Case study: psychiatric misdiagnosis of non-24-hours sleep-wake schedule disorder resolved by melatonin.
This case study describes a 14-year-old male suffering from significant academic and personal difficulties, who has been diagnosed with depression, schizotypal personality disorder, and learning disabilities. Because of excessive sleepiness, assessment for a potential sleep disorder was performed. An overnight polysomnographic study revealed no primary sleep disorders. Wrist actigraphy revealed a non-24-hour sleep-wake pattern. Delay in temperature rhythm and dissociation with melatonin rhythms were also noted. Treatment with oral melatonin restored normal sleep-wake schedule. In a follow-up psychiatric evaluation, none of the above diagnoses were present. Greater awareness of sleep disorders may prevent psychiatric misdiagnosis of treatable sleep-wake schedule disorders.
Dagan
Yaron
Y
Institute for Fatigue and Sleep Medicine, Sheba Medical Center, Tel-Hashomer, Israel. daganyar@sheba.health.gov.il
Ayalon
Liat
L
D000293:Adolescent; D003866:Depressive Disorder / Q000097:blood / Q000175:diagnosis; D003951:Diagnostic Errors; D006970:Disorders of Excessive Somnolence / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D007859:Learning Disabilities / Q000097:blood / Q000175:diagnosis; D008297:Male; D008550:Melatonin / Q000097:blood / Q000627:therapeutic use*; D009043:Motor Activity / Q000187:drug effects; D017286:Polysomnography; D012569:Schizotypal Personality Disorder / Q000097:blood / Q000175:diagnosis; D020178:Sleep Disorders, Circadian Rhythm / Q000097:blood / Q000175:diagnosis*
D008550:Melatonin