DEI/Health Equity

1

Date of Presentation

5-2-2024 12:00 AM

College

Rowan-Virtua School of Osteopathic Medicine

Poster Abstract

Background: Psychogenic polydipsia (PPD) is a condition of excessive water intake and seeking behavior with a 6-20% prevalence among patients with psychiatric illnesses, commonly Schizophrenia. It remains unknown how often concomitant disease can mask other, more serious conditions in psychiatric patients.

Case Description: The patient is a 58-year-old Hispanic, white female with chronic schizophrenia complicated by multiple hospitalizations for hyponatremia secondary to PPD. The patient initially presented to the emergency department (ED) in 2016 with abdominal pain, was treated symptomatically and discharged. From 2020 to 2023, the patient was readmitted seven more times, with two suspected aspirin overdoses, an Ambien overdose, and multiple ED visits for PPD, each time with complaints of abdominal pain, which were attributed to either PPD or overdose. In 2021 the patient was found to have severe iron deficiency anemia, and an initial abdominal ultrasound was unremarkable. In 2022, tumor marker tests yielded abnormal results including: CA125 85.9/50.1, CA19-9 >10, and CEA 0.3. A pelvic ultrasound was completed after another three ED visits, revealing an infiltrative uterine mass measuring up to 5.6 cm, which was confirmed by CT abdomen and pelvis to be Stage IV Uterine Adenocarcinoma.

Discussion: Several potential opportunities for intervention were missed in this patient including: (1) primary prevention (i.e., no documented/completed cancer screenings), (2) inadequate physical exam and history acquisition, (3) delayed diagnostic imaging from onset of abdominal pain to diagnosis. This case highlights the shortcomings across disciplines to provide early intervention, and the disparities of basic patient care in psychiatric patients.

Keywords

psychogenic polydipsia, schizophrenia, hyponatremia, uterine adenocarcinoma, disparities, Adenocarcinoma, Uterine Neoplasms, Healthcare Disparities, Mental Health, Bioethical Issues

Disciplines

Bioethics and Medical Ethics | Female Urogenital Diseases and Pregnancy Complications | Internal Medicine | Medicine and Health Sciences | Neoplasms | Obstetrics and Gynecology | Pathological Conditions, Signs and Symptoms | Psychiatric and Mental Health | Psychiatry

Document Type

Poster

DOI

10.31986/issn.2689-0690_rdw.stratford_research_day.3_2024

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May 2nd, 12:00 AM

Chronic Schizophrenia Presenting with Psychogenic Polydipsia Masking Stage IV Uterine Adenocarcinoma

Background: Psychogenic polydipsia (PPD) is a condition of excessive water intake and seeking behavior with a 6-20% prevalence among patients with psychiatric illnesses, commonly Schizophrenia. It remains unknown how often concomitant disease can mask other, more serious conditions in psychiatric patients.

Case Description: The patient is a 58-year-old Hispanic, white female with chronic schizophrenia complicated by multiple hospitalizations for hyponatremia secondary to PPD. The patient initially presented to the emergency department (ED) in 2016 with abdominal pain, was treated symptomatically and discharged. From 2020 to 2023, the patient was readmitted seven more times, with two suspected aspirin overdoses, an Ambien overdose, and multiple ED visits for PPD, each time with complaints of abdominal pain, which were attributed to either PPD or overdose. In 2021 the patient was found to have severe iron deficiency anemia, and an initial abdominal ultrasound was unremarkable. In 2022, tumor marker tests yielded abnormal results including: CA125 85.9/50.1, CA19-9 >10, and CEA 0.3. A pelvic ultrasound was completed after another three ED visits, revealing an infiltrative uterine mass measuring up to 5.6 cm, which was confirmed by CT abdomen and pelvis to be Stage IV Uterine Adenocarcinoma.

Discussion: Several potential opportunities for intervention were missed in this patient including: (1) primary prevention (i.e., no documented/completed cancer screenings), (2) inadequate physical exam and history acquisition, (3) delayed diagnostic imaging from onset of abdominal pain to diagnosis. This case highlights the shortcomings across disciplines to provide early intervention, and the disparities of basic patient care in psychiatric patients.

 

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