Narcolepsy, Paranoid Psychosis, Major Depression, and Tardive Dyskinesia

Schrader, G.; Ep, Hicks

doi:10.1097/00005053-198407000-00012

Cited by 12 publications

(3 citation statements)

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“…20,21 To complicate matters further, there are case reports of narcolepsy with paranoid psychosis emerging after treatment with psychostimulants, suggesting that treatment can also be involved. [22][23][24] Nevertheless, there are a few reports of individual cases with a proven coexistence of narcolepsy together with a genuine psychotic disorder. [25][26][27] Other reports do not allow definitive conclusions of whether the association with psychosis is primary, or secondary to stimulant treatments.…”

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: 99%

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: 99%

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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“…Several case studies indicate that pharmacological management of narcoleptic patients with drug‐induced psychosis becomes complicated. The clinical course can also include adverse effects of antipsychotics 23,24 . Pawluk et al.…”

Section: Discussionmentioning

confidence: 99%

Schizophrenia and narcolepsy: A review with a case report

Kishi

Konishi

Koizumi

et al. 2004

Psychiatry Clin Neurosci

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Several reports emphasize the importance of differentiating between psychosis in schizophrenia and the psychotic form of narcolepsy. The failure to identify narcolepsy leads to the labeling of patients as refractory to standard treatments for schizophrenia and retards consideration of intervention for narcolepsy in which psychosis can improve with psychostimulant treatment. Psychosis in patients with narcolepsy can occur in three ways: (i) as the psychotic form of narcolepsy with hypnagogic and hypnopompic hallucinations; (ii) as a result of psychostimulant use in a patient with narcolepsy; and (iii) as the concurrent psychosis of schizophrenia in a patient with narcolepsy. The present case report describes a difficult-to-treat patient who likely had concurrent schizophrenia and narcolepsy. It then summarizes the literature related to the treatment of the three types of patients with psychosis associated with narcolepsy.

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“…The reported frequency of side effects of stimulants in clinical practice and in clinical trials varies from 0% to 73%; the extreme variation reflects, at least in part, differences in methods of determining side effects and the definition of a side effect. 30,31 Psychosis and hallucinations are rare in narcoleptic patients treated with stimulants. 6,28 Available studies show that at high doses, side effects as well as disturbed nocturnal sleep are experienced by most patients.…”

Section: Side Effectsmentioning

confidence: 99%