title: Psychiatric comorbidity and cognitive profile in children with narcolepsy with or without association to the H1N1 influenza vaccination.
abstract: OBJECTIVE
  To evaluate psychiatric comorbidity and the cognitive profile in children and adolescents with narcolepsy in western Sweden and the relationship of these problems to H1N1 vaccination.
  
  
  METHODS
  Thirty-eight patients were included in the study.
  
  
  METHODS
  We performed a population-based, cross-sectional study to investigate psychiatric comorbidity using a test battery of semistructured interviews generating Diagnostic and Statistical Manual of Mental Disorders, 4th Edition diagnoses, including the Development and Well-Being Assessment and the attention deficit hyperactivity disorder rating scale. The Autism Spectrum Screening Questionnaire and the Positive and Negative Syndrome Scale were used to screen for autistic traits and psychotic symptoms, respectively. The cognitive assessments were made by a clinical psychologist using the Wechsler Preschool and Primary Scale of Intelligence, Third Edition, the Wechsler Intelligence Scale for Children, Fourth Edition, or the Wechsler Adult Intelligence Scale, Fourth Edition.
  
  
  RESULTS
  In the post-H1N1 vaccination (PHV) narcolepsy group (n = 31), 43% of patients had psychiatric comorbidity, 29% had attention deficit hyperactivity disorder (ADHD) inattentive type, 20% had major depression, 10% had general anxiety disorder, 7% had oppositional defiant disorder (ODD), 3% had pervasive developmental disorder not otherwise specified (i.e., atypical autism), and 3% had eating disorder not otherwise specified (anorectic type). In the non-post-H1N1 vaccination (nPHV) narcolepsy group, one of seven patients had ADHD, inattentive type and ODD. The most frequent psychiatric symptom was temper tantrums, which occurred in 94% of the patients in the PHV group and 71% of the patients in the nPHV narcolepsy group. The cognitive assessment profile was similar in both groups and showed normal results for mean full-scale IQ and perceptual speed but decreased verbal comprehension and working memory. Patients with psychiatric comorbidity had a significantly lower full-scale IQ compared to those without.
  
  
  CONCLUSIONS
  Our study indicates increased psychiatric comorbidity in children and adolescents with narcolepsy. The identified cognitive profile with significantly lower verbal comprehension and working memory compared with the normal mean index could have important implications for social relations and schooling. The small numbers of patients with nPHV narcolepsy make it difficult to draw firm conclusions about the possible differences between the two groups of patients.
authors.affiliation: Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.|Department of Pediatrics, Halmstad County Hospital, Halmstad, Sweden.
authors.forename: Attila
authors.initials: A
authors.lastname: Szakács
authors.affiliation: Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Tove
authors.initials: T
authors.lastname: Hallböök
authors.affiliation: Lund Child and Youth Habilitation Center, Lund, Sweden.
authors.forename: Pontus
authors.initials: P
authors.lastname: Tideman
authors.affiliation: Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Niklas
authors.initials: N
authors.lastname: Darin
authors.affiliation: Gillberg Neuropsychiatry Center, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Elisabet
authors.initials: E
authors.lastname: Wentz
mesh_terms: D000293:Adolescent; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology / Q000523:psychology; D002648:Child; D002659:Child Development Disorders, Pervasive / Q000453:epidemiology / Q000523:psychology; D002675:Child, Preschool; D003071:Cognition / Q000502:physiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology; D007252:Influenza Vaccines / Q000008:administration & dosage* / Q000276:immunology; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology; D009290:Narcolepsy / Q000453:epidemiology* / Q000523:psychology*; D011618:Psychotic Disorders / Q000453:epidemiology / Q000523:psychology; D013548:Sweden / Q000453:epidemiology; D014611:Vaccination / Q000706:statistics & numerical data*; D014888:Wechsler Scales
chemical_list: D007252:Influenza Vaccines
keywords: children; cognition; narcolepsy; psychiatric comorbidity