DEI/Health Equity
1
Chronic Schizophrenia Presenting with Psychogenic Polydipsia Masking Stage IV Uterine Adenocarcinoma
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
Included in
Bioethics and Medical Ethics Commons, Female Urogenital Diseases and Pregnancy Complications Commons, Internal Medicine Commons, Neoplasms Commons, Obstetrics and Gynecology Commons, Pathological Conditions, Signs and Symptoms Commons, Psychiatric and Mental Health Commons, Psychiatry Commons
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.