Atypical antipsychotics and polydipsia: a cause or
Giuseppe Bersani*, Lorenzo Pesaresi, Valerio Orlandi, Simona Gherardelli and Paolo Pancheri
University of Rome, La Sapienza, III Psychiatric Clinic, Department of Psychiatric Sciences and Psychological Medicine, Italy
Primary polydipsia (PP) is a frequent complication that affects many chronic schizophrenic inpatients. Due to possible lethal
consequences, for example, hyponatremia, coma and death, it’s fundamental for the physician achieving early diagnosis and
treating this condition. The first step is identifying polydipsia by clinical, biochemical and pharmacological means.
Nowadays, the pathophysiology of PP remains unclear, and this limits the possibility of detecting an appropriate drug
treatment. Typical antipsychotics have been associated to a worsening of polydipsic behavior, while more recently atypical
antipsychotics have been reported as being useful. However results are still mixed and controversial. It appears that
risperidone and olanzapine are not clearly effective; clozapine may improve symptoms, although it is difficult to manage
from a therapeutic point of view; quetiapine has been poorly studied so far, nonetheless it has given interesting results.
Through a case study analysis, this report presents a brief, yet selective, overview of the current state of psychopharmacology
in the treatment of PP with atypical antipsychotics in schizophrenia. Copyright # 2007 John Wiley & Sons, Ltd.
key words—schizophrenia; polydipsia; atypical antipsychotics; quetiapine
Primary polydipsia (PP) is a relatively frequent
complication of psychiatric patients, being reported
in more than 20% of chronic inpatients (de Leon,
2003). In schizophrenia, the excessive intake of liquid
has been associated to positive symptoms, nicotine,
inappropriate ADH release, and to medication side
effects (Illowsky and Kirch, 1988). When polydipsic
behaviors are detected, the first step is to exclude
possible causes of excess of water int