MRI changes during water loading in patients with polydipsia and intermittent hyponatremia.

Objective: Patients with polydipsia and intermittent hyponatremia have greater ventricle-brain ratios (VBRs) than matched patients without polydipsia and intermittent hyponatremia and normal subjects. Unlike previous studies, this study controlled for the impact of water loading when examining the volume of intracranial structures.

Method: Under controlled conditions, eight male schizophrenic patients with polydipsia and intermittent hyponatremia were first assigned to either normal fluid intake or oral water loading and then the alternative condition the following day.

Behavioral analysis of drinking behaviors in polydipsic patients with chronic schizophrenia.

The authors describe drinking and voiding behaviors that differentiate between psychiatric patients with polydipsia and patient controls. Observations of 9 polydipsic patients and 6 controls were conducted for 153 hr and had high interrater reliability. Polydipsic patients drank 3 times as frequently, ingesting 5 times as much fluid as the controls.

Cigarette use, drinking and voiding in schizophrenic patients with polydipsia and hyponatremia.

Pre-smoking versus post-smoking amounts of drinking and voiding were compared in ten state hospital patients with schizophrenia and polydipsia. Cigarette use was significantly correlated with total amount drunk but was not associated with increased drinking or decreased voiding immediately following smoking. These findings revealed no nicotine effects upon thirst drive or urinary output, but suggest that drinking and smoking represent associated repetitive behaviors.

Clozapine treatment in polydipsia and intermittent hyponatremia.

Background: Recent case reports indicate that clozapine treatment diminishes excessive diurnal weight gain and alleviates hyponatremia observed in some chronically psychotic patients. We examined the influence of clozapine on sodium metabolism and water regulation across a group of patients with the syndrome of polydipsia and intermittent hyponatremia.

Method: Eleven patients with treatment-resistant DSM-III-R schizophrenia or schizoaffective disorder were studied.

Association between stereotypic behavior and polydipsia in chronic schizophrenic patients.

We assessed temporal associations between polydipsia and motor stereotypies in chronic schizophrenia. Subjects included: (a) a polydipsic patient with marked stereotypies; (b) a polydipsic patient with no history of stereotypy; (c) a nonpolydipsic patient. Stereotyped grooming and pacing were significantly associated with drinking for polydipsic patients only (polydipsic patients evidenced a 87% and 66% concordance between excessive grooming and drinking versus 12% in the control).

Affect processing in chronically psychotic patients: development of a reliable assessment tool.

We developed an economical clinical tool for assessing affect processing deficits in patients with chronic schizophrenia and schizoaffective disorder. Using trained raters, we assessed spontaneous prosody, prosodic comprehension, prosodic repetition, and recognition of facial affect. High interrater reliability and good separation between subscales was demonstrated.

Cluster analyses of pain patients' responses to the SCL-90R.

This study sought to identify distinct subgroups of chronic pain patients based on responses to the Symptom Checklist 90-revised (SCL-90R), a measure of psychological distress. Two scoring methods were used: the standard scoring that accompanies the manual, and a scoring method based upon factor scores obtained in an earlier study using low back pain patients. Two separate cluster analyses assigned patients into 2 groups: one based on standard scores and one based on factor scores.

Differential effects of neuroleptic and clozapine on polydipsia and intermittent hyponatremia.

Recent reports indicate that clozapine may dramatically decrease both polydipsia and intermittent hyponatremia associated with chronic psychosis. In contrast, there are conflicting reports regarding the impact of standard neuroleptic treatment in this syndrome. We review the relevant literature examining the effects of antipsychotics on the excessive thirst drive and inordinate arginine vasopressin activity observed in patients with water intoxication.

Multidisciplinary approach to psychosis, intermittent hyponatremia, and polydipsia.

The syndrome of psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome), seen in the seriously mentally ill, can result in severe biopsychosocial impairment, including an excessive death rate if not identified early. Because of its impact on the health, functioning, and quality of life of the seriously mentally ill patient, all mental health care providers must be aware of the signs and symptoms of PIP syndrome. Physiological, psychological, behavioral, self-care, and social factors all play a role in the manifestation of the syndrome; it follows that a multidisciplinary approach is crucial to ensure early detection, monitoring, and treatment of this problem both in the hospital and in the community.

A psychosocial and behavioral comparison of reflex sympathetic dystrophy, low back pain, and headache patients.

Based primarily on anecdotal evidence, patients with reflex sympathetic dystrophy (RSD) have often been suspected of having a high degree of psychosocial disturbance prior to the onset of symptoms as well as in reaction to the disorder. In the present study, patients presenting to a pain center with RSD were compared to patients with low back (LBP) and headache pain (HAP) on a variety of self-reported demographic, behavioral, pain, and mood measures. Typical of most patients experiencing chronic pain, all three groups demonstrated elevations indicative of pain, emotional distress, and behavioral disturbance.

Neuropsychological manifestations of hyponatremia in chronic schizophrenic patients with the syndrome of psychosis, intermittent hyponatremia and polydipsia (PIP).

We examined the neuropsychological sequelae of water intoxication in nine schizophrenic patients with the syndrome of psychosis, intermittent hyponatremia and polydipsia (PIP). Patients were assessed using a standardized test battery on two occasions following laboratory blood work: once during hyponatremia (serum sodium < 130 mmol/l) and once during normonatremia (serum sodium > 136 mmol/l). Results revealed significant deficits during hyponatremia involving complex information processing skills such as mental flexibility and verbal fluency.

Case report: recurrent pseudocyesis in a male patient with psychosis, intermittent hyponatremia, and polydipsia.

This report describes a case of recurrent pseudocyesis in a man with psychosis, intermittent hyponatremia, and polydipsia. The pseudocyesis was documented on three separate occasions coinciding with bouts of acute hyponatremia and rapid weight gain stemming from ingestion of large amounts of water. In contrast, no pseudocyesis was elicited during intervening normonatremic states.

Development and validation of a behavioral observation measure for the syndrome of psychosis, intermittent hyponatremia, and polydipsia.

A behavioral observation scale (Virginia Polydipsia Scale; VPS) for monitoring drinking patterns was developed and its reliability tested during 25 hours of tandem ratings among six patients with the syndrome of psychosis, intermittent hyponatremia, and polydipsia (PIPS). These ratings were compared to those collected from a control group of six psychiatric inpatients who were similarly observed for 25 hours. The scale was subsequently used to assess day-long drinking in a single PIPS patient.

Dysphoria: a major symptom factor in persons with disability or chronic illness.

Depression frequently is diagnosed in persons with chronic illness or following the onset of disability. The overlap of symptoms of many chronic illnesses and disabling conditions with depression may lead to an overestimation of depression in such populations. Some investigators have proposed revised criteria for diagnosing depression in these conditions without an understanding of the contribution of diagnostic criteria in disabling conditions.

Spontaneous coping strategies to manage acute pain and anxiety during electrodiagnostic studies.

Electrodiagnostic studies produce both anxiety and pain, which can prevent adequate examination and limit the usefulness of test results. This study examined the spontaneous coping strategies used to manage the pain and anxiety experienced during electrodiagnostic testing. Fifty patients (26 women and 24 men) evaluated in our electrodiagnostic laboratory were administered visual analogue scale (VAS) pain and anxiety measures and the Spielberger State-Trait Anxiety Inventory (STAI) before the procedure.

Pain complaint and the weather: weather sensitivity and symptom complaints in chronic pain patients.

Chronic pain patients frequently report that weather conditions affect their pain; however, no standardized measures of weather sensitivity have been developed. We describe the development and use of the Weather and Pain Questionnaire (WPQ) which assess patient sensitivity to meteorologic variables defined by the National Weather Service (e.g.

Behavioral intervention to reduce water intake in the syndrome of psychosis, intermittent hyponatremia, and polydipsia.

We describe a non-intensive behavioral intervention using an A-B design with extended follow-up on an open psychiatric unit to reduce water intake in a 52-year-old man with the syndrome of psychosis, intermittent hyponatremia, and polydipsia. A reinforcement schedule contingent upon weight gain secondary to water intake was employed. Mean diurnal weight gain was 7.

Clozapine-induced weight gain: prevalence and clinical relevance.

Objective: The aim of this study was to determine the prevalence and clinical relevance of weight gain during clozapine treatment. Previous reports indicated clinically significant weight gain in 13% to 85% of patients and an average gain of 9.0 to 24.

Behavioral treatment of dizziness secondary to benign positional vertigo following head trauma.

Benign positional vertigo (BPV) represents a challenge to rehabilitation due to the subjective nature of the complaint of dizziness, frequent failure of pharmacologic intervention, and complicating psychologic factors. Behavioral therapy was used to treat a 26-year-old woman who complained of debilitating dizzy spells after mild head injury sustained in a motor vehicle accident. During a three-week baseline period before treatment, the patient reported a weekly average of 48 dizzy spells, which prevented participation in independent activities and kept her homebound and psychologically distressed.

Health locus of control, gender differences and adjustment to persistent pain.

Locus of control (LOC) beliefs, long thought important in adjustment to persistent pain, were studied among 160 subjects (67 males and 93 females) referred to a comprehensive pain rehabilitation program. The subscale structure of the Multidimensional Health Locus of Control (MHLC) was factorially replicated in our sample. Three unique MHLC profile clusters were identified for both males and females.

Chronic pain patients' beliefs about their pain and treatment outcomes.

A novel assessment procedure measuring chronic pain patients' agreement with information presented on a clinic orientation videotape was evaluated as a predictor of short-term treatment outcome. One hundred randomly selected outpatients viewed a 15-minute videotape detailing conservative approaches to pain management and completed a questionnaire measuring factual recall of the videotape presentation and their acceptance or rejection (ie, agreement) of this information. Patient ratings of satisfaction with treatment were assessed one month after treatment.