Is Schizophrenia Associated with Narcolepsy?

Walterfang, Mark; Upjohn, Edward; Velakoulis, Dennis

doi:10.1097/01.wnn.0000160822.53577.2c

Cited by 27 publications

(11 citation statements)

References 91 publications

(98 reference statements)

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“…An intriguing possibility is that intrusion or leakage of REM sleep events into waking may contribute to the gating impairments following prolonged SD. Accordingly, a similar process has been shown to underlie preattentional and attentional disorders in schizophrenia (Zarcone et al, 1969), as well as the psychotic manifestations in narcolepsy (Walterfang et al, 2005).…”

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confidence: 98%

Sleep deprivation disrupts prepulse inhibition of the startle reflex: reversal by antipsychotic drugs

Frau

Orrù

Puligheddu

et al. 2008

Int. J. Neuropsychopharm.

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Sleep deprivation (SD) is known to induce perceptual impairments, ranging from perceptual distortion to hallucinatory states. Although this phenomenon has been extensively described in the literature, its neurobiological underpinnings remain elusive. In rodents, SD induces a series of behavioural patterns that might be reflective of psychosis and mania, such as hyperlocomotion and sensitization to psychotogenic drugs. Notably, such changes are accompanied by transitory alterations of dopaminergic signalling. Based on the hypothesis that both psychotic and manic disorders reflect gating impairments, the present study was aimed at the assessment of the impact of SD on the behavioural model of prepulse inhibition (PPI) of the startle reflex, a reliable paradigm for the study of informational filtering. Rats subjected to SD (24 h, 48 h, 72 h) exhibited a time-dependent increase in startle reflex and a dramatic deficit in PPI. Both alterations were reversed 24 h after termination of the SD period. Interestingly, PPI disruption was efficiently prevented by haloperidol (0.1 mg/kg i.p.) clozapine (5 mg/kg i.p.) and risperidone (1 mg/kg i.p.). Conversely, neither the anxiolytic diazepam (5 mg/kg i.p.) nor the antidepressant citalopram (5 mg/kg i.p) affected the PPI disruption mediated by SD, although diazepam reversed the enhancement in startle reflex magnitude induced by this manipulation. Our data suggest that SD induces gating deficits that might be relevant to the hallucinatory phenomena observed in humans, and provide a novel reliable animal model where such relationship can be studied.

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confidence: 98%

Sleep deprivation disrupts prepulse inhibition of the startle reflex: reversal by antipsychotic drugs

Frau

Orrù

Puligheddu

et al. 2008

Int. J. Neuropsychopharm.

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“…[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%

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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“…A review article suggested that comorbidity of narcolepsy and schizophrenia is likely to be rare and sporadic. 5 Our study presents such a rare case, in a patient suffering from comorbidity of childhood-onset narcolepsy and adolescent-onset schizophrenia.…”

Section: Introductionmentioning

confidence: 96%

Comorbidity of narcolepsy and schizophrenia in an adolescent patient

Chen¹,

Bai²,

Huang³

et al. 2014

Journal of the Chinese Medical Association

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A 13-year-old boy suffered from hypersomnia, fragmented nighttime sleep, and cataplexy since age 10 years, and then developed prominent psychotic symptoms (i.e., auditory and visual hallucination, hallucinatory behavior, delusions of reference, and misidentification) that occurred persistently during the wakeful and consciously clear period when he was aged 12 years. The child underwent additional medical evaluation and testing, and comorbidity of narcolepsy and schizophrenia was diagnosed. The child's psychotic symptoms and narcolepsy improved significantly upon treatment with methylphenidate 30 mg, olanzapine 25 mg, and haloperidol 10 mg. In this case, the child's symptomology of narcolepsy and schizophrenia and the dilemma of the use of antipsychotics and psychostimulants are representative examples of the diagnostic and therapeutic challenges in adolescent psychiatry.

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Is Schizophrenia Associated with Narcolepsy?

Abstract: Objective: To determine the nature of the relationship between schizophrenia-like psychosis and narcolepsy.

Cited by 27 publications

References 91 publications

Sleep deprivation disrupts prepulse inhibition of the startle reflex: reversal by antipsychotic drugs

Sleep deprivation disrupts prepulse inhibition of the startle reflex: reversal by antipsychotic drugs

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

Comorbidity of narcolepsy and schizophrenia in an adolescent patient

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