Narcolepsy and psychopathology: is there an association?

Vourdas, Apostolos; Shneerson, John M.; Gregory, Carol; Smith, Ian; King, Martin; Morrish, Emma; McKenna, Peter J.

doi:10.1016/s1389-9457(02)00062-x

Cited by 62 publications

(24 citation statements)

References 27 publications

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“…Two studied narcolepsy, schizophrenic patients, and control subjects, 31,32 while another studied narcolepsy patients versus matched controls. 33 Although methodologies were different, the main conclusions were similar: the modality of hallucinations (auditory in schizophrenia vs visual and multisensory in narcolepsy) can differentiate narcolepsy from schizophrenia; and delusions are frequent in schizophrenia, but not present in narcolepsy or control subjects, except for rare instances. Moreover, in striking contrast to psychotic patients, narcolepsy patients experience hallucinations only when falling asleep, shortly after awakening, or when they are very sleepy.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 97%

Dual Cases of Type 1 Narcolepsy with Schizophrenia and Other Psychotic Disorders

Cañellas

Lin

Juliá

et al. 2014

Journal of Clinical Sleep Medicine

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Objective: Cases of narcolepsy in association with psychotic features have been reported but never fully characterized. These patients present diagnostic and treatment challenges and may shed new light on immune associations in schizophrenia. Method: Our case series was gathered at two narcolepsy specialty centers over a 9-year period. A questionnaire was created to improve diagnosis of schizophrenia or another psychotic disorder in patients with narcolepsy. Pathophysiological investigations included full HLA Class I and II typing, testing for known systemic and intracellular/synaptic neuronal antibodies, recently described neuronal surface antibodies, and immunocytochemistry on brain sections to detect new antigens. Results: Ten cases were identifi ed, one with schizoaffective disorder, one with delusional disorder, two with schizophreniform disorder, and 6 with schizophrenia. In all cases, narcolepsy manifested fi rst in childhood or adolescence, followed by psychotic symptoms after a variable interval. These patients had auditory hallucinations, which was the most differentiating clinical feature in comparison to narcolepsy patients without psychosis. Narcolepsy therapy may have played a role in triggering psychotic symptoms but these did not reverse with changes in narcolepsy medications. Response to antipsychotic treatment was variable. Pathophysiological studies did not reveal any known autoantibodies or unusual brain immunostaining pattern. No strong HLA association outside of HLA DQB1*06:02 was found, although increased DRB3*03 and DPA1*02:01 was notable. Conclusion: Narcolepsy can occur in association with schizophrenia, with signifi cant diagnostic and therapeutic challenges. Dual cases maybe under diagnosed, as onset is unusually early, often in childhood. Narcolepsy and psychosis may share an autoimmune pathology; thus, further investigations in larger samples are warranted. Keywords: type 1 narcolepsy, psychotic disorders, HLA, brain autoantibodies, autoimmune Citation: Canellas F, Lin L, Julià MR, Clemente A, VivesBauza C, Ollila HM, Hong SC, Arboleya SM, Einen MA, Faraco J, Fernandez-Vina M, Mignot E. Dual cases of type 1 narcolepsy with schizophrenia and other psychotic disorders. J Clin Sleep Med 2014;10(9):1011-1018. S C I E N T I F I C I N V E S T I G A T I O N ST ype 1 narcolepsy is a disabling sleep disorder caused by hypocretin-1 defi ciency affecting approximately 0.02% of adults worldwide.1 It is strongly associated with the DQB1*06:02 allele of the human leucocyte antigen (HLA) system, 2 and is likely due to an autoimmune attack causing a specifi c loss of hypothalamic hypocretin-1 neurons.Narcolepsy is characterized by the presence of daytime sleepiness, cataplectic attacks, hypnagogic/hypnopompic hallucinations, sleep paralysis, and disturbed nocturnal sleep. Initially narcolepsy was considered a psychiatric disorder, as some symptoms are reminiscent of psychiatric disorders, for instance, disordered thinking and confusion-like behaviors due to sleepiness; and psychotic-like symptoms d...

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Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 97%

Dual Cases of Type 1 Narcolepsy with Schizophrenia and Other Psychotic Disorders

Cañellas

Lin

Juliá

et al. 2014

Journal of Clinical Sleep Medicine

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“…Nicotine exhibits antidepressant action (Tizabi et al, 1999), so higher-degree smoking might also be related to increased prevalence of several depressive symptoms (Vourdas et al, 2002;Fortuyn et al, 2010). Higher rate of smokers among narcolepsy patients is not connected to hypocretin deficiency because from animal models it seems that hypocretin system's role is to reduce drug seeking behaviours.…”

Section: Discussionmentioning

confidence: 99%

Smoking Prevalence and Its Clinical Correlations in Patients with Narcolepsy-cataplexy

et al. 2016

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Narcolepsy-cataplexy (NC) is a chronic neurological disease with suggested autoimmune etiopathogenesis. Nicotine stimulates central nervous system and smoking increases the risk of autoimmune diseases. Assessment of smoking habits and its correlation to clinical parameters among 87 adult NC patients (38 male, 49 female) included night polysomnography and multiple sleep latency test. In our sample, 43.7% NC patients were regular smokers, and 19.5% former smokers compared to 22.2%, and 12.6%, respectively, in the general population. Patients started to smoke in the mean age of 20.0 (SD ±6.0) years. 72.2% of NC smokers started to smoke before the onset of NC and the mean of the delay between smoking onset and NC onset was 9.1 (±5. Report / Vol. 117 (2016) No. 2-3, p. 81-89 a direct correlation between smoking duration and the number of awakenings, duration of N1 sleep, REM sleep latency, and apnoea/hypopnoea index (AHI), and, on the contrary, indirect correlation between smoking duration and N3 sleep duration, showing that smoking duration consistently correlates with sleep macrostructure. Smoking is highly prevalent in NC and has relationship with clinical features of NC. 82) Prague Medical

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“…12 Each was also associated with dopaminergic medication, known to be psychotogenic in narcoleptic patients. 6 The disparity between the temporal onset of narcoleptic and psychotic symptoms in each case would argue against the psychosis being a form fruste of narcolepsy. The diagnosis of narcolepsy for case 1 was questioned as she did not have a full ''tetrad'' of narcoleptic symptoms and narcolepsy-like MSLT abnormalities can be seen in depression, idiopathic hypersomnia, and asymptomatic subjects.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Most cases are sporadic, although genetic factors play a complex role, with first-degree relatives having a 40-fold increased risk; monozygotic twins, however, have only 25% concordance rates. 4 Psychosis has long been associated with narcolepsy, 5 although authors have differed on whether psychosis presenting with narcolepsy represents co-incidence, 6 a core ''psychotic form'' of narcolepsy, [7][8][9] or a result of stimulant treatment. 6,10 The reduced dopaminergic tone observed in narcolepsy would suggest an inverse relationship between narcolepsy and psychotic illnesses, the latter being widely considered to result from increased dopaminergic transmission.…”

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confidence: 99%