Comorbidity of narcolepsy and depressive disorders: a nationwide population-based study in Taiwan

Lee, Min-Jing; Lee, Sheng-Yu; Yuan, Shinsheng; Yang, Chengguang; Yang, Kang-Chung; Lee, Tung Liang; Sun, Chi‐Chin; Shyu, Yu-Chiau; Wang, Liang‐Jen

doi:10.1016/j.sleep.2017.07.022

Cited by 41 publications

(19 citation statements)

References 34 publications

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“…The chronicity and debilitating nature of narcolepsy may provide the psychological substrate for development of depression. However, Lee et al identified more than 50% of patients who had narcolepsy and comorbid depression had been diagnosed with depression prior to narcolepsy [ 10 ]. Therefore, a shared pathophysiology related to hypocretin deficiency should be considered.…”

Section: Depressionmentioning

confidence: 99%

“… Venn Diagram of the overlapping relationship between highlighting the intimate relationship between psychiatric disorders and narcolepsy [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. ADHD: attention deficit hyperactivity disorder.…”

Section: Figurementioning

confidence: 99%

“… Venn diagram of the overlapping relationship in pharmaceutical treatment for narcolepsy and select psychiatric disorders [ 4 , 5 , 6 , 9 , 10 , 11 , 24 , 25 ]. Overlapping benefit of pharmaceutical treatment is found in most treatments, except antipsychotics, which can exacerbate symptoms of narcolepsy.…”

Section: Figurementioning

confidence: 99%

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Narcolepsy and Psychiatric Disorders: Comorbidities or Shared Pathophysiology?

Morse

Kothare

2018

Medical Sciences

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Narcolepsy and psychiatric disorders have a significant but unrecognized relationship, which is an area of evolving interest, but unfortunately, the association is poorly understood. It is not uncommon for the two to occur co-morbidly. However, narcolepsy is frequently misdiagnosed initially as a psychiatric condition, contributing to the protracted time to accurate diagnosis and treatment. Narcolepsy is a disabling neurodegenerative condition that carries a high risk for development of social and occupational dysfunction. Deterioration in function may lead to the secondary development of psychiatric symptoms. Inversely, the development of psychiatric symptoms can lead to the deterioration in function and quality of life. The overlap in pharmaceutical intervention may further enhance the difficulty to distinguish between diagnoses. Comprehensive care for patients with narcolepsy should include surveillance for psychiatric illness and appropriate treatment when necessary. Further research is necessary to better understand the underlying pathophysiology between psychiatric disease and narcolepsy.

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Section: Depressionmentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

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Narcolepsy and Psychiatric Disorders: Comorbidities or Shared Pathophysiology?

Morse

Kothare

2018

Medical Sciences

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“…Additionally, Hcrt-KO mice completely lack CPP for morphine ( 106 ). Finally, although its etiology is likely multifactorial in origin, narcoleptic patients have a higher risk of depression ( 107 – 109 ). Taken together, these findings indicate that Hcrt neurons play a role in motivation-driven behavior and are part of a circuitry involved in reward processing ( 110 , 111 ).…”

Section: Hypocretin and Its Role In Diverse Functionsmentioning

confidence: 99%

Sleep-Wake Cycling and Energy Conservation: Role of Hypocretin and the Lateral Hypothalamus in Dynamic State-Dependent Resource Optimization

et al. 2018

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The hypocretin (Hcrt) system has been implicated in a wide range of physiological functions from sleep-wake regulation to cardiovascular, behavioral, metabolic, and thermoregulagtory control. These wide-ranging physiological effects have challenged the identification of a parsimonious function for Hcrt. A compelling hypothesis suggests that Hcrt plays a role in the integration of sleep-wake neurophysiology with energy metabolism. For example, Hcrt neurons promote waking and feeding, but are also sensors of energy balance. Loss of Hcrt function leads to an increase in REM sleep propensity, but a potential role for Hcrt linking energy balance with REM sleep expression has not been addressed. Here we examine a potential role for Hcrt and the lateral hypothalamus (LH) in state-dependent resource allocation as a means of optimizing resource utilization and, as a result, energy conservation. We review the energy allocation hypothesis of sleep and how state-dependent metabolic partitioning may contribute toward energy conservation, but with additional examination of how the loss of thermoregulatory function during REM sleep may impact resource optimization. Optimization of energy expenditures at the whole organism level necessitates a top-down network responsible for coordinating metabolic operations in a state-dependent manner across organ systems. In this context, we then specifically examine the potential role of the LH in regulating this output control, including the contribution from both Hcrt and melanin concentrating hormone (MCH) neurons among a diverse LH cell population. We propose that this hypothalamic integration system is responsible for global shifts in state-dependent resource allocations, ultimately promoting resource optimization and an energy conservation function of sleep-wake cycling.

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“…It has been hypothesized to be caused by a combination of genetic and environmental factors, trigger an autoimmune process that results in hypothalamic destruction, with a loss of hypocretin-1-containing cells, causing the hypocretin deficiency (4,5). Psychiatric comorbidities with narcolepsy are frequent, and include mood, anxiety, attention deficit hyperactivity, eating disorders, and psychosis (6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Comorbidity of Narcolepsy and Psychotic Disorders: A Nationwide Population-Based Study in Taiwan

et al. 2020

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Background: Narcolepsy is a chronic sleep disorder that is likely to have neuropsychiatric comorbidities. Psychotic disorders are characterized by delusion, hallucination, and reality impairments. This study investigates the relationship between narcolepsy and psychotic disorders. Design and Methods: This study involves patients who were diagnosed with narcolepsy between January 2002 and December 2011 (n = 258) and age-and gender-matched controls (n = 2580) from Taiwan's National Health Insurance database. Both the patients and the controls were monitored from January 1, 2002 to December 31, 2011 to identify any occurrence of a psychotic disorder. Drugs that have been approved for treating narcolepsy: immediate-release methylphenidate (IR-MPH), osmotic controlled-release formulations of methylphenidate (OROS-MPH), and modafinil, were analyzed. A multivariate logistic regression model was used to evaluate the potential comorbidity of narcolepsy with psychotic disorders. Results: During the study period, 8.1% of the narcoleptic patients exhibited comorbidity with a psychotic disorder, whereas only 1.5% of the control subjects (1.5%) had psychotic disorders (aOR, 4.07; 95% CI, 2.21-7.47). Of the narcolepsy patients, 41.5, 5.4, and 13.2% were treated with MPH-IR, MPH-OROS, and modafinil, accordingly. Pharmacotherapy for narcolepsy did not significantly affect the risk of exhibiting a psychotic disorder. Conclusions: This nationwide study revealed that narcolepsy and psychotic disorders commonly co-occur. Pharmacotherapy for narcolepsy was not associated with the risk of psychotic disorders. Our findings serve as a reminder that clinicians must consider the comorbidity of narcolepsy and psychosis.

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Comorbidity of narcolepsy and depressive disorders: a nationwide population-based study in Taiwan

Cited by 41 publications

References 34 publications

Narcolepsy and Psychiatric Disorders: Comorbidities or Shared Pathophysiology?

Narcolepsy and Psychiatric Disorders: Comorbidities or Shared Pathophysiology?

Sleep-Wake Cycling and Energy Conservation: Role of Hypocretin and the Lateral Hypothalamus in Dynamic State-Dependent Resource Optimization

Comorbidity of Narcolepsy and Psychotic Disorders: A Nationwide Population-Based Study in Taiwan

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