Schizophrenia and narcolepsy: A review with a case report

Kishi, Yasuhiro; Konishi, Shunichiro; Koizumi, Sachiko; Kudo, Yoshihisa; Kurosawa, Hisashi; Kathol, Roger G.

doi:10.1111/j.1440-1819.2003.01204.x

Cited by 48 publications

(38 citation statements)

References 30 publications

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“…[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. 25,[28][29][30] Psychotic symptoms in narcolepsy have been evaluated in three controlled studies.…”

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%

“…[25][26][27] Other reports do not allow definitive conclusions of whether the association with psychosis is primary, or secondary to stimulant treatments. 25,[28][29][30] Psychotic symptoms in narcolepsy have been evaluated in three controlled studies. Two studied narcolepsy, schizophrenic patients, and control subjects, 31,32 while another studied narcolepsy patients versus matched controls.…”

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%

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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%

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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“…Changes in the brain during sleep modulated by acetylcholine (ACh) input. 45 Brainstem neurons (localized in the pedunculopontine [PPT] and laterodorsal tegmental [LDT] nuclei of the midbrain) release ACh which prompts the activation of ascending projections to the thalamus. This is accompanied by generalized activation of limbic, parahippocampal, and other thalamic pathways.…”

Section: Regional Brain Activation and Neurotransmitter Actionmentioning

confidence: 99%

“…44 Of relevance, the prominence of these hallucinatory-like experiences can lead to a mistaken diagnosis of schizophrenia. 45 The Gradual Descent Hypothesis. The "gradual descent hypothesis" 46,47 suggests that the above phenomena constitute a meaningful class of related phenomena sharing overlapping mechanisms.…”

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confidence: 99%

What Is the Link Between Hallucinations, Dreams, and Hypnagogic–Hypnopompic Experiences?

Waters

Blom²,

Dang‐Vu

et al. 2016

SCHBUL

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By definition, hallucinations occur only in the full waking state. Yet similarities to sleep-related experiences such as hypnagogic and hypnopompic hallucinations, dreams and parasomnias, have been noted since antiquity. These observations have prompted researchers to suggest a common aetiology for these phenomena based on the neurobiology of rapid eye movement (REM) sleep. With our recent understanding of hallucinations in different population groups and at the neurobiological, cognitive and interpersonal levels, it is now possible to draw comparisons between the 2 sets of experiences as never before. In the current article, we make detailed comparisons between sleep-related experiences and hallucinations in Parkinson's disease, schizophrenia and eye disease, at the levels of phenomenology (content, sensory modalities involved, perceptual attributes) and of brain function (brain activations, resting-state networks, neurotransmitter action). Findings show that sleep-related experiences share considerable overlap with hallucinations at the level of subjective descriptions and underlying brain mechanisms. Key differences remain however: (1) Sleep-related perceptions are immersive and largely cut off from reality, whereas hallucinations are discrete and overlaid on veridical perceptions; and (2) Sleep-related perceptions involve only a subset of neural networks implicated in hallucinations, reflecting perceptual signals processed in a functionally and cognitively closed-loop circuit. In summary, both phenomena are non-veridical perceptions that share some phenomenological and neural similarities, but insufficient evidence exists to fully support the notion that the majority of hallucinations depend on REM processes or REM intrusions into waking consciousness.

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“…Aspectos relacionados ao tratamento da narcolepsia também aproximam as duas condições: os tratamentos com estimulantes realizados na narcolepsia podem acompanhar-se de uma psicose paranoide como efeito colateral, que pode assemelharse à E/OTP. Kondsiella & Arlien-Soborg lembram que uma psicose associada a uma narcolepsia constitui um dilema terapêutico: os psicoestimulantes, para tratar a SED da narcolepsia, geram uma elevação da dopamina central e, assim, aumentam os riscos de sintomas psicóticos; enquanto que os neurolépticos, para tratar a psicose, antagonizam receptores dopaminérgicos e geram sedação 43,44 . Contudo, em alguns narcolépticos, o metilfenidato, além de melhorar a SED, melhora inteiramente as alucinações hipnagógicas e outros sintomas psicóticos.…”

Section: Narcolepsia E Esquizofrenia/outros Transtornos Psicóticosunclassified

Narcolepsia: o despertar para uma realidade subestimada

Tavares

Cremaschi

Coelho

2017

Debates em Psiquiatria

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ResumoA narcolepsia é uma doença subestimada, e o tempo para o seu diagnóstico é de cerca de 10 anos. O objetivo do presente trabalho é trazer, para os médicos -particularmente os psiquiatras -e para todos os profissionais da área da saúde, a necessária conscientização acerca da importância de se levar em conta a narcolepsia em seus pacientes na prática clínica diária. O impacto negativo da narcolepsia na qualidade de vida é significativo e comparável àquele da epilepsia ou da esquizofrenia. O diagnóstico se caracteriza pela presença de cinco sintomas cardiais: sonolência excessiva diurna; cataplexia; paralisia do sono; alucinações; e fragmentação do sono noturno. O teste de latências múltiplas do sono, após uma polissonografia basal, se presta para confirmar o diagnóstico. A associação com transtornos depressivos, bipolares e ansiosos é muito prevalente em pacientes com narcolepsia. O tratamento desses pacientes se dá com estimulantes e doses baixas de antidepressivos. Interessantemente, a retirada abrupta de antidepressivos pode gerar uma síndrome transitória assemelhada à cataplexia. Outro achado comum em pacientes com narcolepsia é o transtorno comportamental do sono REM após o uso de antidepressivos. O emprego de psicoestimulantes, usados na narcolepsia para controle da sonolência excessiva diurna, pode acompanhar-se de uma psicose paranoide, assemelhada à esquizofrenia. O diagnóstico, o tratamento e o manejo da narcolepsia associada com comorbidades representam um desafio a ser valorizado.Palavras-chave: Narcolepsia, cataplexia, hipersonolência, hipocretina (orexina), alucinação, paralisia do sono. AbstractNarcolepsy is an underestimated disease that takes about 10 years to be diagnosed. The objective of the present study was to raise the awareness of physicians in general, and psychiatrists in particular, about the importance of considering narcolepsy in their patients in daily clinical practice. The negative impact of narcolepsy on quality of life is significant and comparable to that of epilepsy or schizophrenia. Diagnosis is characterized by the presence of five cardinal symptoms: excessive daytime sleepiness; cataplexy; sleep paralysis; hallucinations; and fragmentation of nocturnal sleep. The multiple sleep latency test is used after a baseline polysomnography to confirm diagnosis. Associated depression, bipolar and anxiety disorders are highly prevalent in patients with narcolepsy. Patients with narcolepsy are treated with stimulants and low doses of antidepressants. Interestingly, the abrupt withdrawal of antidepressants can cause a transient syndrome similar to cataplexy. Another common finding in patients with narcolepsy is REM sleep behavior disorder after the use of antidepressants. The use of psychostimulants, employed in narcolepsy for excessive daytime sleepiness control, can be accompanied by paranoid psychosis, similar to schizophrenia. The diagnosis, treatment, and management of narcolepsy associated with comorbidities are a challenge and should be given due consideration.Keywords: Narcol...

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Schizophrenia and narcolepsy: A review with a case report

Cited by 48 publications

References 30 publications

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

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

What Is the Link Between Hallucinations, Dreams, and Hypnagogic–Hypnopompic Experiences?

Narcolepsia: o despertar para uma realidade subestimada

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