Primary polydipsia

Signs and symptoms of psychogenic polydipsia include:{{Cite journal|last1=Gill|first1=Melissa|last2=McCauley|first2=MacDara|date=2015-01-21|title=Psychogenic Polydipsia: The Result, or Cause of, Deteriorating Psychotic Symptoms? A Case Report of the Consequences of Water Intoxication|journal=Case Reports in Psychiatry|language=en|volume=2015|pages=846459|doi=10.1155/2015/846459|issn=2090-682X|pmc=4320790|pmid=25688318|doi-access=free }}

• Excessive thirst and xerostomia, leading to overconsumption of water
• Hyponatraemia, causing headache, muscular weakness, twitching, confusion, vomiting, irritability etc., although this is only seen in 20–30% of cases.{{Cite journal|last1=de Leon|first1=Jose|last2=Verghese|first2=Cherian|last3=Tracy|first3=Joseph I.|last4=Josiassen|first4=Richard C.|last5=Simpson|first5=George M.|title=Polydipsia and water intoxication in psychiatric patients: A review of the epidemiological literature|journal=Biological Psychiatry|volume=35|issue=6|pages=408–419|doi=10.1016/0006-3223(94)90008-6|pmid=8018788|year=1994|s2cid=21962668 }}
• Hypervolemia, leading to oedema, hypertension and weight gain (due to the kidneys being unable to filter the excess blood) in extreme episodes
• Tonic-clonic seizure{{Cite journal|last1=Hedges|first1=D.|last2=Jeppson|first2=K.|last3=Whitehead|first3=P.|title=Antipsychotic medication and seizures: A review|journal=Drugs of Today|volume=39|issue=7|pages=551–557|doi=10.1358/dot.2003.39.7.799445|pmid=12973403|year=2003}}
• Behavioural changes, including fluid-seeking behaviour; patients have been known to seek fluids from any available source, such as toilets and shower rooms.{{Cite journal|last1=Perch|first1=Julia|last2=O'Connor|first2=Kevin M.|title=Insatiable thirst: Managing polydipsia|url=http://www.mdedge.com/currentpsychiatry/article/63646/insatiable-thirst-managing-polydipsia#bib2|journal=Current Psychiatry|volume=8|issue=7|page=82}}

The most common presenting symptom is tonic-clonic seizure, found in 80% of patients.{{Cite journal|last=Ferrier|first=I N|date=1985-12-07|title=Water intoxication in patients with psychiatric illness.|journal=British Medical Journal (Clinical Research Ed.)|volume=291|issue=6509|pages=1594–1596|issn=0267-0623|pmc=1418423|pmid=3935199|doi=10.1136/bmj.291.6509.1594}} Psychogenic polydipsia should be considered a life-threatening condition, since it has been known to cause severe hyponatraemia, leading to cardiac arrest, coma and cerebral oedema.

File:Brain lobes - insular lobe.png, a structure implicated in PPD]]

Psychogenic polydipsia in individuals with schizophrenia is associated with differences seen in neuroimaging. MRI scans may be used to help with differentiating between PPD and diabetes insipidus, such as by examining the signal of the posterior pituitary (weakened or absent in central DI).{{Cite journal|last1=Moses|first1=A. M.|last2=Clayton|first2=B.|last3=Hochhauser|first3=L.|date=1992-09-01|title=Use of T1-weighted MR imaging to differentiate between primary polydipsia and central diabetes insipidus.|url=http://www.ajnr.org/content/13/5/1273|journal=American Journal of Neuroradiology|language=en|volume=13|issue=5|pages=1273–1277|issn=0195-6108|pmid=1414815|pmc=8335229 }} Some patients, most often with a history of mental illness, show a shrunken cortex and enlarged ventricles on an MRI scan, which makes differentiation between psychogenic and physiological cause difficult.{{Cite web|url=http://www.apadivisions.org/division-31/publications/articles/british-columbia/psychogenic-polydipsia.pdf|title=Psychogenic Polydipsia (Excessive Fluid seeking Behaviour)|last=Hutcheon|first=Donald|website=American Psychological Society Divisions|access-date=29 October 2016}} However, these changes will likely only develop after chronic PPD associated with severe mental illness, as opposed to less severe forms of the disorder as seen in those with anxiety and affective disorders. PPD is also linked with significant reductions in insular cortex volume,{{Cite journal|last1=Nagashima|first1=Tomohisa|last2=Inoue|first2=Makoto|last3=Kitamura|first3=Soichiro|last4=Kiuchi|first4=Kuniaki|last5=Kosaka|first5=Jun|last6=Okada|first6=Koji|last7=Kishimoto|first7=Naoko|last8=Taoka|first8=Toshiaki|last9=Kichikawa|first9=Kimihiko|date=2012-01-01|title=Brain structural changes and neuropsychological impairments in male polydipsic schizophrenia|journal=BMC Psychiatry|volume=12|page=210|doi=10.1186/1471-244X-12-210|issn=1471-244X|pmc=3532364|pmid=23181904 |doi-access=free }} although this may be caused by the secondary hyponatraemia. It has been suggested that these deficits lead to moderate to severe cognitive impairments, especially affecting working memory, verbal memory, executive function, attention and motor speed.{{Cite news|url=http://www.news-medical.net/news/20121128/Polydipsia-linked-to-brain-alterations-in-schizophrenia.aspx|title=Polydipsia linked to brain alterations in schizophrenia|date=2012-11-28|newspaper=News-Medical.net|access-date=2016-12-08}}

Other areas with volume reductions (both white and grey matter) include:

• Right posterior lobe
• Right inferior temporal gyrus
• Parahippocampal gyrus
• Both left and right superior temporal gyri
• Right cuneus
• Left medial frontal gyryus and inferior frontal gyrus
• Right lingual gyrus

As a diagnosis of exclusion, a diagnosis of primary polydipsia may be the result of elimination of the possibility of diseases causing similar signs and symptoms, such as diabetes insipidus.{{Cite web |title=Psychogenic polydipsia - Diagnosis - Approach |url=https://bestpractice.bmj.com/topics/en-gb/865 |access-date=2024-06-25 |website=British Medical Journal Best Practice}}

Diagnosis may be complicated by the fact that chronic and extreme compulsive drinking may impair the response of the kidneys to vasopressin, thus reducing the kidney's ability to concentrate the urine.{{Cite web|url=http://www.gpnotebook.co.uk/simplepage.cfm?ID=-2087059408|title=Primary polydipsia – General Practice Notebook|website=GPnotebook|access-date=29 October 2016}} This means that psychogenic polydipsia may lead to test results (e.g. in a water restriction test) consistent with diabetes insipidus or SIADH, leading to misdiagnosis.{{Cite journal|last1=Zerbe|first1=R. L.|last2=Robertson|first2=G. L.|date=1981-12-24|title=A comparison of plasma vasopressin measurements with a standard indirect test in the differential diagnosis of polyuria|journal=The New England Journal of Medicine|volume=305|issue=26|pages=1539–1546|doi=10.1056/NEJM198112243052601|issn=0028-4793|pmid=7311993}}

Dry mouth is often a side effect of medications used in the treatment of some mental disorders, rather than being caused by the underlying condition.{{cite book|title=Irwin and Rippe's Intensive care medicine|publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins|year=2008|isbn=978-0-7817-9153-3|location=Philadelphia|page=909|author1=Rippe, James M.|author2=Irwin, Richard S.}} Such medications include antipsychotics, antidepressants, anticonvulsants, alpha agonists and anticholinergics.{{Cite journal|title=Psychotropic-induced dry mouth: Don't overlook this potentially serious side effect|url=http://www.mdedge.com/currentpsychiatry/article/64550/depression/psychotropic-induced-dry-mouth-dont-overlook-potentially|journal=Current Psychiatry|date=December 2011|volume=10|issue=12|pages=54–58}} It should also be ensured that the thirst isn't caused by diuretic use (particularly thiazide diuretics), MDMA use, excessive solute intake or chronic alcoholism. Alcoholism may cause physiological thirst since ethanol inhibits vasopressin, the hormone primarily responsible for water retention in osmoregulation.{{Cite journal|last1=Swift|first1=R.|last2=Davidson|first2=D.|date=1998-01-01|title=Alcohol hangover: mechanisms and mediators|journal=Alcohol Health and Research World|volume=22|issue=1|pages=54–60|issn=0090-838X|pmid=15706734|pmc=6761819}}{{Cite journal|last1=Taivainen|first1=H.|last2=Laitinen|first2=K.|last3=Tähtelä|first3=R.|last4=Kilanmaa|first4=K.|last5=Välimäki|first5=M. J.|date=1995-06-01|title=Role of plasma vasopressin in changes of water balance accompanying acute alcohol intoxication|journal=Alcoholism: Clinical and Experimental Research|volume=19|issue=3|pages=759–762|issn=0145-6008|pmid=7573805|doi=10.1111/j.1530-0277.1995.tb01579.x}}{{Cite journal|last1=Fichman|first1=M. P.|last2=Kleeman|first2=C. R.|last3=Bethune|first3=J. E.|date=January 1970|title=Inhibition of Antidiuretic Hormone Secretion by Diphenylhydantoin|journal=Archives of Neurology|language=en|volume=22|issue=1|pages=45–53|doi=10.1001/archneur.1970.00480190049008|pmid=5409600|issn=0003-9942}} The following conditions should also be excluded: DI, cerebral salt wasting, pseudohyponatraemia caused by hyperlipidemia or hyperparaproteinemia, SIADH, mineralcorticoid deficiency, salt-wasting nephropathy, nephrotic syndrome, chronic heart failure and cirrhosis.{{Cite journal|url=http://bestpractice.bmj.com/best-practice/monograph/865/diagnosis/differential.html|title=Psychogenic polydipsia – Diagnosis – Differential diagnosis|date=5 May 2016|journal=British Medical Journal|access-date=29 October 2016|url-access=limited}}

Tobacco smoking is an often overlooked factor linked to hyponatremia, due to the ADH-releasing effect of nicotine, although this is usually limited to heavy smokers.{{Cite journal|last=Blum|first=Alexander|date=1984-11-23|title=The Possible Role of Tobacco Cigarette Smoking in Hyponatremia of Long-term Psychiatric Patients|journal=JAMA: The Journal of the American Medical Association|volume=252|issue=20|pages=2864–2865 |doi=10.1001/jama.1984.03350200050022|pmid=6492367 |issn=0098-7484}} One study suggested that around 70% of patients with self-induced polydipsia were tobacco smokers.{{Cite journal|last1=Jose|first1=C. J.|last2=Evenson|first2=R. C.|date=1980-08-01|title=Antecedents of self-induced water intoxication. A preliminary report|journal=The Journal of Nervous and Mental Disease|volume=168|issue=8|pages=498–500|issn=0022-3018|pmid=7400803|doi=10.1097/00005053-198008000-00009}} Diagnostic tests for primary polydipsia usually involves the fluid deprivation test to exclude ADH problems. The desmopressin test is also used, in which the synthetic hormone is used as a diagnostic workup to test for inappropriate secretion of vasopressin, as seen in DI and SIADH.

Psychogenic polydipsia is found in patients with mental illnesses, most commonly schizophrenia, but also anxiety disorders and rarely affective disorders, anorexia nervosa and personality disorders. PPD occurs in between 6% and 20% of psychiatric inpatients.{{Cite journal|last=de Leon|first=Jose|date=2003-02-01|title=Polydipsia—a study in a long-term psychiatric unit|journal=European Archives of Psychiatry and Clinical Neuroscience|volume=253|issue=1|pages=37–39|doi=10.1007/s00406-003-0403-z|issn=0940-1334|pmid=12664312}} It may also be found in people with developmental disorders, such as those with autism.{{Cite journal|url=http://bestpractice.bmj.com/best-practice/monograph/865/basics/aetiology.html|title=Psychogenic polydipsia – Theory – Aetiology|date=5 May 2016|journal=British Medical Journal|access-date=29 October 2016|url-access=limited}} While psychogenic polydipsia is usually not seen outside the population of those with serious mental disorders, it may occasionally be found among others in the absence of psychosis, although there is no existent research to document this other than anecdotal observations. Such persons typically prefer to possess bottled water that is ice-cold, consume water and other fluids at excessive levels.{{Cite journal |last1=Nauwynck |first1=Elise |last2=Van De Maele |first2=Karolien |last3=Vanbesien |first3=Jesse |last4=Staels |first4=Willem |last5=De Schepper |first5=Jean |last6=Gies |first6=Inge |date=April 2021 |title=Psychogenic polydipsia in a female adolescent without a psychiatric background: A case report |journal=Clinical Case Reports |language=en |volume=9 |issue=4 |pages=1937–1942 |doi=10.1002/ccr3.3910 |issn=2050-0904 |pmc=8077289 |pmid=33936619}} However, a preference for ice-cold water is also seen in diabetes insipidus.{{Cite book|title=Mayo Clinic internal medicine board review.|date=2010|publisher=Mayo Clinic Scientific Press|others=Ghosh, Amit., Mayo Foundation for Medical Education and Research., Mayo Clinic.|isbn=9780199755691|edition=9th|location=[Rochester, MN.]|pages=192|oclc=646395464}}{{Cite book|title=Assessment (Lippincott Manual Handbook)|publisher=Springhouse Publishing Co|year=2006|isbn=978-1582559391|pages=189}}

Treatment for psychogenic polydipsia depends on severity and may involve behavioural and pharmacological modalities.{{Cite journal|last1=Dundas|first1=Brian|last2=Harris|first2=Melissa|last3=Narasimhan|first3=Meera|date=2007-07-03|title=Psychogenic polydipsia review: Etiology, differential, and treatment|journal=Current Psychiatry Reports|language=en|volume=9|issue=3|pages=236–241|doi=10.1007/s11920-007-0025-7|pmid=17521521|s2cid=27207760 |issn=1523-3812}}

If the patient presents with acute hyponatraemia (low sodium levels due to overhydration) caused by psychogenic polydipsia, treatment usually involves administration of intravenous hypertonic (3%) saline until the serum sodium levels stabilise to within a normal range, even if the patient becomes asymptomatic.{{Cite journal |date= |title=Psychogenic polydipsia – Management |url=https://bestpractice.bmj.com/topics/en-gb/865 |journal=British Medical Journal Best Practice |url-access=limited |access-date=2024-06-25}}

If the patient is institutionalised, monitoring of behaviour and serum sodium levels is necessary. In treatment-resistant polydipsic psychiatric patients, regulation in the inpatient setting can be accomplished by use of a weight-water protocol.{{Cite journal|last1=Bowen|first1=L.|last2=Glynn|first2=S. M.|last3=Marshall|first3=B. D.|last4=Kurth|first4=C. L.|last5=Hayden|first5=J. L.|date=1990-03-01|title=Successful behavioral treatment of polydipsia in a schizophrenic patient|journal=Journal of Behavior Therapy and Experimental Psychiatry|volume=21|issue=1|pages=53–61|issn=0005-7916|pmid=2373769|doi=10.1016/0005-7916(90)90049-q}}{{subscription required}} First, base-line weights must be established and correlated to serum sodium levels. Weight will normally fluctuate during the day, but as the water intake of the polydipsic goes up, the weight will naturally rise. The physician can order a stepped series of interventions as the weight rises. The correlation must be individualized with attention paid to the patient's normal weight and fluctuations, diet, comorbid disorders (such as a seizure disorder) and urinary system functioning. Progressive steps might include redirection, room restriction, and increasing levels of physical restraint with monitoring. Such plans should also include progressive increases in monitoring, as well as a level at which a serum sodium level is drawn.{{cn|date=January 2025}}

Behavioural treatments may involve the use of a token economy to provide positive reinforcement to desirable behaviour. Furthermore, cognitive therapy techniques can be used to address the thought patterns that lead to compulsive drinking behaviour. Success has been seen in trials of this technique, with emphasis on the development of coping techniques (e.g. taking small sips of water, having ice cubes instead of drinks) in addition to challenging delusions leading to excessive drinking.{{Cite journal|last1=Costanzo|first1=Erin S.|last2=Antes|first2=Lisa M.|last3=Christensen|first3=Alan J.|date=2016-11-01|title=Behavioral and medical treatment of chronic polydipsia in a patient with schizophrenia and diabetes insipidus|journal=Psychosomatic Medicine|volume=66|issue=2|pages=283–286|issn=1534-7796|pmid=15039516|doi=10.1097/01.psy.0000116717.42624.68|s2cid=26038672 }}{{subscription required}}{{Cite journal |last1=Bowen |first1=Linda |last2=Glynn |first2=Shirley M. |last3=Marshall |first3=Barringer D. |last4=Kurth |first4=C.Lisa |last5=Hayden |first5=Jeffery L. |date=March 1990 |title=Successful behavioral treatment of polydipsia in a schizophrenic patient |url=https://linkinghub.elsevier.com/retrieve/pii/000579169090049Q |journal=Journal of Behavior Therapy and Experimental Psychiatry |language=en |volume=21 |issue=1 |pages=53–61 |doi=10.1016/0005-7916(90)90049-Q|pmid=2373769 |url-access=subscription }}

Psychogenic polydipsia often leads to institutionalisation of mentally ill patients, since it is difficult to manage in the community. Most studies of behavioural treatments occur in institutional settings and require close monitoring of the patient and a large degree of time commitment from staff.

File:Risperdal tablets.jpg

A number of pharmaceuticals may be used in an attempt to bring the polydipsia under control, including:

• Atypical antipsychotics, such as clozapine,{{Cite journal|last1=Lee|first1=H. S.|last2=Kwon|first2=K. Y.|last3=Alphs|first3=L. D.|last4=Meltzer|first4=H. Y.|date=1991-06-01|title=Effect of clozapine on psychogenic polydipsia in chronic schizophrenia|journal=Journal of Clinical Psychopharmacology|volume=11|issue=3|pages=222–223|issn=0271-0749|pmid=2066464|doi=10.1097/00004714-199106000-00022}} olanzapine and risperidone{{Cite journal|last1=Kruse|first1=D.|last2=Pantelis|first2=C.|last3=Rudd|first3=R.|last4=Quek|first4=J.|last5=Herbert|first5=P.|last6=McKinley|first6=M.|date=2001-02-01|title=Treatment of psychogenic polydipsia: comparison of risperidone and olanzapine, and the effects of an adjunctive angiotensin-II receptor blocking drug (irbesartan)|journal=The Australian and New Zealand Journal of Psychiatry|volume=35|issue=1|pages=65–68|issn=0004-8674|pmid=11270459|doi=10.1046/j.1440-1614.2001.00847.x|s2cid=13168153 }}{{subscription required}}
• Demeclocycline, a tetracycline antibiotic, which is effective due to the side effect of inducing nephrogenic diabetes insipidus.{{Cite journal|url=http://www.aafp.org/afp/2004/0515/p2387.html|title=Management of Hyponatremia – American Family Physician|issue=10|pages=2387–2394|last=Goh|first=Kian Peng|journal=American Family Physician|volume=69|access-date=2016-10-29|date=2004-05-15}} Demeclocycline is used for cases of psychogenic polydipsia, including those with nocturnal enuresis (bed-wetting). Its mechanism of action involves direct inhibition of vasopressin at the DCTs, thus reducing urine concentration.

There are a number of emerging pharmaceutical treatments for psychogenic polydipsia, although these need further investigation:

• ACE Inhibitors, such as enalapril{{Cite journal|last1=Greendyke|first1=Robert M.|last2=Bernhardt|first2=Alan J.|last3=Tasbas|first3=Hedy E.|last4=Lewandowski|first4=Kathleen S.|date=1998-04-01|title=Polydipsia in Chronic Psychiatric Patients: Therapeutic Trials of Clonidine and Enalapril|journal=Neuropsychopharmacology|language=en|volume=18|issue=4|pages=272–281|doi=10.1016/S0893-133X(97)00159-0|issn=0893-133X|pmid=9509495|doi-access=free}}
• Clonidine, an alpha-2 adrenergic agonist
• Irbesartan, an angiotensin II receptor antagonist
• Propranolol, a sympatholytic beta blocker{{Cite journal|last1=Shevitz|first1=S. A.|last2=Jameison|first2=R. C.|last3=Petrie|first3=W. M.|last4=Crook|first4=J. E.|date=1980-04-01|title=Compulsive water drinking treated with high dose propranolol|journal=The Journal of Nervous and Mental Disease|volume=168|issue=4|pages=246–248|issn=0022-3018|pmid=7365485|doi=10.1097/00005053-198004000-00011}}
• Vasopressin receptor antagonists, such as conivaptan{{Cite journal|last=Douglas|first=Ivor|date=2006-09-01|title=Hyponatremia: why it matters, how it presents, how we can manage it|journal=Cleveland Clinic Journal of Medicine|volume=73|issue=Suppl 3 |pages=S4–12|issn=0891-1150|pmid=16970147|doi=10.3949/ccjm.73.suppl_3.s4|s2cid=20582060 }}
• Acetazolamide, a carbonic anhydrase inhibitor{{Cite journal|last1=Takagi|first1=Shunsuke|last2=Watanabe|first2=Yutaka|last3=Imaoka|first3=Takefumi|last4=Sakata|first4=Masuhiro|last5=Watanabe|first5=Masako|date=2017-02-01|title=Treatment of psychogenic polydipsia with acetazolamide: a report of 5 cases|journal=Clinical Neuropharmacology|volume=34|issue=1|pages=5–7|doi=10.1097/WNF.0b013e318205070b|issn=1537-162X|pmid=21242740|s2cid=19814264 }}{{subscription required}}

Lithium was previously used for treatment of PPD as a direct competitive ADH antagonist, but is now generally avoided due to its toxic effects on the thyroid and kidneys.

It is important to note that the majority of psychotropic drugs (and a good many of other classes) can cause dry mouth as a side effect, but this is not to be confused with true polydipsia in which a dangerous drop in serum sodium will be seen.{{Cite journal|last1=Meulendijks|first1=Didier|last2=Mannesse|first2=Cyndie K.|last3=Jansen|first3=Paul A. F.|last4=van Marum|first4=Rob J.|last5=Egberts|first5=Toine C. G.|date=2010-02-01|title=Antipsychotic-induced hyponatraemia: a systematic review of the published evidence|journal=Drug Safety|volume=33|issue=2|pages=101–114|doi=10.2165/11319070-000000000-00000|issn=1179-1942|pmid=20082537|s2cid=207298266 }}{{subscription required}}

In diagnosis, primary polydipsia is usually categorised as:

• Psychogenic (PPD) – caused by underlying psychiatric symptoms, including those caused by psychoses and rarely by affective disorders
• Non-psychogenic – another non-psychological cause, including idiopathic (unknown cause)

The terms primary polydipsia and psychogenic polydipsia are sometimes incorrectly used interchangeably – to be considered psychogenic, the patient needs to have some other psychiatric symptoms, such as delusions involving fluid intake or other unusual behaviours. Primary polydipsia may have physiological causes, such as autoimmune hepatitis.

Since primary polydipsia is a diagnosis of exclusion, the diagnosis may be made for patients who have medically unexplained excessive thirst, and this is sometimes incorrectly referred to as psychogenic rather than primary polydipsia.

Although primary polydipsia is usually categorised as psychogenic, there are some rare non-psychogenic causes. An example is polydipsia found in patients with autoimmune chronic hepatitis with severely elevated globulin levels.{{cite journal|date=April 1988|title=Non-psychogenic primary polydipsia in autoimmune chronic active hepatitis with severe hyperglobulinaemia|journal=Gut|volume=29|issue=4|pages=548–9|doi=10.1136/gut.29.4.548|pmc=1433532|pmid=3371724|vauthors=Tobin MV, Morris AI}} Evidence for the thirst being non-psychogenic is gained from the fact that it disappears after treatment of the underlying disease.

Psychogenic polydipsia is also observed in some non-human patients, such as in rats and cats.{{Cite journal|last=Falk|first=John L.|date=1969-05-01|title=Conditions Producing Psychogenic Polydipsia in Animals*|journal=Annals of the New York Academy of Sciences|language=en|volume=157|issue=2|pages=569–593|doi=10.1111/j.1749-6632.1969.tb12908.x|pmid=5255630|issn=1749-6632|bibcode=1969NYASA.157..569F|s2cid=26615730 }}

• Water intoxication
• Fluid deprivation test

{{Reflist}}

• {{cite journal | pmid = 7726704 | volume=155 | issue=9 | title=Risk factors for the development of hyponatremia in psychiatric inpatients | date=May 1995 |vauthors=Siegler EL, Tamres D, Berlin JA, Allen-Taylor L, Strom BL | journal=Archives of Internal Medicine | pages=953–957 | doi=10.1001/archinte.1995.00430090099011}}
• {{cite journal | pmid = 12404683 | doi=10.1002/hup.407 | volume=17 | issue=5 | title=Efficacy of clozapine in a non-schizophrenic patient with psychogenic polydipsia and central pontine myelinolysis | date=July 2002 |vauthors=Mauri MC, Volonteri LS, Fiorentini A, Dieci M, Righini A, Vita A | journal=Human Psychopharmacology | pages=253–255| s2cid=21589725 }}

• [http://www.apadivisions.org/division-31/publications/articles/british-columbia/psychogenic-polydipsia.pdf Psychogenic Polydipsia (Excessive Fluid seeking Behaviour) by Donald "Don" Hutcheon on the APA's website]

{{Medical resources

| DiseasesDB = 10318

| ICD10 = {{ICD10|R|63|1|r|50}}

| ICD9 = {{ICD9|783.5}}

| MedlinePlus = 003085

| MeshID = D059607

}}

Category:Symptoms and signs of mental disorders

Category:Thirst

Category:symptoms of schizophrenia