A Case of Central Diabetes Insipidus in a Female Patient with Bipolar Disorder, Lithium Consumer Over the Last Years

Cade described the effects of lithium on manic episodes in 1949. Schou confirmed these initial observations in 1954. From 1949 until today we can speak of the history of psychopharmacology, in fact it is the oldest drug in mental disorders that is still in full use (Johson, 2006). The Food and Drug Administration (FDA) approved it in 1970 for the treatment of acute mania and in 1974 for the prophylaxis of bipolar disorder. Today lithium valid indications remain in force: acute mania, bipolar depression, prophylaxis and maintenance of bipolar disorder and unipolar depression. Moreover, its use has also been extended to many diseases: personality disorders, aggression, anxiety, etc. (Freeman, 2006). However, it is a drug whose management requires detailed knowledge of their numerous side effects (Table 1), as well as drug interactions (Table 2), contraindications and special situations (Alvarez, 2000). The fact that it is a drug with a very narrow therapeutic window, requires frequent monitoring plasma determinations. We report a case that has, in principle, one of the most common side effects of using this drug, 25 to 35 percent of patients have polyuria and polydipsia (Sadock, 2004), a person who concurrently also presents serious illnesses which require special surveillance. But a close examination proved to be another slightly different pathology documented. Central diabetes insipidus (CDI) is a condition characterized by polyuria, polydipsia, and nocturia and is due to deficiency of arginine vasopressin (AVP). The case has already been published four years ago in a Spanish journal (Gil-Diez, 2007), but we consider it of interest in order to report on the progress of the disease and a bibliographic update.