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IntroductionKleine-Levin syndrome (KLS) is a rare disease characterized by recurrent episodes of hypersomnia, hyperphagia and behavioural symptoms, mainly hypersexuality.ObjectivesWe report the clinical course of KLS in a 18-year-old male. The clinical onset and evolution are described.Aims/methodsThe boy was diagnosed as having KLS after two episodes of hypersomnia lasting for 13 to 15 days each one. When awake, he was depressed and with megaphagia. He also had phases of hypersexuality. The initial interval between episodes was 6 weeks. After the second episode was treated with lithium and remained free of symptoms for 11 months. He had a third episode that lasted 6 days. Serum lithium level was low. In this third episode he had only hypersomnia. He had a relapse two years later with a duration of 4 days, without further relapses.ResultsKLS is more frequent in young males with a mean duration of 8 years and around 7 episodes that lasted 10 days. The pathogenesis remains unknown. It has been related with functional disturbance in the hypothalamus, viral infections, triggering stimulus...Some authors consider KLS as a variant of bipolar disorder. Treatment includes methylphenidate, neuroleptics, antidepressants and mood stabilizers as lithium. With lithium has been reported fewer relapses, shorter duration of episodes and disappearance of behavioural symptoms.ConclusionsDespite being a rare disease, is thought to be underdiagnosed, because diagnosis is mainly clinical, and tests such as EEG, PSG and MSLT reinforce the diagnosis but are not pathognomonic. Today, lithium is the best treatment option.

Introduction: Tapentadol is a centrally-acting synthetic analgesic which acts as a mu-opioid receptor agonist as well as a norepinephrine re-uptake inhibitor. It is use to treat cronic pain. Most prevalence adverse effects are gastrointestinal and nervous symptoms. Furthermore, it has objectified, with less frequency, psychiatric disturbances. Objetives: To analyse the relationship between a maniac episode and tapentadol. Methods: Forty-nine-year-old female, with personal history of dyslipidemia and lumbar herniated discs in L4-L5, L5-S1, in treatment with tapentadol 200 mg/day for 20 days and no past psychiatric history. She was admitted to the Psychiatry Department due to a maniac episode, with desinhibition, pressure and loud speech, euphoria, megalomaniac delusion and sleep disturbance for the last 10 days. Young Mania Rating Scale (YMRS) was 36 points. Olanzapina 15 mg/day was introduced and tapentadol was removed. Symptoms remitted quickly and 6 days later, at discharge, YMRS was 4 points. One year later, the patient continued to be asymptomatic. Results: Opioids can produce psychiatric disorders like hallucination, sleep disorders, depressed mood, disorientation, agitation, nervousness, restlessness, euphoric mood. Secondary mania to tapentadol mechanism is unknown, but having opiate cases described, it is possible to attribute this episode to tapentadol. Conclusions:-Secondary mania is associated with various medical conditions, including vitamin B12 deficiency, brain injury, HIV infection and drugs such as alcohol, caffeine, sympathomimetics, steroids, bupropion, isoniazid, clarithromycin and opioids.-Further research is required to determine if the maniac episode was only isolated by the tapentadol or it is the beginning of a bipolar disorder.