Syndrome of inappropriate secretion of antidiuretic hormone with exacerbated psychosis

The syndrome of inappropriate secretion of antidiuretic hormone (ADH) occurred during an acute psychotic reaction in a patient who was taking no medications and had no evidence of volume depletion or of renal, hepatic, cardiac, or endocrine disease. The syndrome resolved with improvement of the acute psychotic state; it recurred during a second psychotic episode and again resolved with remission of the acute psychosis. It is therefore concluded that the acute psychotic episode, or some consequence thereof, caused the syndrome in this patient. The possible pathway(s) for this inappropriate secretion of vasopressin associated with this acute psychosis, and its implications, are discussed.