title: Effect of psychostimulants on impulsivity and risk taking in narcolepsy with cataplexy.
abstract: OBJECTIVE
  To investigate the effect of psychostimulants on impulsivity, depressive symptoms, addiction, pathological gambling, and risk-taking using objective sensitivity tests in narcolepsy with cataplexy (NC). Drug-free patients with NC present alterations in reward processing, but changes with psychostimulants remain unknown.
  
  
  METHODS
  Prospective case-control study.
  
  
  METHODS
  Academic sleep disorders center.
  
  
  METHODS
  There were 120 participants: 41 drug-free patients with NC, 37 patients with NC taking psychostimulants, and 42 matched healthy controls.
  
  
  METHODS
  All participants underwent a semistructured clinical interview for impulse control and addictive behaviors and completed questionnaires for depression and impulsivity. Risk taking was analyzed through performance on a decision-making task under ambiguity (Iowa Gambling Task [IGT]) and under risk (Game of Dice Task [GDT]). All patients with NC underwent 1 night of polysomnography followed by a multiple sleep latency test for drug-free patients and a maintenance wakefulness test for treated patients.
  
  
  RESULTS
  Depressive symptoms were higher in drug-free patients than in treated patients and controls, with no difference between controls and treated patients. No between-group differences were found for impulsivity, substance addiction, or pathological gambling. Drug-free and treated patients showed selective reduced performance on the IGT and normal performance on the GDT compared with controls, with no differences between patients taking medication and those who did not. No clinical or polysomnographic characteristics or medication type was associated with IGT scores.
  
  
  CONCLUSIONS
  Our results demonstrated that, whether taking psychostimulants or not, patients with narcolepsy with cataplexy preferred risky choices on a decision-making task under ambiguity. However, the lack of association with impulsivity, pathological gambling, or substance addiction remains of major clinical interest in narcolepsy with cataplexy.
authors.affiliation: Service de Neurologie, Unité des Troubles du Sommeil, Hôpital Gui-de-Chauliac Montpellier, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Bayard
authors.forename: Muriel Croisier
authors.initials: MC
authors.lastname: Langenier
authors.forename: Yves
authors.initials: Y
authors.lastname: Dauvilliers
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D000697:Central Nervous System Stimulants / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007175:Impulsive Behavior / Q000139:chemically induced*; D008297:Male; D009290:Narcolepsy / Q000188:drug therapy* / Q000523:psychology; D017286:Polysomnography; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011581:Psychological Tests; D012309:Risk-Taking
chemical_list: D000697:Central Nervous System Stimulants
keywords: Addiction; Game of Dice Task; Iowa Gambling Task; decision making; hypocretin; impulsivity; narcolepsy; pathological gambling; stimulant