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sychogenic polydipsia is, on a and approximately 3.5% – 5% of Psychogenic P continuum, the compulsion to all schizophrenic clients develop seek out and over drink any/ a more serious symptom of self- Polydipsia all fluids and is a type of polydipsia induced (i.e., exhibited by patients with mental SIWI). Individuals diagnosed with (Exessive illness and/or the developmentally ”psychogenic polydipsia” — of which disabled. It is also present in a subset 80% are diagnosed with Fluid Seeking of schizophrenics. These individuals, — have a fluid intake that is usually often chronic schizophrenics 4 – 10L/day, some drink up to 22L/ Behaviour) with a long history of mental day! is a low serum illness, frequently exhibit enlarged sodium level below 130mmol/L ventricles and shrunken cortex on (normal range 135 – 145 mmol/L). donald “don” MRI, making the physiological is urine output in excess of hutcheon, mechanism difficult to isolate 3L/day. In the psychiatric population, ed.d., C. Psychol. from the psychogenic. Psychogenic polyuria exists as a compensatory (UK)., r. psych. polydipsia is a serious disorder that mechanism for polydipsia; 25% The Vice-President of the BC often leads to institutionalization of polydipsia patients have acute Psychological Association. as it can be very difficult to manage development of hyponatremia where outside the inpatient setting. It should there is a precipitous drop in serum be taken very seriously and can be sodium. This occurs sporadically life-threatening, as serum sodium and unpredictably and results in the the use of clozapine (Verghese, deLeon is diluted to an extent that seizures syndrome of water intoxication (i.e., & Josiassen, 1996). and cardiac arrest can occur. Those SIWI). Behavioural strategies include individuals afflicted have been known Clozapine is an atypical limiting the daily water intake when to seek fluids from any source possible. medication, which, indicated, initiating fluid restriction The clinical presentation in low doses, is the most common when there is a significant weight is as follows: the client drinks pharmacological intervention increase, taking a “serum sodium large amounts of any/all fluids, in the treatment of self-induced levels” count if which raises the pressure of the water intoxication (i.e., SIWI). The of intoxication start to appear, extracellular medium. As a side effect, restriction of fluid intake appears providing constant attention for the the antidiuretic hormone level is to have little or no influence on patient which can include locking lowered. The urine produced by these the excessive urge to drink by the individual in seclusion for their clients will have a low electrolyte clients diagnosed with psychogenic own safety. Behavioral management concentration, and it will be produced polydipsia. As a result, investigators programs should be mandatory. in large quantities (i.e., polyuria). If have turned to pharmacological Psychosocial rehabilitation the individual is institutionalized, interventions to treat either the (PSR) programs for individuals close monitoring by staff is necessary polydipsia itself or the hyponatremia. diagnosed with psychogenic to control fluid intake. In extreme Of note: clozapine has well-known polydipsia, requiring tertiary care, episodes, the client’s kidneys will be side effects, including orthostatic should be guided by the principles unable to deal with fluid overload and hypotension, lowering of seizure of psychosocial rehabilitation, with weight gain will be noted (Gibson, threshold, anti-cholinergic sophisticated medication management WikiDoc Resources, 2010). toxicity, and significant incidence and behavioural interventions. The Polydipsia is increased of agranulocytosis (1% – 2%). PSR approach to service delivery and excessive fluid intake, greater Many clients with polydipsia or is based upon fundamental and than 3L per day. As many as 20% hyponatremia may have multiple interconnected concepts (Canadian of schizophrenics are polydipsic physical illnesses that could preclude Code of Ethics, PSR, 2010): 16 Spring 2013

1. PSR programs emphasize the assessment and treatment. 1988). The cause of polydipsia need for individually tailored During the past 10 years, remains unclear. Although there interventions; psychiatric service delivery research is some agreement in common 2. PSR programs emphasize a and expert opinion has successfully areas of diagnosis and treatment flexibility, either the individual’s promoted community-based services interventions (i.e., Clozapine, capacities be adapted to providing tertiary care, to reduce behaviour modification, psychosocial environmental realities or the reliance on traditional hospital- rehabilitation), a consistent environment be changed to suit based tertiary care (Wasylenki et al, treatment approach throughout the the capacities of the person; 2000). In contrast to past reliance years has emphasized PSR strategies 3. PSR programs are oriented to on traditional inpatient settings for such as psycho — education, which exploitation of people’s strengths; tertiary care, it is possible to employ has been implemented in various 4. PSR programs aim at the flexible strategies to maximize time in tertiary care settings. Thank you restoration of hope; the least restrictive settings. Level of for your attention in this matter, 5. PSR programs emphasize the staff expertise is a critical element of and when working in an inpatient vocational potential of mentally ill tertiary care. Tertiary care providers psychiatric setting, be vigilant for individuals; have generally advanced training this threat to patient well-being. 6. PSR programs extend beyond and a commitment to service the work activities to encompass a full population of clients with psychogenic Dr. Donald “Don” Hutcheon C.Psych. array of social and recreational polydipsia. Many long-term residents (UK)., R.Psych. Associate Fellow of life concerns; diagnosed with psychogenic polydipsia the British Psychological Society 7. Recipients of PSR programs are who reside in a provincial or state Fellow of the American actively involved in their own psychiatric hospital, can graduate Psychotherapy Association care; from inpatient tertiary care services 8. The PSR program is an ongoing to a community resource, if the process. funding allows for an appropriate

staffing model. More specifically, references Client Care Requirements hospital patients who have complex Psychosocial Rehabilitation (PSR) (2010). Principles of Psychosocial Tertiary care is generally provided to but stable conditions can be supported Rehabilitation (PSR). Canadian Code of Ethics, 109–118. persons with severe and persistent in community settings with access to Gibson, M.C (2010). Psychogenic polydipsia. mental illness (SPMI). These clients tertiary services Hutcheon, 2012). WikiDoc Resources. Harisprasad, M,K., Eisinger, R.P., & Nadler, exhibit conditions and problem In sum, excessive fluid R.M et al. (1988). Hyponatremia in psychogenic polydipsia. Archives behaviours that require services drinking may occur in almost any of Internal Medicine, 140, 1639– well above those provided with the psychiatric disorder (e.g., Histrionic 1642. Hutcheon, D. (2012). Psychogenic Polydipsia: secondary care level (Wasylenki, Personality Disorder). However, most Treatment Strategies and Housing 80 Options. ACFEI Media, Springfield, Goering, Cochrane, Simon & Wirth- cases (about %) of psychogenic MO and Paul H. Brookes Couchon, 2000). This enriched type polydipsia with self-induced water Publishing Co., Inc. Baltimore. Jose, C., & Perez-Cruet, J. (1979). Incidence of treatment should require referral intoxication, occur with clients with and morbidity of self-induced water intoxication in state hospital from secondary care for those a psychotic illness, usually of the patients. American Journal of individuals with problems that are schizophrenic type. The prevalence . 136(2). 221–222. Vieweg, W.V.R., David, J.J., Rowe, W.T., complex and refractory to primary of compulsive water drinking in state Wampler, G.J., Burns, W.J., & Spradlin, W.W. (1985). Death from and secondary care. Criteria for psychiatric hospitals in the United self-induced water intoxication success usually includes the need States has been estimated between among patients with schizophrenic disorders. Journal for higher levels of management and 7% – 18% (Jose & Perez-Cruet, 1979), of Nervous and Mental Disease, 173, 161–165. security, staff expertise, and staffing and about half of this population Wasylenki, D., Goering, P., Cochrane, J., program resources, all in conjunction suffer from the complications of Simon, L.J., & Wirth-Cauchon, J.L. (2000). Tertiary mental health with more detailed and specialized SIWI (Hariprasad, Eisinger & Naider, services: I.Key concepts. Canadian Journal of Psychiatry, 45, 179–184.