Treatment of psychogenic polydipsia with electroconvulsive therapy (ECT)- A case report

Psychogenic polydipsia (PPD) is a condition characterized by excessive water intake that is not related to a physiological need. It is often seen in patients with schizophrenia and schizoaffective disorders and can lead to hyponatremia, a serious condition characterized by low sodium levels in the blood. This report summarizes the case of a 74-year-old male who had a longstanding history of schizoaffective disorder, bipolar type. At admission to the geriatric unit of a psychiatric hospital, the patient engaged in excessive drinking behavior and his serum sodium level was low (126 mmol/L). The patient required urgent treatment, however had a history of ineffective medication trials (including clozapine), and poor medication adherence. As such, the patient's family member who was the substitute decision maker consented to electroconvulsive therapy (ECT). Upon beginning ECT, there was noted improvement in PPD symptoms with regards to water seeking and eventually improved oral compliance for mediations. The patient completed 25 sessions of ECT and was discharged three months after admission. Significant improvements were also noted in symptoms of psychosis between admission and discharge. Overall, this case report offers ECT as a potential treatment modality for geriatric patients presenting with symptoms of PPD with psychosis.