherapy. Am J Psychiatry. 1993 May;150(5):825-6.[Abstract]
74. Bowen L, Glynn SM, Marshall BD Jr, et al. Successful behavioral treatment of polydipsia in a schizophrenic patient. J Behav Ther Exp Psychiatry. 1990 Mar;21(1):53-61.[Abstract]
75. Leadbetter RA, Shutty MS Jr. Differential effects of neuroleptic and clozapine on polydipsia and intermittent hyponatremia. J Clin Psychiatry. 1994 Sep;55 Suppl B:110-3.[Abstract]
76. Lee HS, Kwon KY, Alphs LD, et al. Effect of clozapine on psychogenic polydipsia in chronic schizophrenia. J Clin Psychopharmacol. 1991 Jun;11(3):222-3.[Abstract]
77. Canuso CM, Goldman MB. Clozapine restores water balance in schizophrenic patients with polydipsia-hyponatremia syndrome. J Neuropsychiatry Clin Neurosci. 1999 Winter;11(1):86-90.[Abstract]
78. Kruse D, Pantelis C, Rudd R, et al. Treatment of psychogenic polydipsia: comparison of risperidone and olanzapine, and the effects of an adjunctive angiotensin-II receptor blocking drug (irbesartan). Aust N Z J Psychiatry. 2001 Feb;35(1):65-8.[Abstract]
79. Goldman MB, Hussain N. Absence of effect of olanzapine on primary polydipsia: results of a double-blind, randomized study. J Clin Psychopharmacol. 2004 Dec;24(6):678-80.[Abstract]
80. Rao N, Venkatasubramanian G, Korpade V, et al. Risperidone treatment for polydipsia and hyponatremia in schizophrenia: a case report. Turk Psikiyatri Derg. 2011 Summer;22(2):123-5.[Abstract]
81. Udelson JE, Smith WB, Hendrix GH, et al. Acute hemodynamic effects of conivaptan, a dual V(1A) and V(2) vasopressin receptor antagonist, in patients with advanced heart failure. Circulation. 2001 Nov 13;104(20):2417-23.[Abstract][Full Text]
82. Josiassen RC, Goldman M, Jessani M, et al. Double-blind, placebo-controlled, multicenter trial of a vasopressin V2-receptor antagonist in patients with schizophrenia and hyponatremia. Biol Psychiatry. 2008 Dec 15;64(12):1097-100.[Abstract]
83. Winzeler B, Sailer CO, Coynel D, et al. A randomized controlled trial of the GLP-1 receptor agonist dulaglutide in primary polydipsia. J Clin Invest. 2021 Oct 15;131(20):e151800.[Abstract][Full Text]
84. Alexander RC, Karp BI, Thompson S, et al. A double blind, placebo-controlled trial of demeclocycline treatment of polydipsia-hyponatremia in chronically psychotic patients. Biol Psychiatry. 1991 Aug 15;30(4):417-20.[Abstract]
85. Hawken ER, Crookall JM, Reddick D, et al. Mortality over a 20-year period in patients with primary polydipsia associated with schizophrenia: a retrospective study. Schizophr Res. 2009 Feb;107(2-3):128-33.[Abstract]
86. Cecconi A, Franco E, de Agustín JA, et al. Hyponatremia-induced stress cardiomyopathy due to psychogenic polydipsia. Int J Cardiol. 2016 Jan 1;202:618-20.[Abstract]
87. Delva NJ, Crammer JL, Jarzylo SV, et al. Osteopenia, pathological fractures, and increased urinary calcium excretion in schizophrenic patients with polydipsia. Biol Psychiatry. 1989 Dec;26(8):781-93.[Abstract]
88. Penders TM, Stanciu CN, Ganpat P, et al. Psychogenic polydipsia, hyponatremia and osmotic myelinolysis. BMJ Case Rep. 2015 Jan 27;2015:bcr2014207508.[Abstract]
89. Siegel AJ, Patti RB, Yip AG. Suicide attempt by clandestine self-induced water intoxication: rapid clinical response averts life-threatening acute cerebral edema. Am J Med. 2021 Mar;134(3):e189-90.[Abstract]
