{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T08:04:40Z","timestamp":1766390680614,"version":"3.48.0"},"reference-count":30,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:00:00Z","timestamp":1759968000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neuropsychopharm Rep"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Primary polydipsia affects approximately 11%\u201320% of patients with chronic schizophrenia, and up to one\u2010third develop symptomatic hyponatremia. Rapid correction of hyponatremia can precipitate osmotic demyelination syndrome (ODS), involving demyelination in the central pons and extrapontine regions. ODS presenting with severe extrapyramidal symptoms (EPS) in schizophrenia has not been previously documented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>A 34\u2010year\u2010old man with chronic schizophrenia, maintained on oral olanzapine and monthly flupentixol decanoate, developed polydipsia\u2010induced hyponatremia. His serum sodium was corrected at 9\u2009mEq\/L\/day at a local hospital. Ten days later, he presented with fever, cough, dysarthria, dysphagia, and lead\u2010pipe rigidity. Laboratory tests revealed leukocytosis and rhabdomyolysis without delirium or autonomic instability. Dysarthria and dysphagia were consistent with pseudobulbar palsy. Brain MRI showed T2\u2010weighted and FLAIR hyperintensities in the bilateral basal ganglia and central pons, confirming ODS. The patient had a favorable clinical course with supportive treatment and regained independent mobility without the need for empirical immunotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This case highlights ODS as a rare but critical differential diagnosis for severe EPS in schizophrenia, particularly when presenting with lead\u2010pipe rigidity and pseudobulbar palsy. Greater awareness of this presentation can facilitate timely diagnosis and appropriate management, avoiding misattribution to antipsychotic\u2010induced side effects that may result in long\u2010term morbidity or mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/npr2.70065","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T08:19:28Z","timestamp":1759997968000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Osmotic Demyelination Syndrome in a Patient With Schizophrenia: A Case Report"],"prefix":"10.1002","volume":"45","author":[{"given":"Yin\u2010Chen","family":"Lai","sequence":"first","affiliation":[{"name":"Department of Psychiatry Taichung Veterans General Hospital  Taichung Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chen\u2010Chia","family":"Lan","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Taichung 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