Treatment of psychogenic polydipsia: comparison of risperidone and olanzapine, and the effects of an adjunctive angiotensin-II receptor blocking drug (irbesartan).

Abstract

OBJECTIVE:

Our objective was to determine the outcome of novel strategies in managing a case of severe polydipsia.

CLINICAL PICTURE:

The patient was a 39-year-old male with a 20-year history of paranoid schizophrenia who, despite only mild residual psychotic symptoms, had been hospitalized for the previous 10 years because of severe polydipsic behaviour complicated by water intoxication.

TREATMENT:

Novel antipsychotic agents, risperidone and olanzapine, as well as the specific angiotensin-II receptor blocking drug, irbesartan were employed at selected intervals in a study lasting nearly 3 years. A strict behavioural management programme was ongoing, in which diurnal weight change and the number of breaches of weight limits, requiring management in a low-stimulus environment, were documented on a daily basis. Summary measures of diurnal weight change and behavioural intervention were charted against changes in treatment.

OUTCOME:

Polydipsic behaviour improved on risperidone up to 4 mg daily, but was not sustained. Olanzapine was similarly successful in stabilizing polydipsia, and improvement was achieved with the addition of irbesartan.

CONCLUSION:

We suggest that the D2-sparing profiles of receptor binding achieved with low-dose risperidone and olanzapine may account for this beneficial effect. The benefit derived with irbesartan implicates the involvement of brain angiotensin systems centrally in helping to regulate drinking behaviour.

• Authors: D Kruse, C Pantelis, R Rudd, J Quek, P Herbert, M McKinley
• Journal: The Australian and New Zealand journal of psychiatry (Aust N Z J Psychiatry) Vol. 35 Issue 1 Pg. 65-8 (Feb 2001) ISSN: 0004-8674 [Print] England
• PMID: 11270459 (Publication Type: Case Reports, Comparative Study, Journal Article)

Chemical References

• Angiotensin Receptor Antagonists
• Angiotensin-Converting Enzyme Inhibitors
• Antipsychotic Agents
• Biphenyl Compounds
• Tetrazoles
• Benzodiazepines
• Pirenzepine
• Irbesartan
• Risperidone
• Olanzapine

Topics

• Adult
• Angiotensin Receptor Antagonists
• Angiotensin-Converting Enzyme Inhibitors (administration & dosage, pharmacology, therapeutic use)
• Antipsychotic Agents (administration & dosage, therapeutic use)
• Benzodiazepines
• Biphenyl Compounds (administration & dosage, pharmacology, therapeutic use)
• Dose-Response Relationship, Drug
• Humans
• Irbesartan
• Male
• Olanzapine
• Pirenzepine (administration & dosage, analogs & derivatives, therapeutic use)
• Risperidone (administration & dosage, therapeutic use)
• Schizophrenic Psychology
• Tetrazoles (administration & dosage, pharmacology, therapeutic use)
• Water Intoxication (drug therapy, etiology)