CLINICAL HANDBOOK OF SCHIZOPHRENIA

13. Co-Occurring Disorders 133can increase symptoms of disorientation and confusion. In some extreme cases, polydipsiacan lead to hyponatremia and seizures.An interdisciplinary team approach can be very useful in helping assess and treatpolydipsia. The initial goal in diagnosing this disorder is to gather baseline data and try toconfirm or rule out presence of the problem. Prior to confirming or assigning a diagnosis ofpolydipsia, other causes such as diabetes mellitus, diabetes insipidus, chronic renal failure,malignancy, pulmonary disease, and hypocalcemia should be excluded. In many cases, thisinformation is contained in medical records from the patient’s primary care providers.Multiple methods may be used to assess whether a patient has polydipsia. Observablesymptoms may include mood swings, confusion, inability to follow commands, disorientation,and rambling speech. If a patient is in an observable setting, such as an inpatient unit,clinical staff may notice an increase in water or fluid consumption. In addition, someantipsychotic medications can increase a patient’s risk for developing polydipsia. Therefore,an initial review of patient records and a medical evaluation can help confirm a diagnosis.Diagnostic lab work using urinalysis can also be used to determine whether polydipsia ispresent. Finally, weight monitoring can be used. If excessive fluid intake is suspected, patientsshould have their weight monitored. Such monitoring should be done closely, whenpossible, such as in an inpatient setting. Patients should be weighed at least twice a day, andnot after eating a large meal. If patients’ morning and evening weights differ by greater than5%, they should be closely monitored for possible seizures due to a change in electrolytes. Inaddition, it is helpful to monitor the intake of water or fluids. Two simple techniques that canbe used are intake logs or a bottle that contains the recommended amount daily of fluids.KEY POINTS• Assessment for drug and alcohol use optimally involves multiple sources of information.• Assessment should be continuous throughout treatment, because substance use disorderstend to be relapsing and remitting.• Objective measures of substance use include Breathalyzer tests and toxicology screeningof urine, blood, and hair.• Cigarette smoking, the most common addiction in schizophrenia, can be monitored withself-reported use and biological measures that test expired air and saliva or urine.• The dangerous physical consequences of infectious diseases that can cause severe medicaldisability and even death require monitoring of both high-risk behaviors and exposure tohepatitis (both B and C) and HIV.• Even patients who are currently abstinent may have infectious diseases of which they areunaware; thus, understanding patients’ past use and behavior is important.• Rates of obesity, diabetes, and metabolic syndrome are elevated among persons withschizophrenia and require close monitoring and coordination with primary care.• Weight and blood pressure can be assessed regularly in psychiatric clinics and should becomea part of routine monitoring and patient education.• Fasting blood tests for lipids and glucose are critical for identifying and tracking metabolicproblems.• Although exercise and diet are difficult to track systematically, simple logs developed for individualpatient monitoring can be helpful.REFERENCES AND RECOMMENDED READINGSBooth, M. L. (2000). Assessment of physical activity: An international perspective. Research Quarterlyfor Exercise and Sport, 71(2), 114–120.Cancer Prevention Research Center. (2007). Stages of change algorithm for the weight: Stages ofChange—Short Form. Available online at www.uri.edu/research/cprc/masures/weight01.htm