taking small sips of water, having ice cubes instead of drinks) in addition to challenging delusions leading to excessive drinking.Psychogenic polydipsia often leads to institutionalisation of mentally ill patients, since it is difficult to manage in the community. Most studies of behavioural treatments occur in institutional settings and require close monitoring of the patient and a large degree of time commitment from staff. Pharmaceutical
A number of pharmaceuticals may be used in an attempt to bring the polydipsia under control, including:

Atypical antipsychotics, such as clozapine, olanzapine and risperidone
Demeclocycline, a tetracycline antibiotic, which is effective due to the side effect of inducing nephrogenic diabetes insipidus. Demeclocycline is used for cases of psychogenic polydipsia, including those with nocturnal enuresis (bed-wetting). Its mechanism of action involves direct inhibition of vasopressin at the DCTs, thus reducing urine concentration.There are a number of emerging pharmaceutical treatments for psychogenic polydipsia, although these need further investigation:
ACE Inhibitors, such as enalapril
Clonidine, an alpha-2 adrenergic agonist
Irbesartan, an angiotensin II receptor antagonist
Propranolol, a sympatholytic beta blocker
Vasopressin receptor antagonists, such as conivaptan
Acetazolamide, a carbonic anhydrase inhibitorLithium was previously used for treatment of PPD as a direct competitive ADH antagonist, but is now generally avoided due to its toxic effects on the thyroid and kidneys.It is important to note that the majority of psychotropic drugs (and a good many of other classes) can cause dry mouth as a side effect, but this is not to be confused with true polydipsia in which a dangerous drop in serum sodium will be seen.
However, these changes will likely only develop after chronic PPD associated with severe mental illness, as opposed to less severe forms of the disorder as seen in those with anxiety and affective disorders. PPD is also linked with significant reductions in insular cortex volume, although this may be caused by the secondary hyponatraemia. It has been suggested that these deficits lead to moderate to severe cognitive impairments, especially affecting working memory, verbal memory, executive function, attention and motor speed.Other areas with volume reductions (both white and grey matter) include:
Right posterior lobe
Right inferior temporal gyrus
Parahippocampal gyrus
Both left and right superior temporal gyri
Right cuneus
Left medial frontal gyryus and inferior frontal gyrus
Right lingual gyrus

Diagnosis
As a diagnosis of exclusion, a diagnosis of primary polydipsia may be the result of elimination of the possibility of diseases causing similar signs and symptoms, such as diabetes insipidus. Diagnosis may be complicated by the fact that chronic and extreme compulsive drinking may impair the response of the kidneys to vasopressin, thus reducing the kidneys ability to concentrate the urine. This means that psychogenic polydipsia may lead to test results (e.g. in a water restriction test) consistent with diabetes insipidus or SIADH, leading to misdiagnosis.Dry mouth is often a side effect of medications used in the treatment of some mental disorders, rather than being caused by the underlying condition. Such medications include antipsychotics, antidepressants, anticonvulsants, alpha agonists and anticholinergics. It should also be ensured that the thirst isnt caused by diuretic use (particularly thiazide diuretics), MDMA use, excessive solute intake or chronic alcoholism.