ABSTRACT
A behavioral observation scale (Virginia Polydipsia Scale; VPS) for monitoring drinking patterns was developed and its reliability tested during 25 hours of tandem ratings among six patients with the syndrome of psychosis, intermittent hyponatremia, and polydipsia (PIPS). These ratings were compared to those collected from a control group of six psychiatric inpatients who were similarly observed for 25 hours. The scale was subsequently used to assess day-long drinking in a single PIPS patient. Results demonstrated that the VPS can be reliably administered by trained raters and that it clearly differentiates the drinking patterns of PIPS patients from controls. In addition, our findings highlight associations among drinking behaviors, psychiatric functioning and low serum sodium concentration. On balance, these results support using observational measures of drinking behaviors in future studies of PIPS patients.
Subject(s)
Hyponatremia/diagnosis , Mental Disorders/diagnosis , Thirst , Adult , Behavior Therapy , Drinking Behavior , Humans , Hyponatremia/therapy , Male , Mental Disorders/therapy , Middle Aged , Psychiatric Status Rating ScalesABSTRACT
Findings of Baker, Beer, and Beer on use of the MacAndrew Scale in relating sensation seeking to alcoholism require comment. It is argued that the MacAndrew Scale does not provide interval level data below the cut-off score so correlations on such data should be point biserial.
Subject(s)
Alcoholism/psychology , Arousal , MMPI/statistics & numerical data , Sensation , Humans , PsychometricsSubject(s)
Commitment of Mentally Ill/legislation & jurisprudence , Mental Competency/legislation & jurisprudence , Commitment of Mentally Ill/standards , Commitment of Mentally Ill/statistics & numerical data , Female , Hospitalization/legislation & jurisprudence , Hospitalization/statistics & numerical data , Humans , Male , Patient Advocacy , Quality Assurance, Health Care/legislation & jurisprudence , United StatesABSTRACT
Diurnal weight gain was found to be abnormal among 44 of 77 institutionalized chronically psychotic patients. All patients were weighed and urine samples obtained weekly for 3 weeks at 7 A.M. and 4 P.M. Diurnal weight gain was normalized 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. Normalized diurnal weight gain (NDWG) was 2.504 +/- 1.266% for the 44 study patients with abnormal findings, .631 +/- .405% for the 16 acutely psychotic controls, and .511 +/- .351% for 29 normals. Urine excretion was related (r = .476, p = .001) to NDWG in the subgroup of study patients with abnormal NDWG, consistent with the observation that their fluid intake exceeded fluid excretion in the afternoon.
Subject(s)
Drinking/physiology , Psychotic Disorders/physiopathology , Water-Electrolyte Balance/physiology , Weight Gain/physiology , Adult , Circadian Rhythm/physiology , Female , Hospitalization , Humans , Hypothalamus/physiopathology , Male , Middle Aged , Psychotic Disorders/psychologyABSTRACT
1. Diurnal weight gain, afternoon hyponatremia, and polyuria were assessed for one year among eight male schizophrenics subject to water intoxication. 2. The authors normalized the diurnal 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. 3. NDWG ranged between 2.69 +/- .99 and 3.34 +/- 1.32 percent (F [3, 5] = .885, p = .509) during the four seasons of the year. 4. The seasonal decrease in afternoon serum sodium compared to its morning counterpart ranged between 4.23 +/- 1.96 and 6.14 +/- 2.82 mmol/l (F [3, 5] = 2.212, p = .205). 5. Seasonal polyuria ranged between 8.2 +/- 3.5 and 8.8 +/- 3.2 liters (F [3, 5] = .228, p = .873). 6. Among schizophrenics subject to water intoxication, the seasonal stability in our three parameters of water imbalance suggest they may be used to follow patients with altered water homeostasis over time. This finding has both clinical and research implications.
Subject(s)
Schizophrenia/physiopathology , Water Intoxication/physiopathology , Water-Electrolyte Balance , Adult , Blood Pressure , Circadian Rhythm , Humans , Male , Polyuria , Pulse , Schizophrenia/complications , Seasons , Sodium/blood , Water Intoxication/complications , Weight GainABSTRACT
We found diurnal weight gain to be abnormal among 41 institutionalized patients with manic-depressive spectrum disorders. They were weighed at 7 AM and 4 PM weekly for three weeks. We normalized the diurnal weight gain (NDWG) as a percentage by subtracting the 7 AM weight from the 4 PM weight, multiplying the difference by 100, and then dividing the result by the 7 AM weight. NDWG was 2.216 +/- 1.513 percent for the study population, .631 +/- .405 percent for 16 young, newly admitted controls, and .511 +/- .351 percent for 29 normals. Abnormal NDWG may be an additional feature of manic-depressive spectrum disorders.
Subject(s)
Bipolar Disorder/physiopathology , Body Weight , Circadian Rhythm/physiology , Adult , Bipolar Disorder/drug therapy , Blood Pressure , Chlorpromazine/therapeutic use , Female , Humans , MaleABSTRACT
We found abnormal diurnal weight gain among 25% of acutely psychotic patients with schizophrenia and 68% of chronically psychotic patients with schizophrenia. They were weighed at 7:00 AM and 4:00 PM weekly for 3 weeks. We normalized the diurnal weight gain (NDWG) as a percentage by subtracting the 7:00 AM weight from the 4:00 PM weight, multiplying the difference by 100, and dividing the result by the 7:00 AM weight, NDWG was 0.93% +/- 0.89% for the 36 acutely psychotic patients and 2.2% +/- 1.5% for the 68 chronically psychotic patients (F = 25.297, p less than 0.0001). Drugs did not explain this difference. Our data, though preliminary, suggest that water dysregulation, as manifested by abnormal diurnal weight gain, develops in schizophrenia as patients progress into Arieti's third stage of this disorder. A longitudinal study design, rather than our cross-sectional one, would be necessary to assess developmental changes in schizophrenia.
Subject(s)
Schizophrenia/physiopathology , Schizophrenic Psychology , Water Intoxication/physiopathology , Water-Electrolyte Balance/physiology , Adult , Chronic Disease , Circadian Rhythm/physiology , Humans , Male , Psychiatric Department, Hospital , Weight Gain/physiologyABSTRACT
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.
Subject(s)
Circadian Rhythm , Schizophrenia/physiopathology , Schizophrenic Psychology , Urodynamics , Water Intoxication/physiopathology , Weight Gain , Adult , Chronic Disease , Drinking , Female , Humans , Male , Middle Aged , Pituitary Gland, Posterior/physiopathology , Polyuria/physiopathology , Reference Values , Risk FactorsABSTRACT
We studied 20 geriatric and 87 nongeriatric chronically psychotic male inpatients, 16 acutely psychotic male control subjects, and 14 male normal subjects. The subjects were weighed at 7 a.m. and 4 p.m. weekly for 3 weeks. We normalized the diurnal weight gain (NDWG) as a percentage by subtracting the 7 a.m. weight from 4 p.m. weight, multiplying the difference by 100, and then dividing the result by the 7 a.m. weight. NDWG was .509% +/- .337%, 2.209% +/- 1.529%, .631% +/- .405%, and .533% +/- .410%, among the geriatric men, nongeriatric men, control subjects, and normal subjects respectively. Differences in diagnoses and drugs did not explain these findings. We hypothesize that abnormal diurnal weight gain may be a risk factor for premature death among chronically psychotic inpatients.
Subject(s)
Psychotic Disorders/physiopathology , Weight Gain , Adult , Aged , Antipsychotic Agents/administration & dosage , Blood Pressure , Carbamazepine/administration & dosage , Chronic Disease , Circadian Rhythm , Humans , Lithium/administration & dosage , Male , Pulse , Risk Factors , Water Intoxication/physiopathologyABSTRACT
We compared the diurnal weight gain of 46 patients with mental retardation to that of 21 patients with organic mental syndromes. They were weighed at 7 a.m. and 4 p.m. weekly for 3 weeks. We normalized the diurnal weight gain as a percentage by subtracting the 7 a.m. weight from the 4 p.m. weight, multiplying the difference by 100, and dividing the result by the 7 a.m. weight. Normalized diurnal weight gain was abnormal among one fourth of patients with mental retardation and two thirds of those with organic mental syndromes. Differences in age, sex, baseline weight, antipsychotic drugs, lithium, carbamazepine, blood pressure, and pulse did not explain our results. We believe that our findings provide additional evidence to separate patients with mental retardation from those with psychosis.
Subject(s)
Circadian Rhythm , Intellectual Disability/physiopathology , Weight Gain , Adult , Blood Pressure , Female , Humans , Male , Middle Aged , Sodium Chloride/blood , Water Intoxication/therapy , Weight Gain/drug effectsABSTRACT
We found diurnal weight gain to be abnormal among 28 institutionalized chronically psychotic patients. They were weighed daily for 15 days at 7 a.m. and 4 p.m. We normalized the diurnal 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 2.8 +/- 1.3% for the 28 study patients, 0.631 +/- 0.405% for 16 acutely psychotic controls, and 0.511 +/- 0.351% for 29 normals. Ninety-three per cent of the study sample had NDWG values above the upper limit of normal. Sex, diagnosis, smoking, baseline weight, blood pressure, and pulse did not explain these observations. NDWG related (N = 28, r = 0.552, P = 0.002) to antipsychotic drug dose. The implications of our findings are discussed.
Subject(s)
Circadian Rhythm , Psychotic Disorders/physiopathology , Weight Gain , Adult , Affective Disorders, Psychotic/physiopathology , Blood Pressure/drug effects , Chlorpromazine/therapeutic use , Circadian Rhythm/drug effects , Drinking Behavior/physiology , Female , Humans , Male , Neurocognitive Disorders/physiopathology , Personality Disorders/physiopathology , Schizophrenia/physiopathology , Smoking/physiopathology , Water-Electrolyte Balance/drug effects , Weight Gain/drug effectsABSTRACT
We found diurnal weight gain to be abnormal among 93 chronically psychotic patients, most of whom had schizophrenia. They were weighed at 7 a.m. and 4 p.m. weekly for 3 weeks. We normalized the diurnal 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 dividing the result by the 7 a.m. weight. NDWG was 1.7 +/- 1.0 percent for the study sample, 0.6 +/- 0.4 percent for 16 acutely psychotic controls, and 0.5 +/- 0.4 percent for 29 normals. More than 60 percent of the study sample had abnormal NDWG values. NDWG related to antipsychotic drug dose (r = 0.290, p = 0.005) with variability in drug dose accounting for 8 percent of the variability in NDWG. This report provides yet another piece of evidence that disordered water balance is common in chronic psychiatric patients. The etiology is unknown, but it may relate to subtle brain abnormalities in the regulation of fluid intake and excretion.
Subject(s)
Circadian Rhythm , Psychotic Disorders/physiopathology , Water-Electrolyte Imbalance/complications , Weight Gain , Adult , Antipsychotic Agents/pharmacology , Chronic Disease , Female , Humans , Male , Middle Aged , Psychotic Disorders/complications , Weight Gain/drug effectsABSTRACT
1. The diurnal weight gain was found to be abnormal among 129 chronically psychotic inpatients. 2. The patients were weighed at 7 a.m. and 4 p.m. weekly for three weeks. We normalized the diurnal 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. 3. NDWG was 2.2 +/- 1.5 percent for 87 male patients compared (p less than .0001) with .53 +/- .41 for 14 male controls. 4. NDWG was 1.8 +/- 1.0 percent for 42 female patients compared (p less than .0001) with .49 +/- .30 for 15 female controls. 5. Seventy percent of male and female patients had NDWG values greater than two standard deviations above the mean values of controls. 6. Differences in age, sex, morning weight, antipsychotic drugs, lithium, carbamazepine, phenytoin, blood pressure, and pulse did not explain these findings.
Subject(s)
Antipsychotic Agents/adverse effects , Body Weight/drug effects , Psychotic Disorders/complications , Adult , Age Factors , Antipsychotic Agents/administration & dosage , Blood Pressure/drug effects , Chlorpromazine/administration & dosage , Chlorpromazine/adverse effects , Chronic Disease , Circadian Rhythm , Female , Humans , Inpatients , Male , Middle Aged , Mood Disorders/complications , Neurocognitive Disorders/complications , Pulse , Schizophrenia/complications , Sex FactorsABSTRACT
Ten male patients (mean age 37.3 +/- 6.4 years) with psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome) underwent measurement of weight, sitting and standing blood pressure, and serum sodium concentration at 7 a.m. and 4 p.m. weekly for 8 consecutive weeks. Blood pressure was higher in the afternoon than in the morning. The diurnal decrease in serum sodium (141.4 +/- 2.8 to 134.2 +/- 4.8 mEq/l) was associated with a diurnal increase in weight (78.4 +/- 9.7 to 80.0 +/- 10.3 kg). When the weight increase was normalized by dividing by 7 a.m. weight (NDWG), the following relationship evolved: diurnal serum sodium decrease = 3.060 + [201.728 x NDWG]. Therefore, NDWG accounted for 63.1% of the variability of serum sodium. Using the known relationship of plasma water, total body water, and total body weight, we calculated that antidiuresis (afternoon weight gain) accounted for 62.5% of afternoon hyponatremia. Thus, two separate methods of calculating the relationship between antidiuresis and hyponatremia provided remarkably similar findings. We derived a table to predict 4 p.m. serum sodium values based on 7 a.m. weight, 7 a.m. serum sodium, and 4 p.m. weight.
Subject(s)
Circadian Rhythm , Drinking , Hyponatremia/psychology , Psychotic Disorders/psychology , Sodium/blood , Weight Gain , Adult , Bipolar Disorder/psychology , Humans , Hyponatremia/blood , Male , Psychotic Disorders/blood , Schizophrenic Psychology , SyndromeABSTRACT
We evaluated diurnal weight gain and polyuria among 31 institutionalized chronically psychotic patients receiving lithium and 42 controls not receiving this drug. The patients were weighed weekly for three weeks at 7 a.m. and 4 p.m. We normalized the diurnal 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. Polyuria was assessed using mean urine creatinine concentration (MUCR). NDWG was abnormal among study patients (1.9 +/- 1.2%) and controls (1.6 +/- 1.5%) independent of lithium treatment. The variation in MUCR explained about 20% of the variation in NDWG in both groups.
Subject(s)
Bipolar Disorder/drug therapy , Lithium/adverse effects , Polyuria/chemically induced , Psychotic Disorders/drug therapy , Weight Gain/drug effects , Adult , Chronic Disease , Female , Humans , Lithium/therapeutic use , Male , Neurocognitive Disorders/drug therapy , Schizophrenia/drug therapyABSTRACT
We report inappropriate antidiuresis as manifested by abnormal diurnal weight gain among 29 male and female chronically psychotic patients compared to a control population. Abnormal diurnal weight gain may be a new metabolic marker for chronically psychotic patients.
Subject(s)
Bipolar Disorder/physiopathology , Circadian Rhythm , Psychotic Disorders/physiopathology , Schizophrenia/physiopathology , Weight Gain , Adult , Blood Pressure , Brain/physiopathology , Female , Humans , Inappropriate ADH Syndrome/physiopathology , Male , Middle AgedABSTRACT
From a study population of 29 institutionalized chronically psychotic patients, 70% of whom had schizophrenic or schizoaffective disorders, nonpolyuric and polyuric patients had similar diurnal patterns of urine excretion. Patients excreted a larger portion of daily urine volume after noon (55%) than before noon (45%).
Subject(s)
Psychotic Disorders/urine , Schizophrenia/urine , Adult , Chronic Disease , Female , Humans , Male , Middle Aged , UrodynamicsABSTRACT
Clinical and demographic data were collected on 203 state mental hospital patients whose length of stay was greater than one year. They comprised 45% of the average adult census and 37% were less than 35 years old. Males were younger and females more educated and likely to have been married at one time. The majority have diagnoses of schizophrenia or organic mental disorders; a few have personality disorders. Patients were treated with drugs but risk/benefit parameters remain to be defined. Thirty-two percent of patients have had a violent episode during the past six months. The prevalence of neurological abnormalities supports the need for specialized neurological and neuropsychological consultation and medical consultation. Most patients require the level of care provided by a hospital, while 15% are ready for discharge but have no housing available. Intermediate care facilities could provide alternatives for some patients otherwise unable to leave the hospital. The implications raised by these findings are discussed.
