Atrial Fibrillation due to Psychogenic Polydipsia in Schizophrenia: A case report

Abstract

Psychogenic polydipsia (PP) is characterized by excessive water consume that is not related with physiological thirsting. PP can cause serious medical complications. PP is mostly accompanied with schizoprenia. Hypokalemia, hyponatremia and hypocalcemia may occur due to excessive water consume and polyuria. Electrolyte imbalances, such as hypokalemia, hyponatremia and hypocalcemia, may occur due to excessive water intake and polyuria. Hyponatremia can cause confusion, convulsions and coma in the central nervous system, whereas hypokalemia can cause QT prolongation, supraventricular or ventricular ectopic beats, supraventricular and life-threatening ventricular arrhythmias. In this case, it is aimed to discuss in the light of the literature of a schizophrenic patient with acute AF who admitted to the emergency department with confusion related to psychogenic polydipsia.

Keywords

• Atrial fibrillation
• psychogenic polydipsia
• schizophrenia

Şizofrenide Psikojenik Polidipsiye Bağlı Gelişen Atrial Fibrilasyon: Bir Olgu Sunumu

Öz

Psikojenik polidipsi (PP), fizyolojik olan susama hissinden bağımsız olarak aşırı su alımıyla karakterizedir. PP ciddi tıbbi komplikasyonlara sebep olabilir. PP, sıklıkla şizofreni hastalarında görülür. Aşırı su alımına ve poliüriye bağlı olarak hipokalemi, hiponatremi ve hipokalsemi gibi elektrolit dengesizlikleri oluşabilir. Hiponatremi merkezi sinir sisteminde konfüzyon, konvülziyon, komaya neden olabilirken, hipokalemi QT uzaması, supraventriküler veya ventriküler ektopik atımlar, supraventriküler ve hayatı tehdit eden ventriküler aritmilere neden olabilir. Bu olguda psikojenik polidipsiye bağlı konfüzyon ile acil servise başvuran ve daha sonra atriyal fibrilasyonla takip edilen şizofreni hastasının literatür bilgileri ışığında tartışılması amaçlanmıştır.

Anahtar Kelimeler

• atriyal fibrilasyon
• psikojenik polidipsi
• şizofreni

Kaynakça

1. Spanevello C, Banava E, Gachoud D, Berney A, Tzartzas K, Maccaferri GE. Psychogenic polydipsia: a (still) unknown psychosomatic entity. Rev Med Suisse. 2020;16(681):318-321.
2. Perestrelo J, Teixeira B. Psychogenic polydipsia and hyponatremia–A side effect of psychosis: a review with a case report. J Bras Psiquiatr. 2016;65(3):300-303. doi: 10.1590/0047- 2085000000135
3. Sailer CO, Winzeler B, Christ-Crain M. Primary polydipsia in the medical and psychiatric patient: characteristics, complications and therapy. Swiss Med Wkly. 2017;147:w14514. doi: 10.4414/smw.2017.14514
4. Andrade J, Khairy P, Dobrev D, ve ark. The clinical profile and pathophysiology of atrial fibrillation: relationships among clinical features, epidemiology, and mechanisms. Circ Res. 2014;114(9):1453-1468.
5. Weiss JN, Qu Z, Shivkumar K. Electrophysiology of hypokalemia and hyperkalemia. Circ Arrhythm Electrophysiol. 2017;10 (3):e004667.a. doi: 10.1161/CIRCEP.116.004667
6. Kirino S, Sakuma M, Misawa F, ve ark. Relationship between polydipsia and antipsychotics: a systematic review of clinical studies and case reports. Prog Neuropsychopharmacol Biol Psychiatry. 2020;96:109756. doi: 10.1016/ j.pnpbp.2019.109756
7. Yıldız G, Kayataş M, Candan F. Hyponatremia; current diagnosis and treatment. Turk Neph Dial Transpl. 2011;20(2):115-131. doi: 10.5262/tndt.2011.1002.02
8. Tazmini K, Frisk M, Lewalle A, ve ark. Hypokalemia Promotes Arrhythmia by Distinct Mechanisms in Atrial and Ventricular Myocytes. Circ Res 2020;126(7):889-906. doi: 10.1161/CIRCRESAHA.119.315641