Narcolepsy and psychotic states--a case report.
Narcolepsy is characterized by symptoms that include excessive sleepiness during the daytime, cataplexy, hypnagogic hallucinations and sleep paralysis. We present a single unusual case report of a patient who was admitted to a psychiatric facility. A 20-year-old single woman was hospitalized in a general hospital due to involuntary movements in her limbs. Following complaints of continual daily sleepiness and instances of a loss of muscle tone she was referred for sleep assessment. The patient was diagnosed with narcolepsy and cataplexy. Later, due to auditory hallucinations she was referred to a psychiatric hospital. Her reality judgement was poor, with partial insight regarding her illness. The patient was treated with methylphenidate 20 mg/day and antipsychotic medication; risperidone of up to 4 mg/day, and paroxetine 20 mg/day to prevent cataplexy. Following further exacerbation, pharmacotherapy was changed to risperidone 6 mg/day and modafinil 200 mg/day. This treatment led to a significant improvement in her condition. The report presented here suggests that combined treatment with a psycho-stimulant drug, an SSRI in combination with antipsychotic treatment, may be indicated in narcolepsy with cataplexy and vivid psychotic production. Multidisciplinary cooperation of neurologists and psychiatrists enabled this therapy to be administered for the patient's benefit.
Melamed
Yuval
Y
Lev Hasharon Mental Health Center, Netanya, Israel. ymelamed@post.tau.ac.il
Daliahu
Yael
Y
Paleacu
Diana
D
D014150:Antipsychotic Agents / Q000627:therapeutic use; D001559:Benzhydryl Compounds / Q000627:therapeutic use; D002385:Cataplexy / Q000175:diagnosis* / Q000188:drug therapy; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D015897:Comorbidity; D004359:Drug Therapy, Combination; D005260:Female; D006212:Hallucinations / Q000175:diagnosis* / Q000188:drug therapy; D006760:Hospitalization; D006801:Humans; D000077408:Modafinil; D009290:Narcolepsy / Q000175:diagnosis* / Q000188:drug therapy; D017374:Paroxetine / Q000627:therapeutic use; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000188:drug therapy; D012017:Referral and Consultation; D018967:Risperidone / Q000627:therapeutic use; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D020188:Sleep Paralysis / Q000175:diagnosis / Q000188:drug therapy; D055815:Young Adult
D014150:Antipsychotic Agents; D001559:Benzhydryl Compounds; D000697:Central Nervous System Stimulants; D000077408:Modafinil; D017374:Paroxetine; D018967:Risperidone; D017367:Selective Serotonin Reuptake Inhibitors