2021 AM Posters-Alcohol Use Disorder, Psychogenic Polydipsia, and Schizophrenia,

Alcohol Use Disorder, Psychogenic Polydipsia, and Schizophrenia,

Pdf Summary

This document discusses two cases involving individuals with severe, persistent mental illness and comorbid substance use disorders. Both cases also involve hyponatremia, which can be caused by various factors including the mental illness itself, antipsychotic medications, and excessive alcohol consumption. The patients in these cases have varying insight into their schizophrenia but little to no insight into their alcohol use disorder.<br /><br />The document raises questions about ethical and legal considerations when treating patients with severe, persistent mental illness and substance use disorders. In most states, individuals cannot be involuntarily committed to substance use treatment, creating challenges in pursuing treatment for these patients.<br /><br />The first case describes a 53-year-old female with a history of schizophrenia, alcohol use disorder, seizures, and hyponatremia. She has a pattern of frequent emergency department visits for similar episodes of agitation and disorganized behavior, often requiring medical admission for hyponatremia management which is complicated by seizures. She has been stable on risperidone but has experienced decompensation in the last two years. Despite understanding the need for fluid restriction, she refuses to stop alcohol use. The patient has a longstanding history of auditory hallucinations and attributes her alcohol issues to one of the voices, not herself.<br /><br />The second case involves a 61-year-old woman with a history of schizophrenia, psychogenic polydipsia, alcohol use disorder, and hypertension. She was found rolling in the street and was agitated, requiring restraint. She displayed verbally and physically abusive behavior towards staff, as well as sexually provocative actions.<br /><br />Overall, these cases highlight the complexities and challenges of treating individuals with severe, persistent mental illness and comorbid substance use disorders. The document discusses the need for appropriate management and treatment of alcohol use disorder in this population, as well as the ethical considerations involved.

Keywords

severe mental illness

substance use disorders

hyponatremia

insight into schizophrenia

ethics

legal considerations

involuntary commitment

treatment challenges

risperidone

alcohol use disorder treatment

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