Narcoleptic and schizophrenic hallucinations

Dahmen, Norbert; Kasten, Meike; Mittag, K; Müller, Matthias J.

doi:10.1007/s10198-002-0113-x

Cited by 31 publications

(3 citation statements)

References 22 publications

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“…The only different characteristic of hallucinations was the frequency of unimodal hallucinations (higher in schizophrenia) and of hypnagogic/hypnopompic hallucinations (higher in narcolepsy). Our data are in line with previous evidence showing that the lifetime prevalence of hallucinations does not differ in schizophrenia and narcolepsy (90.5 and 75%, respectively, in this study and 81 and 80%, respectively, in a previous one [39]). The pathogenesis of hallucinations in narcolepsy is ascribed to a dissociated REM sleep phenomenon [40] for their frequent occurrence at the transition between wakefulness and REM sleep together with their association with sleep paralysis.…”

Section: Discussionsupporting

confidence: 82%

Schizophrenia-Like Symptoms in Narcolepsy Type 1: Shared and Distinctive Clinical Characteristics

et al. 2015

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Background/Aims: The occurrence of psychotic symptoms in narcolepsy type 1 (NT1) has been reported as responsible for delayed diagnosis due to the misdiagnosis of schizophrenia. This study aimed to identify shared and distinctive clinical characteristics between NT1 and schizophrenia, with the focus on psychotic symptoms. Methods: A total of 28 NT1 and 21 schizophrenia patients were included. Hallucination characteristics and PANSS (Positive and Negative Syndrome Scale), HRSD (Hamilton Rating Scale for Depression), DES (Dissociative Experiences Scale), and STAI (State-Trait Anxiety Inventory) scores were collected. Symptom overlap was investigated by χ², Fisher's or t tests and multiple logistic regression models. Results: Hallucinations and illusions frequently occurred in both diseases. Unimodal hallucinations were more common in schizophrenia (p = 6.30e-07) and multimodal hallucinations in NT1, but no clear difference was identified in their sensory modality. Hypnagogic/hypnopompic hallucinations were typical of NT1 (p = 5.22e-07), and 25% of NT1 patients exhibited some degree of insight deficit. Hypnagogic/hypnopompic hallucinations, unimodal hallucinations and PANSS score were the most distinctive clinical characteristics. Clinical overlap was found in the dissociative and anxiety domains, while higher depressive scores were observed in schizophrenia. Conclusion: The overlap between NT1 and schizophrenia should be further investigated under a clinical and pathogenetic point of view to improve diagnostic and therapeutic approaches.

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Section: Discussionsupporting

confidence: 82%

Schizophrenia-Like Symptoms in Narcolepsy Type 1: Shared and Distinctive Clinical Characteristics

et al. 2015

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“…However, its frequency remains unknown, and results are highly variable between studies, ranging from 1% to 10% 3 6 7 8 9 . Due to some overlapping symptoms (e.g., hallucinations) and similar age of onset for both conditions, patients with schizophrenia may be misdiagnosed with narcolepsy, and patients with narcolepsy may be misdiagnosed with psychotic disorders 3 7 14 15 Most patients with narcolepsy have sleep and body posture-related hallucinations, mainly visual or multisensory, and rarely unimodal verbal-auditory or stereotypic 3 7 14 15 16 17 . We found hypnagogic hallucinations in 70% of patients at disease onset, as expected in adults with NT1 1 3 14 , and various auditory stereotypic hallucinations in all patients but one at time of psychotic episode.…”

Section: Discussionmentioning

confidence: 99%

Absence of NMDA receptor antibodies in the rare association between Type 1 Narcolepsy and Psychosis

Dauvilliers

Gaig

Barateau

et al. 2016

Sci Rep

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Frequency and mechanisms underlying the association between narcolepsy type 1 (NT1) and psychosis remain unclear with potential role for a common immune pathway. We estimated the frequency of psychosis and its characteristics in NT1 at two European sleep centers (France, n = 381; Spain, n = 161) and measured IgG autoantibodies that recognize the GluN1 subunit of the NMDAR in 9 patients with NT1 with psychosis, and 25 NT1 patients without psychosis. Ten NT1 patients (6 in France, 4 in Spain) were diagnosed with comorbid psychosis, a frequency of 1.8%. One patient reported psychotic symptoms few months before narcolepsy onset, two patients few months after onset, and one patient one year after onset but after modafinil introduction. The six remaining patients reported long delays between NT1 and psychosis onset. Half the patients, mostly male adults, reported onset or worsening of psychotic symptoms after medication. We found no IgG antibodies to NR1/NR2B heteromers of the NMDARs in patients with NT1 with or without psychosis. To conclude, psychosis is rare in NT1, with limited evidence for a key impact of stimulants, and no association with anti-NMDAR antibodies. However, dramatic NT1 and schizophrenia exists especially in early onset NT1, which may lead to inappropriate diagnosis and management.

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“…Differences between the core symptoms of psychosis and symptoms of narcolepsy have been elaborated elsewhere93 in a study comparing 148 narcolepsy patients, 21 schizophrenic patients, and 128 healthy subjects, which found that episodes of hallucination in narcolepsy were sleep-related and posture-related, and more likely to be visual and kinetic (83% and 71% in narcolepsy, respectively, compared with 29% and 5% in schizophrenia);93 the drawback of the study included discordant sample sizes for the groups, and the groups were also from different populations.…”

Section: Differential Diagnosesmentioning

confidence: 99%

Narcolepsy: a review

Akintomide¹,

Rickards

2011

NDT

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Narcolepsy is a lifelong sleep disorder characterized by a classic tetrad of excessive daytime sleepiness with irresistible sleep attacks, cataplexy (sudden bilateral loss of muscle tone), hypnagogic hallucination, and sleep paralysis. There are two distinct groups of patients, ie, those having narcolepsy with cataplexy and those having narcolepsy without cataplexy. Narcolepsy affects 0.05% of the population. It has a negative effect on the quality of life of its sufferers and can restrict them from certain careers and activities. There have been advances in the understanding of the pathogenesis of narcolepsy. It is thought that narcolepsy with cataplexy is secondary to loss of hypothalamic hypocretin neurons in those genetically predisposed to the disorder by possession of human leukocyte antigen DQB1*0602. The diagnostic criteria for narcolepsy are based on symptoms, laboratory sleep tests, and serum levels of hypocretin. There is no cure for narcolepsy, and the present mainstay of treatment is pharmacological treatment along with lifestyle changes. Some novel treatments are also being developed and tried. This article critically appraises the evidence for diagnosis and treatment of narcolepsy.

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Narcoleptic and schizophrenic hallucinations

Cited by 31 publications

References 22 publications

Schizophrenia-Like Symptoms in Narcolepsy Type 1: Shared and Distinctive Clinical Characteristics

Schizophrenia-Like Symptoms in Narcolepsy Type 1: Shared and Distinctive Clinical Characteristics

Absence of NMDA receptor antibodies in the rare association between Type 1 Narcolepsy and Psychosis

Narcolepsy: a review

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