We found diurnal weight gain to be abnormal among 39 chronic schizophrenic patients. The patients were weighed and urine samples obtained weekly for three weeks at 7 a.m. and 4 p. m. We normalized the dirunal weight gain (NDWG) as a percentage by subtracting the 7 a.m. weight from the 4 p.m. weight, multiplying the difference by 100, and then dividing the result by the 7 a.m. weight. NDWG was 2.075 ± 1.331% for the 38 study patients, .631 ± .405% for 16 acutely psychotic controls and. 511 ± .351% for 29 normals. Seventy-seven percent of the study patients had abnormal NDWG values and 62 % were polyuric. NDWG related to urine volume (n = 39, r = .356, p = .026) with the variability in urine excretion explaining 13% of the variability in NDWG. We discuss factors that may have contributed to our findings.
References
1.
SchaferEA, HerringPT. The action of pituitary extracts upon the kidney. Proc Roy Soc London1906; 77: 571–572.
2.
AchardC, RamondL.Ptomanie chez un enfant. Bull et mem Soc med d hop de Paris1905; 12: 380.
3.
ReichardtM.Der diabetes insipidus, symptom einer geisteskrankheit?Arb a d psychiat Klin zu Wurzburg1908; 2: 49.
4.
EbsteinW.Beitrage zur lehre vom diabetes insipidus. Deutsches Arch f klin Med1909; 95: 1.
5.
WeirJF, LarsonEE, RowntreeLG. Studies in diabetes insipidus, water balance, and water intoxication. Arch Int Med1922; 29: 306–330.
6.
RowntreeLG. Water intoxication. Arch Int Med1923; 32: 157–174.
7.
HoskinsRG. Schizophrenia from the physiological point of view. Ann Int Med1933; 7: 445–456.
SleeperFH. Investigation of polyuria in schizophrenia. Am J Psychiatry1935; 91: 1019–1031.
10.
SleeperFH, JellinekEM. A comparative physiologic, psychologic, and psychiatric study of polyuric and nonpolyuric schizophrenic patients. J Nerv Ment Dis1936; 83: 557–563.
11.
BarahalHS. Water intoxication in a mental case. Psychiatr Q1938; 12: 767–771.
12.
BarlowED, DeWardenerHE. Compulsive water drinking. Q J Med1959; 28: 235–258.
13.
SchwartzWB, BennettW, CurelopS, Syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate secretion of antidiuretic hormone. Am J Med1957; 23: 529–542.
14.
HobsonJA, EnglishJT. Self-induced water intoxication: case study of a chronically schizophrenic patient with physiological evidence of water retention due to inappropriate release of antidiuretic hormone. Ann Int Med1963; 58: 324–332.
15.
ZubenkoGS. Water hoemostasis in psychiatric patients. Biol Psychiatry1987; 22: 121–125.
16.
IllowskyBP, KirchDG. Polydipsia and hyponatremia in psychiatric patients. Am J Psychiatry1988; 145: 675–683.
17.
ViewegV, RoweW, DavidJ, Hyposthenuria as a marker for self-induced water intoxication and schizophrenic disorders. Am J Psychiatry1984; 141: 1258–1260.
18.
ViewegWVR, RoweWT, DavidJJ, Evaluation of patients with self-induced water intoxication and schizophrenic disorders (SIWIS). J Nerv Ment Dis1984; 172: 552–555.
19.
ViewegWVR, RoweWT, DavidJJ, The “Mini-mental state” examination in the syndrome of self-induced water intoxication and schizophrenic disorders (SIWIS): a pilot study. Int J Psychiatry Med1984; 14: 347–359.
20.
ViewegWVR, DavidJJ, RoweWT, Death from self-induced water intoxication among patients with schizophrenic disorders. J Nerv Ment Dis1985; 173: 161–165.
21.
KoczapskiA, IbraheemS, ParedesJ, Diurnal variations in hyponatremia and body weight in chronic schizophrenics with self-induced water intoxication. J Clin Invest Med1985; 8: A86.
22.
ViewegWVR, GodleskiLS, GrahamP, Abnormal diurnal weight gain among long-term patients with schizophrenic disorders. Schizophr Res1988; 1: 67–71.
23.
ViewegV, GodleskiL, YankG.Diurnal weight gain as an index of polyuria and hyponatremia among chronically psychotic patients. Neuroendocrinol Lett1987; 9: 218.
24.
DelvaNJ, CrammerJL. Polydipsia in chronic psychiatric patients: body weight and plasma sodium. Br J Psychiatry1988; 152: 242–245.
ViewegWVR, DavidJJ, GlickJL, Polyuria among patients with psychosis. Schizophr Bull1986; 12: 739–743.
27.
GodleskiLS, ViewegWVR, BarberJW, Prevalence of polyuria among chronically psychotic men. Psychiatric Med1988; (in press).
28.
ViewegV, GodleskiL, YankG.Diurnal variation of serum sodium and ADH among patients with psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome). Neuroendocrinol Lett1987; 9: 219.
29.
ViewegV, GodleskiL, YankG.Hyponatremia and volume expansion in psychosis. Neuroendocrinol Lett1987; 9: 219.
30.
ViewegWVR, RobertsonGL, GodleskiLS, Diurnal variation in water homeostasis among schizophrenic patients subject to water intoxication. Schizophr Res1988; 1: 351–357.
31.
ViewegWVR, CareyRM, GodleskiLS, The syndrome of psychosis, intermittent hyponatremia, and polydipsia: evidence for diurnal volume expansion. Psychiatr Med1989; (in press).
32.
GoldmanMB, LuchinsDJ, RobertsonGL. Mechanisms of altered water metabolism in psychotic patients with polydipsia and hyponatremia. N Engl J Med1988; 318: 397–403.
33.
Diagnostic and Statistical Manual of Mental Disorders, fourth edition, revised (DSM-III-R). Washington, D.C.: APA, 1987.
34.
ViewegWVR, DavidJJ, RoweWT, Diurnal variation of urinary excretion for patients with psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome). Biol Psychiatry1986; 21: 1031–1042.
35.
ViewegWVR, YankGR, RoweWT, Diurnal variation of sodium and water metabolism among patients with psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome). Biol Psychiatry1987; 22: 224–227.
36.
ViewegWVR, HundleyPL, GodleskiLS, Weight gain as a predictor of serum sodium concentration among patients with psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome). Psychiatr Res1988; 26: 305–312.
37.
ViewegWVR, GodleskiLS, HundleyPL, Diurnal weight gain as an index of polyuria and hyponatremia among chronically psychotic patients. Psych Med1989; 6: 23–28.
38.
ViewegWVR, GodleskiLS, GoldmanF, Abnormal diurnal weight gain among chronically psychotic patients compared to a control population. Acta Psychiatr Scand1988; 78: 169–171.
39.
ViewegWVR, GodleskiLS, HundleyPL, Lithium, polyuria, and abnormal diurnal weight gain in psychosis. Acta Psychiatr Scand1988; 78: 510–514.
40.
ViewegWVR, GodleskiLS, GrahamP, . Diurnal weight gain in chronic psychosis. Schizophr Bull1989; (in press).
41.
ViewegWVR, GodleskiLS, GrahamP, Abnormal diumal weight gain among institutionalized patients with manic-depressive spectrum disorders. Psych Med1989; (in press).
42.
ViewegWVR, GodleskiLS, HundleyPL, Failure of antipsychotic drug dose to explain abnormal diurnal weight gain among 129 chronically psychotic inpatients. Prog Neuro-Psychopharmacol Biol Psychiatr1989; 13: 709–723.
43.
ViewegWVR, GodleskiLS, ShannonC, Normilization of abnormal diurnal weight gain among chronically psychotic geriatric patients. Is abnormal diurnal weight gain a risk factor in chronic psychosis? J Nerv Ment Dis1989; 177: 542–545.
44.
ViewegWVR, GodleskiLS, PavalonisDL, Abnormal diurnal weight gain without seasonal change among chronically psychotic patients. Neuropsychobiology1989; 19: 176–179.
45.
ViewegWVR, GodleskiLS, MitchellM, Abnormal diurnal weight gain among chronically psychotic patients contrasted with acutely psychotic patients and normals. Psychol Med1989; 19: 105–109.
46.
ViewegWVR, GodleskiLS, HundleyPL, Disturbed biodynamics among patients with organic mental syndromes: Abnormal diurnal weight gain. Aust NZ J Psych1989; (in press).
WaldingerRJ. Psychiatry for medical students. Washington, D.C.: APA1984.
49.
GelenbergAJ. Psychosis. In: BassukEL, SchoonoverSC, GelenbergAJ, eds. The practioner's guide to psychoactive drugs.New York: Plenum Publishing Corporation, 1983.
50.
WelchBL. The significance of the difference between two means when the population variances are unequal. Biometrika1938; 29: 350–362.
51.
DavidsonC, SmithD, MorganDB. Diurnal pattern of water and electrolyte excretion and body weight in idiopathic orthostatic hypotension. Am J Med1976; 61: 709–715.
52.
BartterFC. The syndrome of inappropriate secretion of antidiuretic hormone (SIADH). In: Disease-a-Month.Chicago: Yearbook Medical, 1973.
53.
BerlT, AndersonRJ, McDonaldKM, : Clinical disorders of water metabolism. Kidney Int1976; 10: 117–132.
BleilerRE, SchedlHP. Creatinine excretion. Variability and relationships to diet and body size. J Lab Clin Med1962; 59: 945–955.
56.
ViewegWVR, HundleyPL, GodleskiLS, Similarity of patterns of urine excretion among nonpolyuric and polyuric patients with thought disorders. Schizophr Res1988; 1: 295–298.
57.
SandiferMG. Hyponatremia due to psychotropic drugs. J Clin Psychiatry1983; 44: 301–303.
58.
RaskindMA, CourtneyN, MurburgMM, Antipsychotic drugs and plasma vasopressin in normals and acute schizophrenic patients. Biol Psychiatry1987; 22: 453–462.
59.
CampbellA, BaldessariniRJ. Prolonged pharmacologic activity of neuroleptics. Arch Gen Psychiatry1985; 42: 637.
60.
CampbellA, BaldessariniRJ, TeicherMH, Prolonged antidopaminergic actions of single doses of butyrophenones in the rat. Psychopharmacol1985; 87: 161–166.
61.
KirchDG, KorpiER, VenableD, Pharmacokinetic and clinical aspects of withdrawal from halperidol. 14th Annual Meeting, American College of Neuropsychopharmacology (ACNP), December, 1985.
