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The value of spousal involvement in the management of psychogenic polydipsia: a case report.

To the Editor: Psychogenic polydipsia is a rare disorder of which the primary clinical feature is excessive drinking of water or other fluids in the absence of a physiologic stimulus to drink.1 Excessive water intake can worsen psychiatric symptoms; can produce nausea, vomiting, delirium, ataxia, seizures, and coma; and can be fatal.1 The diagnosis of psychogenic polydipsia is one of exclusion and requires special investigation and management; the most useful test is the water deprivation test, which should be considered carefully.2 In this condition, the patient’s chronic desire to drink water diminishes the response of the kidneys to antidiuretic hormone so that they are not able to concentrate urine to maximal levels.1 Patients with psychogenic polydipsia can easily tolerate excessive water drinking unless hyponatremia (low sodium in the blood) supervenes.1 It is important for clinicians to keep in mind that psychogenic polydipsia, similar to schizophrenia, has a relapsing course and warrants vigilance and appropriate management.2 Working toward resolving the main cause of the disorder will help in improving management of the excessive fluid intake.2 
 
It is also a challenge for psychiatrists to recognize both the potentially severe complications of this disorder in patients with comorbid mental illness and the necessity of including management of the dysregulation of fluid intake when treating these patients. We report a novel finding in the treatment of psychogenic polydipsia, which is the value of spousal involvement in the management of the disorder, perhaps above the value of pharmaceutical interventions. We have not found any literature considering the value of spousal involvement in the treatment of psychogenic polydipsia. It is our hope that this case report will promote future studies comparing the treatment of psychogenic polydipsia with spousal involvement in the treatment plan prior to initiation of medication. A psychogenic polydipsia model requires a milieu that balances maximizing the patients’ treatment with their safety.2