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Compulsive water drinking is associated with a broad spectrum of psychopathology, from mild neurosis to psychosis. Since the normal kidney is capable of excreting large volumes of fluid rapidly, water intoxication requires both a pathological basis and a psychiatric explanation of why so much water is being taken. Excessive water consumption can be dangerous, so that the fluid intake of patients with a history of polyuria together with a low urinary specific gravity should be closely observed. Four cases of water intoxication resulting from psychogenic polydipsia are described, three of them in chronic schizophrenics, where inappropriate ADH secretion might represent part of the psychosis.

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The Beauchamp ISU based at Central Hospital, Warwick, has admitted 105 patients over a six-year period, 14 of these on more than one occasion, which has accounted for 121 admissions with 109 discharges. The opening of a pre-discharge unit in 1985 resulted in a 50 per cent increase in the number of patients admitted to the ISU. The majority of patients were male and had a diagnosis of schizophrenia, and 30 per cent of patients were of non-European origin. The mean length of stay was six months. The future role of secure units is discussed. There will be a need for the forensic psychiatric service to adapt to the changes resulting from the present government policy of community psychiatric care. The group of patients at present identified as requiring secure accommodation need a range of facilities and the number of patients requiring those facilities is likely to increase as psychiatric hospitals close. The special funding of the secure units must be maintained and any attempt to erode or to accept a lower level of funding must be resisted.

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