It also harbors extensive contacts within the central nervous system (CNS) including projections to the ventral tegmental area (VTA), main CNS regions involved in motivation and reinforcement processes ( 9). The hypocretin system has a complex interplay with the dopaminergic and also serotonergic systems involved in schizophrenia ( 8). Type 1 narcolepsy is caused by selective loss of hypocretin producing cells in the lateral hypothalamus area ( 7). Etiological Similarities in Narcolepsy and Schizophrenia However, there are also recent reports about psychotic symptoms in narcolepsy not related to medications suggesting possible link between narcolepsy and schizophrenia ( 5, 6). Some of these reports most likely presented iatrogenic amphetamine psychoses. In a more recent Taiwanese series, 9.8% of narcoleptic children developed schizophrenia at an average age of 2.5 (☑.8) years after narcolepsy onset ( 5).
#Cataplexy hallucinations series#
In a case series study of Roy, 1 out of 20 narcolepsy patients had schizophrenia-like psychosis ( 4). The first cases of psychosis in narcolepsy were described in the early twentieth century ( 2, 3). Psychiatric comorbidity is frequently seen but there is little information about the prevalence of psychotic symptoms in narcolepsy. The other three are excessive daytime sleepiness (EDS), cataplexy (CPL), and sleep paralysis (SP) but other symptoms such as fragmented sleep are also common. Hypnagogic and hypnopompic hallucinations (HG, HP) are part of the classic narcolepsy tetrad ( 1). In case of SXB-induced psychotic symptoms or hallucinations, reducing SXB dose or adding antipsychotic medication can be tried. Hallucinations resemble those seen in schizophrenia however, the insight that symptoms are delusional is usually preserved. Adding antipsychotic treatment (risperidone) alleviated psychotic symptoms in two cases.Ĭonclusion: Psychotic symptoms in narcolepsy may appear during SXB treatment. Tapering down SXB was tried and helped in two out of four cases. Two patients also had delusional symptoms primarily associated with mental disorders. Results: Three out of four patients had hallucinations typical for psychosis and one had symptoms that resembled aggravated hypnagogic hallucinations. In addition, we searched the literature for descriptions of hallucinations in narcolepsy and similarities and differences with psychotic symptoms in schizophrenia. Method: We present altogether four patients with narcolepsy who experienced psychotic symptoms during treatment with SXB. Furthermore, we analyze the characteristics of hallucinations to determine their nature as mainly psychotic or hypnagogic and raise a discussion about whether SXB causes psychosis or if psychosis occurs as an endogenous complication in narcolepsy. We aim to analyze the relation between sodium oxybate (SXB) treatment and psychotic symptoms in narcolepsy patients. The effect of medication on hallucinations is of interest since treatment of narcolepsy may provoke psychotic symptoms. Narcolepsy patients may also experience daytime hallucinations unrelated to sleep–wake transitions. 5Department of Clinical Neurosciences, University of Helsinki, Helsinki, FinlandĪim: Hypnagogic and hypnopompic hallucinations are characteristic symptoms of narcolepsy, as are excessive daytime sleepiness, cataplexy, and sleep paralysis.4Department of Neurology, Linköping University Hospital, Linköping, Sweden.3Department of Neurology, Uppsala University Hospital, Uppsala, Sweden.2Helsinki Sleep Clinic, Vitalmed Research Centre, Helsinki, Finland.1Department of Neurology, Central Finland Central Hospital, Jyväskylä, Finland.Anne-Marie Landtblom 3,4 and Markku Partinen 2,5
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