Joseph K. Stanilla

Polydipsia and water intoxication in a long-term psychiatric hospital

This cross-sectional survey attempts to establish the prevalence of polydipsia and water intoxication at a state hospital (N = 360) using staff diagnosis, specific gravity of the urine (SPGU), weight changes, and chart review. There were 150 [42%, 95% confidence interval (CI) 37-47%] patients diagnosed as polydipsic by the staff or by SPGU. At least 93 (26%, CI 21-30%) had primary polydipsia not explained by other causes. Chart review identified 17 (5%, CI 3-7%) patients with a history of water intoxication. Using a case-control study design, schizophrenia, extended duration of hospitalization, and heavy smoking were associated with primary polydipsia in a logistic regression analysis (respective odds ratios were 1.6, 1.8, and 3.6). All patients with a history of water intoxication were Caucasian (versus 83% in those without a history) and had significantly more extended hospitalizations (94 vs. 49%). Future case-control studies should combine longitudinal identification of true cases and controls and exhaustive collections of clinical information in a standardized way.

Treatment of polydipsia and hyponatremia in psychiatric patients can clozapine be a new option

Polydipsia occurs frequently in chronic schizophrenic patients, some of whom develop intermittent hyponatremia. Most therapeutic efforts have tried to control the hyponatremia. Four schizophrenic patients, followed for more than one year, showed improvement on clozapine. Case 1 was an outpatient without history of hyponatremia who improved from polydipsia and psychosis. The last three were inpatients with polydipsia, intermittent hyponatremia, and psychosis who showed minimal improvement of psychosis but significant decrease in polydipsia and water intoxication. Case 2 relapsed to polydipsia when clozapine was discontinued on two occasions. Case 3 demonstrated polyuria during 39% of days before clozapine and in 0% of days after two weeks of clozapine. In case 4, most baseline sodium levels were abnormal, but all became normal after clozapine. A time-series analysis for intervention effects showed a significant effect of clozapine (p =. 017). The limited information provided by these case reports suggest the need for controlled studies of the clozapine effect on polydipsic patients.

Misidentification Syndromes in Schizophrenia: Case Reviews with Implications for Classification and Prevalence

Misidentification syndromes represent false, delusionally-based identification of self and/or others. These are variants of the Capgras Syndrome. Although the frequency of misidentification syndromes in schizophrenic populations has not yet been established, the authors believe this syndrome is more prevalent than previously described. Seven of twenty-five (28%) consecutive patients admitted to a chronic clozapine unit with a variant of misidentification syndrome will be described. Their symptoms are categorised according to traditional classification, and Silvas proposed nomenclature. Problems inherent in these classifications are discussed. The need for a more systematic classification of misidentification syndromes is emphasised. Longitudinal studies of misidentification syndrome, and the development of a standardised assessment tool for clinicians who treat chronically psychotic patients, are encouraged.

Therapeutic effects of clozapine on tardive dyskinesia

Neuroleptic-induced tardive dyskinesia (TD) negatively impacts the quality of life for persons with schizophrenia. While no satisfactory treatment is available for TD, a growing body of literature suggests the efficacy of clozapine in reducing TD. This paper describes the efficacy of clozapine in reducing TD in relation to the variables of treatment duration and dosage. Eighteen schizophrenic patients were categorized as with and five as without probable TD, and a pattern of reversible decrease in severity of TD on higher doses was found. The importance of this information for behaviorally oriented psychiatrists, psychologists, social workers, and nurses who work with the serious mentally ill is emphasized. Because of their strong scientific training and their roles as treatment team leaders, behavioral clinicians need to understand these new findings and disseminate them to mental health treatment teams. Combining this information with cognitive and behavioral interventions should lead to improved outcomes, less serious side effects, and improved quality of life for schizophrenic and schizoaffectively disordered patients.

Diurnal and weekly variation of tardive dyskinesia measured by digital image processing

The diurnal and weekly variability of tardive dyskinesia (TD) was assessed instrumentally by digital image processing. Weekly assessments were obtained in ten patients over a 6-week period. In six of the ten patients, assessments were obtained four times over a single 12-h period. Results indicate that TD movements measured by instrumental assessment vary from week to week and throughout the day. Factors that appear to have affected the variability were changes in medications and the time of day when the assessments were conducted.