Psychogenic polydipsia

Last reviewed: 25 Aug 2022
Last updated: 10 Aug 2022

Summary

Definition

History and exam

Key diagnostic factors

  • medical history of psychiatric disorder or neurodevelopmental disorder
  • water-seeking and drinking
More key diagnostic factors

Other diagnostic factors

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

Risk factors

  • psychiatric disorders
  • neurodevelopmental disorders
  • smoking
More risk factors

Diagnostic investigations

1st investigations to order

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

Investigations to consider

  • vasopressin test
  • plasma antidiuretic hormone
More investigations to consider

Treatment algorithm

ACUTE

severe hyponatremia (<125 mEq/L) or with neurologic symptoms

hyponatremia (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

Pieter Joost van Wattum, MD, MA

Assistant Clinical Professor of Child Psychiatry

Yale School of Medicine

Medical Director of Psychiatry

Clifford W. Beers Guidance Clinic

New Haven

CT

Disclosures

PJvW declares that he has no competing interests.

Branimir Margetić, MD

Neuropsychiatric Hospital "Dr Ivan Barbot"

Popovaca

Croatia

Disclosures

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

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