Abstract
SummaryIn the literature, several cases of an association between hyponatremia and psychotic symptoms have been reported. We present the case of a young Caucasian male presenting with rapid, incoherent speech, religious and megalomanic delusions, and emotional lability. The patient was described by his relatives as being healthy until a few days before admission. He had no significant medical or psychiatric history, except a short drug-induced psychotic episode a few years earlier. Somatic workup showed moderate hyponatremia, but no other abnormalities. Tests for narcotics, in particular, were also negative. Antipsychotic treatment with risperidone was initiated. After normalization of sodium levels using intravenous saline, the patient remitted within a few days and risperidone was discontinued on day 3. He was discharged by day 13 without further pharmacological treatment.Dysfunction of voltage-gated ion channels, particularly sodium and calcium channels, has been implicated in the pathogenesis of bipolar disorder. We therefore assume a causal relationship between hyponatremia and manic-psychotic symptoms in our patient. Hyponatremia was most likely induced by excessive water intake during a period of fasting in the context of a wellness practice.
Highlights
Voltage-gated sodium and calcium channels have been implicated in the pathophysiology of bipolar disorder
We report on a 31-year old Caucasian male who was admitted to our hospital while he experienced a manic episode with psychotic symptoms
Psychotic symptoms remitted within the following days, concurrently with normalization of sodium levels
Summary
Voltage-gated sodium and calcium channels have been implicated in the pathophysiology of bipolar disorder. We report on a 31-year old Caucasian male who was admitted to our hospital while he experienced a manic episode with psychotic symptoms. He presented with rapid, incoherent speech, religious and megalomanic delusions and emotional lability. The patient had no known psychiatric history except a short, most likely MDMA-induced psychotic episode some years ago. Psychotic symptoms remitted within the following days, concurrently with normalization of sodium levels (day 2: 132 mmol/l; day 5: 137 mmol/l; see Fig. 1). Since the patient’s symptoms remitted after only 3 days of treatment with risperidone while sodium levels normalized concurrently as well, we suspected hyponatremia as the cause of psychotic symptoms and decided to discontinue antipsychotic treatment at this point. By day 13, the patient was discharged in complete remission from psychosis and without pharmacological treatment
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