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Chronic Fatigue Syndrome: Limbic Encephalopathy in a Dysregulated Neuroimmune Network
Published in Jay A. Goldstein, Chronic Fatigue Syndromes, 2020
CFS patients are often thirsty. The traditional regulators of thirst are osmoreceptors controlling release of vasopressin, and volume receptors which secrete atrial natriuretic peptide. CGRP (calcitonin gene-related peptide) has recently been added to the list as a promo-tor of venous capacitance. There is little evidence to suggest that these mechanisms are operative in CFS. Psychogenic polydipsia is sometimes seen. The most powerful stimulus to thirst is angiotensin II, and the receptors for this peptide in the brain may be dysregu-lated in CFS. Treatment with angiotensin-converting enzyme inhibitors is sometimes effective.80 Nitric oxide acts as an inhibitory mechanism when thirst is stimulated by water deprivation or angiotensin II in the preoptic area.81 If nitric oxide synthase is inhibited, psychogenic polydipsia could ensue. Sicca syndrome is frequently seen in the CFS patient. Sjogren antibodies are not present although enhancement of the salivary glands on MRI in CFS patients with positive antinuclear antibodies is rarely present. The Schirmer test is often positive. This deficit is probably due to dysfunctional autonomic control of tear and saliva secretion and waxes and wanes along with other symptoms. It could also be caused via descending pathways to brain stem parasympathetic nuclei.
Endocrinology, growth and puberty
Published in Rachel U Sidwell, Mike A Thomson, Concise Paediatrics, 2020
Rachel U Sidwell, Mike A Thomson
Psychogenic polydipsia (compulsive water drinking). Here the urine will concentrate on water deprivation testing; however, there may be a decreased ability to concentrate urine if the condition is prolonged
Analytical Toxicology of Vitreous Humor
Published in Steven H. Y. Wong, Iraving Sunshine, Handbook of Analytical Therapeutic Drug Monitoring and Toxicology, 2017
Psychogenic polydipsia (compulsive water drinking), although generally thought to be relatively benign, has resulted in several fatalities. DiMaio and DiMaio67 note that, in three patients hospitalized before death, blood electrolyte analyses were available to substantiate the history and diagnosis. In their reported fatality, the patient was found dead at home. After a 6-day hospitalization for psychogenic water intoxication, she was discharged. The following day, she was found dead at home. Because serum electrolyte results were not considered reliable, vitreous humor was submitted for electrolyte analysis. The results were: sodium, 115 meq/1; chloride, 105 meq/1; potassium, 7.6 meq/1; glucose, <25 mg/dl; and creatinine, 0.4 mg/dl. Using the prior history, lack of evidence of pathological or other toxicological injury, and the hyponatremia revealed by the vitreous humor results, the pathologist ruled the death to be caused by water intoxication.
Psychogenic polydipsia associated with sertraline treatment: a case report
Published in Psychiatry and Clinical Psychopharmacology, 2019
Esra Okyar, Leyla Bozatlı, Işık Görker, Serap Okyar
Psychogenic polydipsia (PP) is a clinical condition characterized by excessive fluid intake in the absence of physiological stimuli to drink [5]. It rarely causes hyponatremia in the presence of normal renal function, but it is known that it may have fatal consequences [6]. More than 20% of those with chronic mental illness are accompanied by PP. Polydipsia is common especially in schizophrenia [7]. Its pathogenesis is not fully known, but it is thought that antidiuretic hormone (ADH) is increased by non-osmotic stimuli [8]. It is also believed that anticholinergic side effects of antipsychotic drugs contribute to this [9]. Although PP is more common in schizophrenia, it is also seen in cases of bipolar disorder, anorexia nervosa, chronic alcoholism, mental retardation, autism, and dementia [10]. It has been reported in the literature that PP developed as a behavioral safety measure in a patient with panic disorder [11].