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Mazhar F, Battini V, Pozzi M, Invernizzi E, Mosini G, Gringeri M, Capuano A, Scavone C, Radice S, Clementi E, Carnovale C. Hyponatremia Following Antipsychotic Treatment: In Silico Pharmacodynamics Analysis of Spontaneous Reports From the US Food and Drug Administration Adverse Event Reporting System Database and an Updated Systematic Review. Int J Neuropsychopharmacol 2021; 24:477-489. [PMID: 33575781 PMCID: PMC8278799 DOI: 10.1093/ijnp/pyab005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 01/14/2021] [Accepted: 02/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hyponatremia associated with antipsychotic drugs is a rare but potentially life-threatening adverse drug reaction; the underlying pharmacological mechanism has not yet been explained. METHODS We investigated the relationship between pharmacological targets of antipsychotic drugs and the occurrence of hyponatremia by conducting a nested case-control study using the Food and Drug Administration Adverse Event Reporting System database. Multiple logistic regression was used to determine the associations between antipsychotics receptor occupancy and hyponatremia. We also performed a systematic review of clinical studies on this association. RESULTS Of 139 816 reports involving at least 1 antipsychotic, 1.1% reported hyponatremia. Olanzapine was the most frequently suspected drug (27%). A significant positive association was found between dopamine D3, D4, and hyponatremia, while adrenergic α 1, serotonin 5-HT1A, and 5-HT2A receptor occupancies were negatively associated. A multivariable stepwise regression model showed that dopamine D3 (adj. odds ratio = 1.21; 95% CI = 1.09-1.34; P < .05) predicted the risk for hyponatremia (P < .05), while serotonin 5-HT2A occupancy (Adj. odds ratio = 0.78; 95% CI = 0.68-0.90; P < .01) exhibited a protective effect against hyponatremia. Among the 11 studies included in the systematic review, incidence rates of hyponatremia diverged between 0.003% and 86%, whereas the odds of developing hyponatremia from effect studies ranged between 0.83 and 3.47. CONCLUSIONS Antipsychotic drugs having a combined modest occupancy for D3 and 5-HT2A receptors and higher levels of D3 receptor occupancy correspond to different degrees of risk for hyponatremia. Based on the few, relatively large-scale available studies, atypical antipsychotics have a more attenuated risk profile for hyponatremia.
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Affiliation(s)
- Faizan Mazhar
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, “Luigi Sacco” University Hospital, Università di Milano, Milan, Italy
| | - Vera Battini
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, “Luigi Sacco” University Hospital, Università di Milano, Milan, Italy
| | - Marco Pozzi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Italy
| | - Elena Invernizzi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, “Luigi Sacco” University Hospital, Università di Milano, Milan, Italy
| | - Giulia Mosini
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, “Luigi Sacco” University Hospital, Università di Milano, Milan, Italy
| | - Michele Gringeri
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, “Luigi Sacco” University Hospital, Università di Milano, Milan, Italy
| | - Annalisa Capuano
- Section of Pharmacology “L. Donatelli,” Department of Experimental Medicine, Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania “Luigi Vanvitelli,”Naples, Italy
| | - Cristina Scavone
- Section of Pharmacology “L. Donatelli,” Department of Experimental Medicine, Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania “Luigi Vanvitelli,”Naples, Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, “Luigi Sacco” University Hospital, Università di Milano, Milan, Italy
| | - Emilio Clementi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, “Luigi Sacco” University Hospital, Università di Milano, Milan, Italy
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Italy
| | - Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, “Luigi Sacco” University Hospital, Università di Milano, Milan, Italy
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Peritogiannis V, Rizos DV. Catatonia Associated with Hyponatremia: Case Report and Brief Review of the Literature. Clin Pract Epidemiol Ment Health 2021; 17:26-30. [PMID: 34249136 PMCID: PMC8227445 DOI: 10.2174/1745017902117010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 02/28/2021] [Accepted: 03/09/2021] [Indexed: 11/24/2022]
Abstract
Background: Catatonia is a syndrome of altered motor behavior that is mostly associated with general medical, neurologic, mood and schizophrenia-spectrum disorders. The association of newly onset catatonic symptoms with hyponatremia has been rarely reported in the literature. Case Presentation: We present a rare case of a young female patient with schizophrenia, who presented with catatonic symptoms in the context of hyponatremia due to water intoxication. The symptoms were eliminated with the correction of hyponatremia. There are only a few reports of hyponatremia-associated catatonia in psychiatric and non-psychiatric patients. Sometimes, catatonic symptoms may co-occur with newly onset psychotic symptoms and confusion, suggesting delirium. In several cases, the catatonic symptoms responded to specific treatment with benzodiazepines or electroconvulsive therapy.
Conclusion:
Hyponatremia may induce catatonic symptoms in patients, regardless of underlying mental illness, but this phenomenon is even more relevant in patients with a psychotic or mood disorder, which may itself cause catatonic symptoms. It is important for clinicians not to attribute newly-onset catatonic symptoms to the underlying psychotic or mood disorder without measuring sodium serum levels. The measurement of sodium serum levels may guide treating psychiatrists to refer the patient for further investigation and appropriate treatment.
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Affiliation(s)
- Vaios Peritogiannis
- Mobile Mental Health Unit of the prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - Dimitrios V Rizos
- Intensive Care Unit, "Hatzikosta" General Hospital, Ioannina, Greece
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Suicide Attempt by Clandestine Self-Induced Water Intoxication: Rapid Clinical Response Averts Life-Threatening Acute Cerebral Edema. Am J Med 2021; 134:e189-e190. [PMID: 33002496 DOI: 10.1016/j.amjmed.2020.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 11/21/2022]
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Abstract
OBJECTIVES To examine the effectiveness of low-dose lithium carbonate for managing carbamazepine-induced hyponatremia. METHODS Single case study in an 88 year old man with bipolar illness and vascular dementia who had failed to respond to other mood stabilizers. RESULTS The patient had developed hyponatremia on two separate occasions when treated with carbamazepine. Introduction of low-dose lithium resulted in prompt normalization of serum sodium levels, which was maintained for the subsequent 8 weeks. CONCLUSIONS Carbamazepine may sometimes be the best or only viable treatment option for patients with bipolar illness or other conditions. When its use is complicated by syndrome of inappropriate ADH, dose reduction and fluid restriction are the simplest options but, if ineffective, addition of lithium may be a feasible, albeit somewhat complicated, alternative.
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Takaoka Y, Akaho R, Inada K, Muraoka H, Hokama C, Inoue A, Nishimura K. <p>Posterior Reversible Encephalopathy Syndrome Due to Acute Water Intoxication in a Patient with Schizophrenia</p>. Int Med Case Rep J 2020; 13:117-121. [PMID: 32308504 PMCID: PMC7150669 DOI: 10.2147/imcrj.s237430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/26/2020] [Indexed: 11/23/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome that presents as transient cerebral edema (vasogenic edema), usually on a background of hypertensive encephalopathy, puerperal eclampsia, or immunosuppressant drug use. We describe a case of PRES that arose in the context of a psychiatric disorder. The patient was a 26-year-old woman with schizophrenia who was hospitalized upon falling into a catatonic stupor and then suffered acute anxiety leading to impulsive polydipsia and subsequent water intoxication. She lost consciousness, and brain magnetic resonance imaging revealed a high density area, primarily affecting the cortex and subcortical white matter in areas in the occipital and parietal lobes, leading to the diagnosis. We did not treat the hyponatremia by means of aggressive sodium supplementation but rather balanced the extracellular fluid by continuous infusion of isotonic electrolyte replacement fluid. The patient’s level of consciousness improved gradually, but a total 141 days passed before hospital discharge was appropriate. The prognosis for PRES is generally favorable, but irreversible neurological damage can occur. We believe, therefore, that brain magnetic resonance imaging should be performed promptly whenever PRES is suspected and that timely, appropriate treatment is of utmost importance. If PRES is observed in a psychiatric patient, it is important to investigate whether the condition might have been caused by water intoxication and to treat the condition accordingly.
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Affiliation(s)
- Yohei Takaoka
- Department of Psychiatry, Tokyo Women’s Medical University, Tokyo, Japan
- Department of Psychiatry, Kuki Suzunoki Hospital, Kuki, Saitama, Japan
| | - Rie Akaho
- Department of Psychiatry, Tokyo Women’s Medical University, Tokyo, Japan
- Correspondence: Rie Akaho Department of Psychiatry, Tokyo Women’s Medical University, Tokyo, Japan Email
| | - Ken Inada
- Department of Psychiatry, Tokyo Women’s Medical University, Tokyo, Japan
| | - Hiroyuki Muraoka
- Department of Psychiatry, Tokyo Women’s Medical University, Tokyo, Japan
| | - Choryo Hokama
- Department of Psychiatry, Tokyo Women’s Medical University, Tokyo, Japan
| | - Atsuko Inoue
- Department of Psychiatry, Tokyo Women’s Medical University, Tokyo, Japan
| | - Katsuji Nishimura
- Department of Psychiatry, Tokyo Women’s Medical University, Tokyo, Japan
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Singh A, Ahuja R, Sethi R, Pradhan A, Srivastava V. Prevalence and incidence of hyponatremia and their association with diuretic therapy: Results from North India. J Family Med Prim Care 2019; 8:3925-3930. [PMID: 31879637 PMCID: PMC6924227 DOI: 10.4103/jfmpc.jfmpc_604_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/21/2019] [Accepted: 10/14/2019] [Indexed: 11/04/2022] Open
Abstract
Introduction: Hyponatremia is associated with substantial morbidity and mortality. Correct estimation of their prevalence, incidence and risk factors, especially the diuretics in Indian patients is important in determining preventive strategies. Methods: This multistage mixed methods-based study was conducted in a high-volume cardiac care center to ensure the correct estimation. Patients receiving oral diuretics on an outpatient basis and those admitted to hospital for hyponatremia were enrolled. Results: The prevalence of hyponatremia was 27% while the incidence rate was 18% and 29% after 3- and 6-month of the diuretic therapy. The highest rates of hyponatremia were observed in warm season (45%, 111 in 247 patients). Multivariate logistic regression analysis revealed that low solute and nutritious intake and edematous state were negatively correlated with serum sodium levels. Neither diarrhea/vomiting nor diuretic use were found to be associated with hyponatremia. Conclusions: Diuretics use was not associated with hyponatremia in adults in this population cohort. However, elderly people on diuretics are comparatively more likely to have hyponatremia. However, a randomized parallel arm trial comparing diuretics with other antihypertensives be done to establish whether diuretics are associated with hyponatremia in this patient population.
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Affiliation(s)
- Abhishek Singh
- Deparment of Internal Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ramesh Ahuja
- Department of Internal Medicine, ApolloMedics Hospital and Research Center, Lucknow, Uttar Pradesh, India
| | - Rishi Sethi
- Deparment of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Akshyaya Pradhan
- Principal, Prasad Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vinod Srivastava
- Deparment of Internal Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India.,Department of Internal Medicine, ApolloMedics Hospital and Research Center, Lucknow, Uttar Pradesh, India.,Deparment of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India.,Principal, Prasad Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Rizvi S, Gold J, Khan AM. Role of Naltrexone in Improving Compulsive Drinking in Psychogenic Polydipsia. Cureus 2019; 11:e5320. [PMID: 31598428 PMCID: PMC6777931 DOI: 10.7759/cureus.5320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Psychogenic polydipsia or self-induced water intoxication is a potentially lethal condition seen in many chronic psychiatric patients. This is a literature review based on therapeutic significance of Naltrexone in improving compulsive water drinking behavior in chronic psychiatrically ill patients with psychogenic polydipsia. Naltrexone is an opioid antagonist approved by FDA for alcohol dependence. Extensive literature search provides a line of evidence that suggests correlation of opioid receptor with compulsive water ingestion in animals. However, there is limited data regarding clinical utility of naltrexone in improving psychogenic polydipsia in human species. This review highlights the necessity for further research and trials to elucidate the role of naltrexone in human psychogenic drinking behavior.
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Affiliation(s)
- Sukaina Rizvi
- Psychiatry, Manhattan Psychiatric Center, Manhattan, USA
| | - Jeffrey Gold
- Psychiatric, Manhattan Psychiatric Center, Manhattan, USA
| | - Ali M Khan
- Psychiatry, University of Texas Rio Grande Valley, Harlingen, USA
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Chikowe I, Domingo M, Mwakaswaya V, Parveen S, Mafuta C, Kampira E. Adverse drug reactions experienced by out-patients taking chlorpromazine or haloperidol at Zomba Mental Hospital, Malawi. BMC Res Notes 2019; 12:376. [PMID: 31262359 PMCID: PMC6604158 DOI: 10.1186/s13104-019-4398-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 06/22/2019] [Indexed: 11/30/2022] Open
Abstract
Objective Drugs for managing mental disorders can cause adverse drug reactions (ADRs) that have negative impacts on patients yet, in Malawi, epidemiological data on the drug-related problems are limited. This study assessed the prevalence and severity of ADRs in out-patients at Zomba Mental Hospital. Results Twenty-six of forty patients (65.0%) were taking haloperidol and 14 (35.0%) chlorpromazine. The commonest diagnosis was schizophrenia (n = 23, 57.5%) followed by epileptic psychosis (n = 4, 10.0%) and general psychosis (n = 4, 10.0%) with one of psychotic depression and one psychosis secondary to general medical condition. Comorbidities were also found with epilepsy being the commonest (n = 4, 10.0%). All patients reported at least one ADR of varying severity (mild, moderate and severe). Polydipsia was the most prevalent (24, 60.0%) followed by weight gain (20, 50.0%), spasm (15, 37.5%) and xerostomia (15, 37.5%). Some ADRs were gender specific and these included impotence (6/27, 29.6%) for males and menstrual changes (3/14, 21.4%) for females. Severe ADRs were more common in the older aged group (> 35 years 8.3% vs 7.1%), in males (11.1% vs 0.0%) and on chlorpromazine (14.3% vs 3.8%). Patients taking chlorpromazine and haloperidol are at risk of experiencing a wide range of ADRs with varying degrees of severity. Electronic supplementary material The online version of this article (10.1186/s13104-019-4398-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ibrahim Chikowe
- Pharmacy Department, College of Medicine, University of Malawi, Blantyre, Malawi.
| | - McDonald Domingo
- Pharmacy Department, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Vasco Mwakaswaya
- Pharmacy Department, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Shagufta Parveen
- Department of Pharmacology, Government Medical College Srinagar, Srinagar, India
| | | | - Elizabeth Kampira
- Medical Laboratory Sciences, College of Medicine, University of Malawi, Blantyre, Malawi
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Takayama A, Nagamine T, Matsumoto Y, Nakamura M. Duloxetine and Angiotensin II Receptor Blocker Combination Potentially Induce Severe Hyponatremia in an Elderly Woman. Intern Med 2019; 58:1791-1794. [PMID: 30799349 PMCID: PMC6630130 DOI: 10.2169/internalmedicine.2059-18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 12/11/2018] [Indexed: 12/13/2022] Open
Abstract
We encountered a case of syndrome of inappropriate antidiuretic hormone secretion (SIADH) caused by duloxetine, serotonin and norepinephrine reuptake inhibitor (SNRI). A 74-year-old woman complaining of severe lethargy was transferred to our emergency department. Her serum sodium level was 109 mEq/L. Plasma hypo-osmolality with urine normo-osmolality was observed, indicating SIADH. Her essential hypertension had long been treated with telmisartan, and she had just started duloxetine 20 mg/day for chronic musculoskeletal pain 4 days prior to admission. On prescribing duloxetine in the primary care setting, clinicians should be aware of the possibility of duloxetine-induced hyponatremia, particularly in combination with telmisartan.
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Affiliation(s)
- Atsushi Takayama
- Department of Family Medicine, Iwakuni Municipal Miwa Hospital, Japan
- Jichi Medical University Center for Community Medicine, Division of Community and Family Medicine, Japan
| | - Takahiko Nagamine
- Sunlight Brain Research Center, Japan
- Department of Emergency Medicine, Matsumoto Surgical Hospital, Japan
| | | | - Masaru Nakamura
- Department of Psychiatric Internal Medicine, Kosekai-Kusatsu Hospital, Japan
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Filmyer DM, Finkel G, Plasay M, Shaughnessy RA, Josiassen RC. A comparison of simple reaction times in psychotic inpatients with and without hyponatremia. Schizophr Res 2019; 208:449-450. [PMID: 30992156 DOI: 10.1016/j.schres.2019.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Dawn M Filmyer
- Translational Neuroscience, Conshohocken, PA 19428, USA.
| | - Genna Finkel
- Translational Neuroscience, Conshohocken, PA 19428, USA
| | | | - Rita A Shaughnessy
- Translational Neuroscience, Conshohocken, PA 19428, USA; Drexel University College of Medicine, Philadelphia, PA 19104, USA
| | - Richard C Josiassen
- Translational Neuroscience, Conshohocken, PA 19428, USA; Drexel University College of Medicine, Philadelphia, PA 19104, USA
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Hyponatremia in Association With Second-Generation Antipsychotics: A Systematic Review of Case Reports. Ochsner J 2018; 18:230-235. [PMID: 30275787 DOI: 10.31486/toj.17.0059] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background Hyponatremia is generally defined as a serum sodium level <135 mmol/L and is considered severe if serum sodium is <125 mmol/L. Hyponatremia is a potentially life-threatening medical comorbidity for patients with schizophrenia. The incidence of hyponatremia in patients with schizophrenia who are taking second-generation antipsychotics (SGAs) has not been well established. Methods We conducted a systematic review of case reports of hyponatremia associated with the use of SGAs in patients with schizophrenia. We searched MEDLINE (from 1946 through September 2016) using the medical subject headings antipsychotic agents, hyponatremia, and water intoxication to identify reported diagnoses of hyponatremia following treatment with SGAs in patients with schizophrenia. Results We abstracted 12 potentially relevant case reports from 157 records. Nine case reports met the selection criteria. Three cases involved the use of aripiprazole (Abilify), 3 involved the use of risperidone (Risperdal), and the other 3 cases involved ziprasidone, olanzapine, and clozapine. Approximately equal numbers of males and females were represented, and 2 of the 9 patients were aged ≥60 years. The average patient age was 47 years, and the average time to the hyponatremia event was 17 days. The average serum sodium was 138 mmol/L at baseline, 112 mmol/L at treatment nadir, and 138 mmol/L after treatment discontinuation. Conclusion Hyponatremia can result from the use of SGAs in patients with schizophrenia and can be avoided with proper management of treatment. Physicians, psychiatrists, and other healthcare workers should be aware of the potential for severe hyponatremia with the use of commonly prescribed SGAs. SGA-induced hyponatremia is generally reversible after discontinuing treatment.
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Perestrelo J, Teixeira B. Psychogenic polydipsia and hyponatremia – A side effect of psychosis: a review with a case report. JORNAL BRASILEIRO DE PSIQUIATRIA 2016. [DOI: 10.1590/0047-2085000000135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Primary polydipsia, or psychogenic polydipsia, is a condition that results in considerable morbidity and mortality. In psychiatric patients, psychogenic polydipsia and the syndrome of inappropriate antidiuretic hormone secretion may cause hyponatremia. In the 1970s, it was recognized that antipsychotics such as tiotixene and haloperidol could impair the excretion of a free water load. There are also several case reports of drug-induced hyponatremia in patients using atypical drugs suggesting that these probably can also impair water balance and induce hyponatremia. Case report and review of relevant literature are reported in this article. Psychogenic polydipsia is a common cause of hyponatremia among individuals with chronic mental illness. A case of severe hyponatremia caused by psychogenic polydipsia is described involving a female patient with an adult lifelong history of chronic mental illness diagnosed as schizoaffective disorder. After switching her antipsychotic medication to clozapine water ingestion was normalized as well as sodium levels and her psychotic symptoms improved. Primary polydipsia occurs commonly with schizophrenia and other mental diseases and can cause hyponatremia. PPD may present as an acute psychotic state or as inexplicable emergence of seizures. Appropriate, timely clinical assessment with special attention to thirst, fluid intake, and urine output is essential. Proper treatment may include drug withdrawal and fluid and saline restriction. Once corrected, some pharmacological agents can be tried. The article illustrates the importance of the diagnosis of psychogenic polydipsia given its electrolyte disturbances and life threatening situations.
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Malt EA, Juhasz K, Malt UF, Naumann T. A Role for the Transcription Factor Nk2 Homeobox 1 in Schizophrenia: Convergent Evidence from Animal and Human Studies. Front Behav Neurosci 2016; 10:59. [PMID: 27064909 PMCID: PMC4811959 DOI: 10.3389/fnbeh.2016.00059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/11/2016] [Indexed: 12/22/2022] Open
Abstract
Schizophrenia is a highly heritable disorder with diverse mental and somatic symptoms. The molecular mechanisms leading from genes to disease pathology in schizophrenia remain largely unknown. Genome-wide association studies (GWASs) have shown that common single-nucleotide polymorphisms associated with specific diseases are enriched in the recognition sequences of transcription factors that regulate physiological processes relevant to the disease. We have used a “bottom-up” approach and tracked a developmental trajectory from embryology to physiological processes and behavior and recognized that the transcription factor NK2 homeobox 1 (NKX2-1) possesses properties of particular interest for schizophrenia. NKX2-1 is selectively expressed from prenatal development to adulthood in the brain, thyroid gland, parathyroid gland, lungs, skin, and enteric ganglia, and has key functions at the interface of the brain, the endocrine-, and the immune system. In the developing brain, NKX2-1-expressing progenitor cells differentiate into distinct subclasses of forebrain GABAergic and cholinergic neurons, astrocytes, and oligodendrocytes. The transcription factor is highly expressed in mature limbic circuits related to context-dependent goal-directed patterns of behavior, social interaction and reproduction, fear responses, responses to light, and other homeostatic processes. It is essential for development and mature function of the thyroid gland and the respiratory system, and is involved in calcium metabolism and immune responses. NKX2-1 interacts with a number of genes identified as susceptibility genes for schizophrenia. We suggest that NKX2-1 may lie at the core of several dose dependent pathways that are dysregulated in schizophrenia. We correlate the symptoms seen in schizophrenia with the temporal and spatial activities of NKX2-1 in order to highlight promising future research areas.
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Affiliation(s)
- Eva A Malt
- Department of Adult Habilitation, Akershus University HospitalLørenskog, Norway; Institute of Clinical Medicine, Ahus Campus University of OsloOslo, Norway
| | - Katalin Juhasz
- Department of Adult Habilitation, Akershus University Hospital Lørenskog, Norway
| | - Ulrik F Malt
- Institute of Clinical Medicine, University of OsloOslo, Norway; Department of Research and Education, Institution of Oslo University HospitalOslo, Norway
| | - Thomas Naumann
- Centre of Anatomy, Institute of Cell Biology and Neurobiology, Charite Universitätsmedizin Berlin Berlin, Germany
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Siegel AJ, Forte SS, Bhatti NA, Gelda SE. Drug-Related Hyponatremic Encephalopathy: Rapid Clinical Response Averts Life-Threatening Acute Cerebral Edema. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:150-3. [PMID: 26956638 PMCID: PMC4787525 DOI: 10.12659/ajcr.896572] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Patient: Female, 63 Final Diagnosis: Drug-induced hyponatremic encephalopathy Symptoms: Seizures • coma Medication: Hypertonic 3% saline infusion Clinical Procedure: — Specialty: Internal Medicine
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Affiliation(s)
- Arthur J Siegel
- Department of Internal Medicine, McLean Hospital, Belmont, MA, USA
| | - Sophie S Forte
- Department of Internal Medicine, McLean Hospital, Belmont, MA, USA
| | - Nasir A Bhatti
- Department of Internal Medicine, McLean Hospital, Belmont, MA, USA
| | - Steven E Gelda
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
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Rafat C, Flamant M, Gaudry S, Vidal-Petiot E, Ricard JD, Dreyfuss D. Hyponatremia in the intensive care unit: How to avoid a Zugzwang situation? Ann Intensive Care 2015; 5:39. [PMID: 26553121 PMCID: PMC4639545 DOI: 10.1186/s13613-015-0066-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 09/02/2015] [Indexed: 12/11/2022] Open
Abstract
Hyponatremia is a common
electrolyte derangement in the setting of the intensive care unit. Life-threatening neurological complications may arise not only in case of a severe (<120 mmol/L) and acute fall of plasma sodium levels, but may also stem from overly rapid correction of hyponatremia. Additionally, even mild hyponatremia carries a poor short-term and long-term prognosis across a wide range of conditions. Its multifaceted and intricate physiopathology may seem deterring at first glance, yet a careful multi-step diagnostic approach may easily unravel the underlying mechanisms and enable physicians to adopt the adequate measures at the patient’s bedside. Unless hyponatremia is associated with obvious extracellular fluid volume increase such as in heart failure or cirrhosis, hypertonic saline therapy is the cornerstone of the therapeutic of profound or severely symptomatic hyponatremia. When overcorrection of hyponatremia occurs, recent data indicate that re-lowering of plasma sodium levels through the infusion of hypotonic fluids and the cautious use of desmopressin acetate represent a reasonable strategy. New therapeutic options have recently emerged, foremost among these being vaptans, but their use in the setting of the intensive care unit remains to be clarified.
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Affiliation(s)
- Cédric Rafat
- AP-HP, Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Colombes, France. .,AP-HP, Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Paris, France.
| | - Martin Flamant
- AP-HP, Service de Physiologie Rénale, Hôpital Bichat, Paris, France. .,Université Paris Diderot, Sorbonne Paris Cité, Paris, France. .,INSERM, U1149, Centre de Recherche sur l'Inflammation, Paris, France.
| | - Stéphane Gaudry
- AP-HP, Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Colombes, France. .,Université Paris Diderot, Sorbonne Paris Cité, Paris, France. .,ECEVE UMR 1123, ECEVE, Paris, France.
| | - Emmanuelle Vidal-Petiot
- AP-HP, Service de Physiologie Rénale, Hôpital Bichat, Paris, France. .,Université Paris Diderot, Sorbonne Paris Cité, Paris, France. .,INSERM, U1149, Centre de Recherche sur l'Inflammation, Paris, France.
| | - Jean-Damien Ricard
- AP-HP, Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Colombes, France. .,Université Paris Diderot, Sorbonne Paris Cité, Paris, France. .,INSERM UMR 1137, IAME, Paris, France.
| | - Didier Dreyfuss
- AP-HP, Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Colombes, France. .,Université Paris Diderot, Sorbonne Paris Cité, Paris, France. .,INSERM UMR 1137, IAME, Paris, France.
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Siegel AJ. Is urine concentration a reliable biomarker to guide vaptan usage in psychiatric patients with symptomatic hyponatremia? Psychiatry Res 2015; 226:403-4. [PMID: 25639370 DOI: 10.1016/j.psychres.2014.12.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 12/30/2014] [Accepted: 12/31/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Arthur J Siegel
- Internal Medicine, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Harvard Medical School, Boston, MA 02114, USA.
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Psychogenic polydipsia: the result, or cause of, deteriorating psychotic symptoms? A case report of the consequences of water intoxication. Case Rep Psychiatry 2015; 2015:846459. [PMID: 25688318 PMCID: PMC4320790 DOI: 10.1155/2015/846459] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 12/29/2014] [Accepted: 12/31/2014] [Indexed: 11/17/2022] Open
Abstract
Water intoxication is a rare condition characterised by overconsumption of water. It can occur in athletes engaging in endurance sports, users of MDMA (ecstasy), and patients receiving total parenteral nutrition. This case outlines water intoxication in a patient with psychogenic polydipsia. When the kidney's capacity to compensate for exaggerated water intake is exceeded, hypotonic hyperhydration results. Consequences can involve headaches, behavioural changes, muscular weakness, twitching, vomiting, confusion, irritability, drowsiness, and seizures. Cerebral oedema can lead to brain damage and eventual death. In this case, psychogenic polydipsia led to significant hyponatraemia, cerebral oedema, and tonic-clonic seizures. Differential diagnoses for hyponatraemia are outlined. The aetiology of psychogenic polydipsia is uncertain, but postulated hypotheses are explored. Psychogenic polydipsia occurs in up 20% of psychiatric patients and this case serves to remind us to be cognizant of water overconsumption.
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Atsariyasing W, Goldman MB. A systematic review of the ability of urine concentration to distinguish antipsychotic- from psychosis-induced hyponatremia. Psychiatry Res 2014; 217:129-33. [PMID: 24726819 PMCID: PMC6195808 DOI: 10.1016/j.psychres.2014.03.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 01/31/2014] [Accepted: 03/20/2014] [Indexed: 12/23/2022]
Abstract
Life-threatening hyponatremia in psychotic patients is common and typically is attributable to either antipsychotic medication or to acute psychosis in those with the polydipsia-hyponatremia syndrome. The preferred treatment for one situation may worsen the hyponatremia if caused by the other situation. Hence it is critical to distinguish between these two possibilities. Case reports and series were identified through electronic databases. Fifty-four cases of hyponatremia without recognized causes in psychotic patients were divided into those with dilute (<plasma osmolality) or concentrated (>plasma osmolality) urine. The distribution of urine concentration and measures likely to be associated with psychotic illness and its treatment were compared in both groups. Naranjo׳s scale was utilized to determine the probability hyponatremia was drug-induced. Urine osmolality fit a bimodal distribution (intersection 219mOsm/kg) better than a unimodal distribution. 'Probable' drug-induced cases occurred 6.8 (95%CI=1.6-28.9) times more often in those with concentrated urine. Acute psychotic exacerbations occurred 4.5 (95%CI=0.4-54.1) times more often in those with dilute urine. These findings, as well as several other trends in the data, indicate that measures of urine concentration can help distinguish between antipsychotic-induced and psychosis-induced hyponatremia.
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Affiliation(s)
- Wanlop Atsariyasing
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Morris B Goldman
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 446 East Ontario, Suite 7-100Chicago, IL 60611, USA.
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Achalia R, Lakkas Y, Prakash O. Management of geriatric mania complicated by hyponatremia and psychogenic adipsic hypernatremia. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.jcgg.2013.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Liamis G, Filippatos TD, Elisaf MS. Treatment of hyponatremia: the role of lixivaptan. Expert Rev Clin Pharmacol 2014; 7:431-41. [DOI: 10.1586/17512433.2014.911085] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Abstract
Hyponatremia is a common phenomenon in psychiatry occurring as an adverse effect to drugs or following polydipsia. We performed a retrospective in-depth analysis of hyponatremia cases in a large unselected population of psychiatric inpatients. During a 3-year period, all cases of hyponatremia were identified among patients admitted to a large psychiatric state and university hospital by the institution's electronic laboratory database. Demographic, treatment-related, and laboratory data were obtained by consecutive chart review, respectively. Hyponatremia occurred in 347 (4.9%) of 7113 cases, of which the majority (78%) displayed only a mild manifestation. Symptoms were recorded in 28.8% of cases, already occurred in mild forms, and comprised gait impairment (45%, including falls), confusion (30%), sedation (26%), and dyspepsia (41%). Age, female sex, nonpsychiatric drug polypharmacy-particularly with thiazides and/or angiotensin-converting enzyme inhibitors-and diagnosis of a mood disorder were associated with more severe hyponatremia, respectively. The proportion of hyponatremic patients treated with venlafaxine, trazodone, carbamazepine, oxcarbazepine, and first-generation antipsychotics, respectively, was significantly higher in the hyponatremia sample than in the normonatremic population. This was, surprisingly, not the case with selective serotonin reuptake inhibitors or any other antidepressant drug class. We found prescription with second-generation antipsychotics to be significantly associated with less severe hyponatremia.Hyponatremia may be mainly attributed to the syndrome of inappropriate antidiuretic hormone secretion, as indicated by decreased serum osmolarity in our sample. Besides old age and female sex, treatment with certain drugs-rather than whole drug classes-carries a substantially increased risk.
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Yam FK, Jackson EA, Kwan BK. Syndrome of inappropriate antidiuretic hormone associated with aripiprazole. Am J Health Syst Pharm 2013; 70:2110-4. [PMID: 24249761 DOI: 10.2146/ajhp130142] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
PURPOSE A probable case of aripiprazole-induced syndrome of inappropriate antidiuretic hormone (SIADH) is reported. SUMMARY A 65-year-old Caucasian man arrived in the emergency department (ED) with dizziness, headache, abdominal pain, nausea, and vomiting. There had been no recent additions or changes to the patient's medication regimen except for an increase in the daily dose of aripiprazole (from 10 to 20 mg) about two months prior. On admission, the patient's serum sodium concentration was 108 meq/L, prompting discontinuation of aripiprazole use and fluid restrictions. Over the next 72 hours, the serum sodium level increased to a near-normal concentration (127 meq/L), and the man was discharged back to a nursing facility. Three days later, the patient was readmitted to the ED with recurrent symptoms and a serum sodium concentration of 118 meq/L, a serum osmolality of 254 mOsm/kg, a urine osmolality of 575 mOsm/kg, and a urine sodium concentration of 101 meq/L. It was learned that aripiprazole use had been inappropriately resumed at the nursing facility. Aripiprazole was again discontinued, and fluid restrictions were imposed, with subsequent abatement of hyponatremia over four days. Application of the adverse drug reaction probability scale of Naranjo et al. in this case yielded a score of 7, indicating probable aripiprazole-associated SIADH. CONCLUSION A 65-year-old man developed severe hyponatremia after an aripiprazole dosage increase. Hyponatremia resolved promptly with the discontinuation of aripiprazole. After discharge from the hospital, the patient inadvertently received aripiprazole again and was subsequently readmitted with another episode of severe hyponatremia.
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Affiliation(s)
- Felix K Yam
- Felix K. Yam, Pharm.D., M.A.S., BCPS, is Health Sciences Assistant Clinical Professor, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego (UCSD), La Jolla. Elizabeth A. Jackson, Pharm.D., is Postgraduate Year 1 Pharmacy Practice Resident, Veterans Affairs San Diego Healthcare System, La Jolla; at the time of writing, she was a pharmacy student, Skaggs School of Pharmacy and Pharmaceutical Sciences, UCSD. Brian K. Kwan, M.D., is Health Sciences Assistant Clinical Professor, School of Medicine, UCSD
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Manu P, Ray K, Rein JL, De Hert M, Kane JM, Correll CU. Medical outcome of psychiatric inpatients with admission hyponatremia. Psychiatry Res 2012; 198:24-7. [PMID: 22424891 DOI: 10.1016/j.psychres.2012.01.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 11/25/2011] [Accepted: 01/22/2012] [Indexed: 10/28/2022]
Abstract
Hyponatremia at time of inpatient admission is associated with increased severity of illness and mortality in patients hospitalized for treatment of medical conditions. This study was conducted to determine the clinical outcome of psychiatric inpatients with admission hyponatremia. The cohort comprised 1000 adults consecutively admitted to a free-standing psychiatric hospital in 2010. Emergency transfer to a general hospital was used as a proxy marker for poor medical outcome. The point prevalence of hyponatremia (sodium level <136 mEq/l) at admission was 6.49%. Older age and a diagnosis of arterial hypertension were independent correlates of admission hyponatremia. Medical deteriorations occurred in 26.7% of hyponatremic patients and 13.1% of those with normal sodium levels. Admission hyponatremia is associated with an increased rate of significant medical deteriorations of psychiatric inpatients and should trigger enhanced clinical monitoring to identify and treat somatic disorders.
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Affiliation(s)
- Peter Manu
- Zucker Hillside Hospital, North Shore - Long Island Jewish Health System, Glen Oaks, NY 11004, United States.
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Quinn CJ, Iyegha UP, Beilman GJ, Cerra FB. Acute correction of hyponatremia secondary to psychogenic polydipsia. AMERICAN JOURNAL OF CASE REPORTS 2012; 13:69-71. [PMID: 23569492 PMCID: PMC3616165 DOI: 10.12659/ajcr.882772] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 05/10/2012] [Indexed: 11/24/2022]
Abstract
Background: Psychogenic polydipsia is prevalent amongst psychiatric patients, but less common in the general population. Generally, hyponatremia ensues with complications of cerebral edema resulting in confusion, seizures, coma, and death. Rapid correction of serum sodium levels can lead to further complications of osmotic demyelination of neurons, e.g. central pontine myelinolysis. Case Report: We present a case of a 32-year-old male who presented with seizures while being treated at a drug rehabilitation facility. He was discovered to be hyponatremic secondary to suspected psychogenic polydipsia. The patient impressively responded to treatment of fluid restriction and desmopressin and symptoms improved. Conclusions: Among the causes of hyponatremia, psychogenic polydipsia may be more difficult to diagnose especially if an apparent psychiatric condition is not present. Current literature supports cautious correction of hyponatremia to prevent complications. However, rapid corrections may be driven by the physiology of the patient and may not be avoidable. Fortunately, our case illustrates rapid, positive outcomes for the patient.
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Affiliation(s)
- Coridon J Quinn
- Department of Surgery, University of Minnesota, Minneapolis, MN, U.S.A
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Josiassen RC, Curtis JL, Shaughnessy RA, Filmyer DM, Geboy AG, Skuban N, Ouyang J, Czerwiec F. Vaptans: a potential new approach for treating chronic hyponatremia in psychotic patients. ACTA ACUST UNITED AC 2012; 6:21-6. [PMID: 22453866 DOI: 10.3371/csrp.6.1.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Hyponatremia (serum sodium concentration [Na+] <136 mEq/L) is a potentially life-threatening condition often found chronically in patients with psychotic disorders. Vasopressin antagonists have recently been shown in short-term studies to correct hyponatremia in diverse patient populations, including individuals with both psychosis and idiopathic hyponatremia. However, the safety and efficacy of long-term administration of vaptans is only beginning to be investigated. The objective of this study was to assess whether one of the vaptans, specifically tolvaptan, maintained its safety and efficacy over a prolonged period in patients with psychosis and chronic idiopathic hyponatremia. METHODS SALTWATER was a multicenter, open-label extension of the Study of Ascending Levels of Tolvaptan in Hyponatremia. Of the 111 patients enrolled in SALTWATER, eight were patients with both psychosis and idiopathic hyponatremia. These eight subjects provided a total of 7,406 patient days of exposure to oral tolvaptan. RESULTS Mean serum [Na+] in the eight psychotic patients increased from 131.6 mEq/L at baseline to >135 mEq/L throughout the observation period (p<0.05 versus baseline at most points). No drug-related adverse events led to study discontinuation. CONCLUSIONS Chronic hyponatremia is known to have deleterious effects on the quality of life for many patient groups. These preliminary results suggest that oral tolvaptan provides rapid, effective, and safe treatment of chronic hyponatremia in patients with psychotic disorders and that the effect is safely sustained over long periods of time. These findings represent an important step forward in treating a significant unmet need in psychotic populations.
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Abstract
AIM Greater soft drink consumption was associated with increased risk of mental health problems in Western countries. The objective of the study was to examine the association between soft drink and sweet food consumption and suicidal behaviours among adolescents in China. METHODS In 2005, a population-based cross-sectional study was conducted in 100 schools in Jiangsu Province, China. Participants were aged 12-19 years old (n = 23,976). RESULTS Among the participants, 20.5% reported daily soft drink consumption; 18.6% reported having suicidal ideation. Soft drink consumption was significantly and positively associated with risk of suicidal plan or suicide attempt. Prevalence of suicidal plan was 12.8% among those who consumed soft drink at least three times per day and 6.2% among those who did not consume any soft drinks. In multivariate analyses, compared with soft drink consumption less than once per day, consumption at least three times per day was associated with 80% increased risk for suicidal plan and more than 3.5-fold increased risk for suicide attempt. Of note, nonconsumption of soft drinks was also associated with about 32% elevated risk for suicidal plan and suicidal attempt. High frequency intake of sweet food was associated with increased risk of suicidal behaviours. CONCLUSIONS There is a positive association between consumption of soft drinks and sweet food and risks for suicidal behaviours among adolescents in China. Prospective studies are warranted to confirm these findings.
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Affiliation(s)
- Xiaoqun Pan
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
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Josiassen RC, Curtis J, Filmyer DM, Geboy AG, Shaughnessy RA. 64-Year-Old Male with Undifferentiated Schizophrenia, Lengthy Institutionalization, Water Imbalance. Psychiatr Ann 2011. [DOI: 10.3928/00485713-20110119-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Psychotropic medication use, hyponatremia, and falls in an inpatient population: a retrospective study. J Clin Psychopharmacol 2011; 31:395-7. [PMID: 21532373 DOI: 10.1097/jcp.0b013e318218f446] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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McKnight RF, Hampson S. Hyponatremia-induced change in mood mimicking late-onset bipolar disorder. Gen Hosp Psychiatry 2011; 33:83.e5-7. [PMID: 21353139 DOI: 10.1016/j.genhosppsych.2010.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2010] [Revised: 09/20/2010] [Accepted: 09/21/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Hyponatremia and bipolar disorder are rarely considered to have common features. This report describes a case of hyponatremia secondary to syndrome of inappropriate antidiuretic hormone secretion (SIADH) presenting as late-onset bipolar disorder and discusses the evidence linking hyponatremia to mood disorders. METHOD Case report and review of published literature. RESULTS This case provides evidence that mood changes identical to those seen in bipolar disorder may be caused by hyponatremia at a variety of concentrations. CONCLUSIONS Further research is required to determine causes of SIADH in psychiatric patients with symptomatic hyponatremia and to elucidate the mechanism by which hyponatremia causes changes in mood. In older patients presenting with new-onset bipolar disorder, a physical etiology must always be excluded.
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Affiliation(s)
- Rebecca F McKnight
- Department of Psychiatry, Warneford Hospital, University of Oxford, Warneford Lane, OX3 7JX Oxford, UK.
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Katsarou A, Singh S. Hyponatraemia associated rhabdomyolysis following water intoxication. BMJ Case Rep 2010; 2010:2010/sep08_1/bcr0220102720. [PMID: 22778200 DOI: 10.1136/bcr.02.2010.2720] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
A young man with bipolar disorder was admitted in a coma. Cerebral oedema secondary to severe hyponatraemia was implicated. This was due to self-induced water intoxication. He developed rhabdomyolysis, a massive creatine kinase (out of proportion to longstanding antipsychotic medication) and acute renal failure. In the intensive care unit, hyponatraemia was corrected, and following appropriate fluid resuscitation, with forced alkaline diuresis, the rhabdomyolysis and renal function normalised, averting renal support. While a full recovery ensued, the persisting risk factors for hyponatraemia, that is polydipsia, and its association with rhabdomyolysis, increased the chances of a recurrence. Closely supervised regulation of his water intake, and monitoring of antipsychotic efficacy (for biochemical homeostatsis) are essential for secondary prevention. Rhabdomyolysis is a rare complication of hyponatraemia. When associated with psychogenic polydipsia, the acute and chronic management are challenging. Vaptans, which are aquaretics, that preferentially prevent renal tubular water reabsorption, may be beneficial in this situation.
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Affiliation(s)
- Alexia Katsarou
- Department of Medicine, Central Middlesex Hospital, London, UK
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Josiassen RC, Curtis J, Filmyer DM, Audino B, Skuban N, Shaughnessy RA. Tolvaptan: a new tool for the effective treatment of hyponatremia in psychotic disorders. Expert Opin Pharmacother 2010; 11:637-48. [PMID: 20163274 DOI: 10.1517/14656561003610656] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
IMPORTANCE OF THE FIELD Hyponatremia (serum sodium concentration < 136 mEq/liter) is a common and potentially life-threatening medical comorbidity seen in patients with psychotic disorders. Tolvaptan, a selective antagonist of the V(2)-receptor, is FDA-approved for the treatment of clinically significant hypervolemic and euvolemic hyponatremia. This represents a major development in the care of psychotic individuals with hyponatremia. AREAS COVERED IN THE REVIEW This review provides an overview of the existing literature on prevalence rates and risk factors associated with hyponatremia in psychotic patients (1923 - present). Tolvaptan is discussed as a potential advance in the treatment of hyponatremia in patients with psychotic disorders, and preliminary data are reviewed. WHAT THE READER WILL GAIN The reader will gain an appreciation of the prevalence of hyponatremia among psychotic individuals, an understanding of the distinctions between acute and chronic hyponatremia in this population, and awareness that effective treatments are becoming available. TAKE HOME MESSAGE A modest literature exists regarding prevalence rates and risk factors associated with hyponatremia in psychotic populations. Hyponatremia is common and serious enough to merit clinical concern. Perhaps, now that tolvaptan has been FDA-approved, progress will accelerate and new insights will develop that begin to bring relief from this medical comorbidity among psychotic patients.
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Affiliation(s)
- Richard C Josiassen
- Drexel University College of Medicine, 1427 Vine Street, Philadelphia, PA 19102, USA.
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Abstract
OBJECTIVE To examine the association between soft drink consumption and mental health problems, including self-reported doctor-diagnosed anxiety, stress-related problem and depression, suicidal ideation and psychological distress, among adults in South Australia. DESIGN Data were collected using a risk factor surveillance system. Each month a representative random sample of South Australians was selected from the Electronic White Pages with interviews conducted using computer-assisted telephone interviewing. SETTING South Australia. SUBJECTS Participants were aged 16 years and above. RESULTS Among 4741 participants, 12.5% reported daily soft drink consumption of more than half a litre. High levels of soft drink consumption were positively associated with depression, stress-related problem, suicidal ideation, psychological distress and a current mental health condition, but not anxiety. Overall, 24.0% of those having suicidal ideation reported consuming more than half a litre of soft drink per day. In the multivariate analysis, after adjusting for sociodemographic and lifestyle factors, those who consumed more than half a litre of soft drink per day had approximately 60% greater risk of having depression, stress-related problem, suicidal ideation, psychological distress or a current mental health condition, compared with those not consuming soft drinks. The soft drink to total fluid consumption ratio had similar associations with mental health problems. CONCLUSIONS There is a positive association between consumption of soft drinks and mental health problems among adults in South Australia.
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Ng F, Mammen OK, Wilting I, Sachs GS, Ferrier IN, Cassidy F, Beaulieu S, Yatham LN, Berk M. The International Society for Bipolar Disorders (ISBD) consensus guidelines for the safety monitoring of bipolar disorder treatments. Bipolar Disord 2009; 11:559-95. [PMID: 19689501 DOI: 10.1111/j.1399-5618.2009.00737.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Safety monitoring is an important aspect of bipolar disorder treatment, as mood-stabilising medications have potentially serious side effects, some of which may also aggravate existing medical comorbidities. This paper sets out the International Society for Bipolar Disorders (ISBD) guidelines for the safety monitoring of widely used agents in the treatment of bipolar disorder. These guidelines aim to provide recommendations that take into consideration the balance between safety and cost-effectiveness, to highlight iatrogenic and preventive clinical issues, and to facilitate the broad implementation of therapeutic safety monitoring as a standard component of treatment for bipolar disorder. METHODS These guidelines were developed by an ISBD workgroup, headed by the senior author (MB), through an iterative process of serial consensus-based revisions. After this, feedback from a multidisciplinary group of health professionals on the applicability of these guidelines was sought to develop the final recommendations. RESULTS General safety monitoring recommendations for all bipolar disorder patients receiving treatment and specific monitoring recommendations for individual agents are outlined. CONCLUSIONS These guidelines are derived from evolving and often indirect data, with minimal empirical cost-effectiveness data available to provide guidance. These guidelines will therefore need to be modified to adapt to different clinical settings and health resources. Clinical acumen and vigilance remain critical ingredients for safe treatment practice.
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Affiliation(s)
- Felicity Ng
- Discipline of Psychiatry, School of Medicine, University of Adelaide, SA, Australia
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