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ResumenEntre 1986 y 1998, una revisión de 61 historias médicas de pacientes que murieron antes de la edad de 53 años en ocho centros psiquiátricos, cuya área de captación tenía una población total de 559.429 habitantes, reveló que 24 (39,3%) de esos pacientes tenían un trastorno esquizofrénico. Uno de ellos (4,17%; IC del 95%: 0-21%) murió a causa de las complicaciones de una intoxicación acuosa autoinducida (IAAI). Entre los 37 pacientes restantes, dos (5,4%; IC del 95%: 0-18%) fallecieron a causa de las complicaciones de una IAAI.

SummaryBetween 1986 and 1998, a review of 61 records of patients who died before the age of 53 years in eight psychiatric departments whose catchment area had a total population of 559,429 inhabitants revealed that 24 (39.3%) of those patients had a schizophrenic disorder. Of those 24 patients, one (4.17%; 95% CI: 0–21%) died from complications of self-induced water intoxication (SIWIS). Among the 37 remaining patients, two (5.4%; 95% CI: 0–18%) died from complications of SIWIS.

IntroductionAccording to several authors, water intoxication can lead to irreversible brain damage and could be the cause of nearly a fifth of the deaths of schizophrenic patients below the age of 53 years. The aim of our study was first to determine the prevalence of polydipsia and water intoxication in a population of psychiatric inpatients of a well-defined French geographic area (the Somme), and secondly to determine the clinical and socio-demographic factors associated with this disorder.MethodsA cross-sectional survey was done on the 450 psychiatric beds whose catchment area had a total population of 559,429 inhabitants. Using staff reports and patients’ charts, the drinking habits of 353 psychiatric inpatients hospitalised during the survey in the 450 psychiatric beds of this area were examined.ResultsThirty-eight patients (10.76%; 95% confidence interval: 7.53–13.99%) among the 353 inpatients were polydipsic. About one-third of these patients were at risk of water intoxication. Polydipsia appeared to be significantly associated with male gender, smoking, celibacy and chronicity. The polydipsic patients presented also a high prevalence of schizophrenia, mental retardation, pervasive developmental disorders and high frequency of somatic disorders.

Polydipsia, unrelated to organic polyuria is present in 20% of the patients hospitalised in psychiatry on a long term basis. It seems that about a third of them have presented at some point an episode of water intoxication. Most patients with psychogenic polydipsia excrete all the water they absorb. In a subgroup of them, at risk for water intoxication, the capacity to excrete water is deficient. This is usually due to an inappropriate secretion of antidiuretic hormone. The first two steps in the treatment of patients with psychogenic polydipsia consist in making the diagnosis and in evaluating the risk of water intoxication. To do this, one must monitor throughout the day their weight and the serum sodium plasma level if necessary, then reduce the risk factors and prescribe water restriction during the high risk periods. Behavioural therapy is sometimes used; prospects for chemotherapy are being studied. It is probable that there is not a single type of patient with psychogenic polydipsia but several subtypes, the etiology being multifactorial.