WordNet

of first rank or importance or value; direct and immediate rather than secondary; "primary goals"; "a primary effect"; "primary sources"; "a primary interest"
a preliminary election where delegates or nominees are chosen (同)primary_election
one of the main flight feathers projecting along the outer edge of a birds wing (同)primary feather, primary quill
(astronomy) a celestial body (especially a star) relative to other objects in orbit around it
not derived from or reducible to something else; basic; "a primary instinct"
excessive thirst (as in cases of diabetes or kidney dysfunction)

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『第一の』,『主要な』 / 『初期の』,『初等の』,初級の / 『根本的な』,基本的な,本来の,直接的な / 《名詞の前にのみ用いて》(回路・コイル・巻き・電流などが)一次の / 原色(三原色の一つ) / 《米》=primary election

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/06/24 21:43:30」(JST)

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Primary polydipsia or psychogenic polydipsia is a special form of polydipsia.^[1] It is usually associated with a patient's increasing fluid intake due to the sensation of having a dry mouth.

When the term "psychogenic polydipsia" is used, it implies that the condition is caused by mental disorders. However, the dry mouth is often due to phenothiazine medications used in some mental disorders, rather than the underlying condition.^[2]

Some forms of primary polydipsia are explicitly characterized as non-psychogenic.^[3]

Clinical presentation

Patients have been known to seek fluids from any source possible.

In extreme episodes, the patient's kidneys will be unable to deal with the fluid overload, and weight gain will be noted.

Primary polydipsia can be life threatening as serum sodium is diluted to an extent that seizures and cardiac arrest can occur (hyponatremia).

Treatment

If the patient is institutionalised, close monitoring by staff is necessary to control fluid intake.

In treatment-resistant polydipsic psychiatric patients, regulation in the inpatient milieu can be accomplished by use of a weight-water protocol. First, baseline weights must be established and correlated to serum sodium levels. Weight will normally fluctuate during the day, but as the water intake of the polydipsic goes up, the weight will naturally rise. The physician can order a stepped series of interventions as the weight rises. The correlation must be individualized with attention paid to the patient's normal weight and fluctuations, diet, comorbid disorders (such as a seizure disorder) and urinary system functioning. Progressive steps might include redirection, room restriction, and increasing levels of physical restraint with monitoring. Such plans should also progressive increases in monitoring, as well as a level at which a serum sodium level is drawn.

It is important to note that the majority of psychotropic drugs (and a good many of other classes) can cause dry mouth, but this is not to be confused with true polydipsia in which a dangerous drop in serum sodium will be seen.

Primary polydipsia often leads to institutionalization as it can be very difficult to manage outside the inpatient setting.

Patient profiles

Psychogenic polydipsia is a type of polydypsia described in patients with mental illnesses and/or the developmentally disabled. It is present in a subset of people with schizophrenia. These patients, most often with a long history of illness, exhibit enlarged ventricles and shrunken cortex on MRI, making the physiological mechanism difficult to isolate from the psychogenic.

While psychogenic polydipsia is usually not seen outside the population of those with serious mental disorders, it may occasionally be found among others in the absence of psychosis, although there is no extant research to document this other than anecdotal observations. Such persons typically prefer to possess bottled water that is ice cold, consume water and other fluids at excessive levels, and may be falsely diagnosed as suffering from diabetes insipidus, since the chronic ingestion of excessive water can produce symptoms and diagnostic results that mimic mild diabetes insipidus.

Veterinary Medicine

Psychogenic polydipsia is also observed in some animal patients.

References

^ Saito T, Ishikawa S, Ito T, et al (June 1999). "Urinary excretion of aquaporin-2 water channel differentiates psychogenic polydipsia from central diabetes insipidus". J. Clin. Endocrinol. Metab. 84 (6): 2235–7. doi:10.1210/jc.84.6.2235. PMID 10372737.
^ Rippe, James M.; Irwin, Richard S. (2008). Irwin and Rippe's Intensive care medicine. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. p. 909. ISBN 0-7817-9153-7.
^ Tobin MV, Morris AI (April 1988). "Non-psychogenic primary polydipsia in autoimmune chronic active hepatitis with severe hyperglobulinaemia". Gut 29 (4): 548–9. doi:10.1136/gut.29.4.548. PMC 1433532. PMID 3371724.

External links

Psychogenic Polydipsia at GPnotebook

UpToDate Contents

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1. 多尿および尿崩症の診断 diagnosis of polyuria and diabetes insipidus
2. 低ナトリウム血症の原因 causes of hyponatremia
3. 低ナトリウム血症の治療の概要 overview of the treatment of hyponatremia
4. 統合失調症に対するクロザピン投与のガイドライン guidelines for prescribing clozapine in schizophrenia
5. 横紋筋融解症の原因 causes of rhabdomyolysis

English Journal

Brain circuit dysfunction in a distinct subset of chronic psychotic patients.

Goldman MB.
Schizophrenia research.Schizophr Res.2014 Aug;157(1-3):204-13. doi: 10.1016/j.schres.2014.06.001. Epub 2014 Jul 1.
OBJECTIVE: To identify the mechanism of unexplained hyponatremia and primary polydipsia in schizophrenia and its relationship to the underlying psychiatric illness.METHODS: Briefly review previous studies that led to the conclusion the hyponatremia reflects altered hippocampal inhibition of peripher
PMID 24994556

Asymptomatic elevation of creatine kinase in patients with hyponatremia.

Khow KS1, Lau SY, Li JY, Yong TY.
Renal failure.Ren Fail.2014 Jul;36(6):908-11. doi: 10.3109/0886022X.2014.900600. Epub 2014 Mar 27.
Elevated creatine kinase (hyper-CKemia) has been observed in small number of patients with hyponatremia. This study evaluated the features and outcomes of patients admitted with hyponatremia complicated by hyper-CKemia. Patients admitted with hyponatremia and concurrently found to have elevated crea
PMID 24673369

Nephrotic syndrome complicated by idiopathic central diabetes insipidus.

Konomoto T1, Tanaka E, Imamura H, Orita M, Sawada H, Nunoi H.
Pediatric nephrology (Berlin, Germany).Pediatr Nephrol.2014 May;29(5):927-30. doi: 10.1007/s00467-013-2728-9. Epub 2014 Jan 10.
BACKGROUND: There is ongoing discussion regarding the mechanisms underlying edema formation in nephrotic syndrome (NS). Many studies published in the last decade reported that primary renal sodium retention was a major factor in edema formation. However, many of the factors influencing edema formati
PMID 24408226

Japanese Journal

繊毛病

中西浩一,吉川徳茂
日本小児腎臓病学会雑誌 25(2), 127-131, 2012
　繊毛は細胞表面から突出する小器官であり，気管などに存在する運動性の繊毛と，ほぼすべての細胞に存在する非運動性の一次繊毛が存在する。一次繊毛の役割は長らく不明であったが，近年，一次繊毛とその関連構造物の遺伝子変異により腎嚢胞，肝臓・胆管異常，内臓逆位，多指症，脳梁低形成，認知障害，網膜色素変性症，頭蓋・骨格異常，糖尿病など多岐にわたる異常を生じることが明らかになった。これら一群の繊毛機能不全疾病を …
NAID 130003346839

Recurrent autoimmune hypophysitis successfully treated with glucocorticoids plus azathioprine: a report of three cases

, , , , , , , , ,
Endocrine Journal 58(8), 675-683, 2011
… It is even more rare than primary hypophysitis. … case 2 was a 70-year-old with dry mouth, polydipsia, and polyuria; … case 3, a 32-year-old, with polydipsia, polyuria and menstrual disorders with headache and dizziness. …
NAID 130004443734

Primary granulomatous hypophysitis: a case report and literature review

, , ,
Endocrine Journal 58(6), 467-473, 2011
… Primary granulomatous hypophysitis (PGH) is a rarely occurred inflammatory disease of unknown etiology. … The patient was a 56-year-old female who presented with 4 months history of headache and 2 months history of polyuria and polydipsia. …
NAID 130004443709