THE CONSULTING PSYCHIATRIST AND THE POLYDIPSIA-HYPONATREMIA-SYNDROME IN SCHIZOPHRENIA

Objective: The authors seek to extend understanding and treatment of h ospitalized schizophrenics presenting with complications of polydipsia and dilutional hyponatremia. Attending physicians may ask the consult ation/liaison psychiatrist to see schizophrenics with hyponatremically -induced delirium or other psychiatric syndromes. The referring physic ian may or may not have identified polydipsia and dilutional hyponatre mia and their complications. This article will help the consultation/l iaison psychiatrist recognize early evidence of water imbalance, descr ibe evaluation, and provide somatic and behavioral treatment approache s to this life-threatening syndrome. Method: Over the past ten years, the authors have treated more than 100 patients with the polydipsia-hy ponatremia syndrome. The authors discuss their and others' experience with drugs that help and hinder patients suffering from dilutional hyp onatremia. They review current key articles from the polydispsia-hypon atremia syndrome literature including articles identified via Medline search 1985-94. Results: Schizophrenics with the polydipsiahyponatremi a syndrome most commonly present with polydipsia, polyuria, urinary in continence, cognitive, affective, and behavioral changes, seizures, or coma. Quantitating polydipsia, hyponatremia, and diurnal changes in b ody weight facilitate therapeutic interventions. Treatment include pat ient and caregiver education, drug therapies to better treat psychosis and better treat osmotic dysregulation, behavioral interventions to i nterdict polydipsia, and diurnal weight monitoring. Conclusions: Once recognized, acute, subacute, and chronic complications of the polydips ia-hyponatremia syndrome are readily treatable. Besides treating the p atient, consultation/liaison psychiatrists can teach their medical col leagues about this syndrome. In so doing, they will enhance the qualit y of their patients' lives and help the internist and surgeon feel mor e comfortable when working with schizophrenics.