Psychogenic polydipsia

Last reviewed: 3 Jan 2023
Last updated: 28 Sep 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • water-seeking and drinking
More key diagnostic factors

Other diagnostic factors

  • agitation
  • polyuria
  • headache
  • nausea or vomiting
  • lethargy or confusion
  • seizures, delirium, or coma
Other diagnostic factors

Risk factors

  • psychiatric disorders
  • neurodevelopmental disorders
  • smoking
  • alcohol abuse
More risk factors

Diagnostic investigations

1st investigations to order

  • plasma osmolality
  • urine osmolality
  • urine sodium
  • serum sodium
  • 24-hour urine volume
  • urinalysis
  • serum urea
  • water restriction test
More 1st investigations to order

Investigations to consider

  • vasopressin test
  • plasma antidiuretic hormone
More investigations to consider

Treatment algorithm

ACUTE

severe hyponatraemia (<125 mmol/L [<125 mEq/L]) or with neurological symptoms

hyponatraemia (125-130 mmol/L [125-130 mEq/L]) or with GI symptoms

ONGOING

chronic polydipsia

Contributors

Authors

Shilpa Srinivasan, MD, DFAPA, DFAAGP
Shilpa Srinivasan

Vice Chair, Medical Staff Affairs, Behavioral Health Midlands, Prisma Health

Professor of Clinical Psychiatry

Program Director: Geriatric Psychiatry Fellowship

Director: Psychiatry Acting Internship and M4 Clerkship

Department of Neuropsychiatry and Behavioral Science

Prisma Health - University of South Carolina School of Medicine Columbia

Columbia

SC

Disclosures

SS is a board member of the American Association for Geriatric Psychiatry and serves on the Geriatric Psychiatry Exam Committee for the American Board of Psychiatry and Neurology.

Meera Narasimhan, MD, DFAPA
Meera Narasimhan

Professor and Chair

Department of Neuropsychiatry and Behavioral Science

Senior Medical Director

Prisma Health

Special Advisor to University of South Carolina President

Health Innovations and Economic Development

University of South Carolina School of Medicine Columbia

Columbia

SC

Disclosures

MN is a member of an advisory board for Alkermes.

Acknowledgements

Dr Shilpa Srinivasan and Dr Meera Narasimhan would like to gratefully acknowledge Dr Emily Williams and Dr Brian Dundas, previous contributors to this topic.

Disclosures

EW declares that she has no competing interests. BD is an author of one of the references for this topic.

Peer reviewers

Branimir Margetić, MD

Neuropsychiatric Hospital "Dr Ivan Barbot"

Popovaca

Croatia

Disclosures

BM is an author of a reference cited in this topic.

Aaron Pinkhasov, MD, DFAPA, FACLP

Chairman

Department Of Psychiatry

NYU Langone Hospital

Professor of Psychiatry and Medicine

NYU Long Island School of Medicine

Long Island

NY

Disclosures

AP declares that he has no competing interests.

Richard C Millson, MD, DTM&H, FRCPC

Associate Professor of Psychiatry

Queen's University

Kingston

Ontario

Canada

Disclosures

RCM declares that he has no competing interests. He is the author of some of the references cited in this topic.

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