64-Year-Old Male with Undifferentiated Schizophrenia, Lengthy Institutionalization, Water Imbalance

摘要

The prevailing view that mild to moderate chronic hyponatremia in psychotic individuals is essentially "asymptomatic" has resulted in poor management of this condition. Insufficient diagnostic tests are ordered and patients usually remain untreated. A small, but growing body of evidence suggests that the concept of "asymptomatic hyponatremia" is a misnomer. 8,19 Thus, the possibility of relieving subtle but important neurological and cognitive symptoms in the psychotic population by correcting even mild hyponatremia warrants consideration. Rapid recognition of the condition and optimal treatment with the new AVP-receptor antagonists 20 could have beneficial long-term consequences. Correcting serum [Na+] may reduce the risk of death and symptom severity, permit less intensive care, reduce the duration of hospitalizations and associated costs, increase success in treatment of underlying comorbid conditions, and improve quality of life. Most importantly, after 2 years of ongoing treatment with tolvaptan, the patient was deemed sufficiently clinically stable to be discharged into the community.