Narcolepsy-cataplexy and psychosis: a case study. / Narcolepsia-cataplejia y psicosis: estudio de un caso.

AIMS: To report a challenging patient a girl who developed narcolepsyy with cataplexy (NT1) and a psychosis during adolescence. To discuss diagnostic and therapeutic challenges of the comorbid cases. CASE REPORT: A 14-year-old girl was referred to Sleep and Epilepsy Unit for excessive daytime sleepiness, impaired nocturnal sleep, binge eating and weight gain, over the last year. After being diagnosed with a NT1 the patient was treated with modafinil and sodium oxybate. She was hospitalized for psychotic symptoms after starting NT1 treatment. Withdrawal of the narcolepsy treatment and initiation of haloperidol 1 mg/day (the only antipsychotic treatment she could tolerate) improved the delusions, hallucinations and dysphoria but worsened the narcolepsy symptoms. Polysomnography showed fragmented nocturnal sleep and five sleep REM onset periods in MSLT. Positive HLA-QB1*06:02 and undetectable level of hypocretine in the cerebrospinal fluid were found. MRI and CT-scan were normal. Diagnostic Interview for Genetic Studies Adapted for Narcolepsy (DIGSAN) questionnaire confirmed that patient presented a dual diagnostic NT1 and psychotic symptoms. The last sleep follow-up while on psychopharmacological treatment, showed an increased sleep efficiency index. She currently has severe somnolence, obesity, and partial cataplectic attacks along with normal mood, academic failure and social isolation. CONCLUSION: The coexistence of narcolepsy with psychoses is a rare clinical entity, more frequent in adolescents than in adults. The comorbidity of the two illnesses worsens clinical and therapeutic prognosis and also suggests interesting pathophysiological hypotheses.

TITLE: Narcolepsia-cataplejia y psicosis: estudio de un caso.Objetivo. Describir una paciente que en la adolescencia desarrollo narcolepsia con cataplejia (NT1) y psicosis. Caso clinico. Niña de 14 años remitida a la unidad de sueño por presentar somnolencia diurna, sueño nocturno fragmentado, hambre compulsiva y aumento de peso durante el ultimo año. Tratada inicialmente con modafinilo y oxibato sodico, tuvo que ser hospitalizada por presentar sintomas psicoticos. Se suprimio el tratamiento antinarcoleptico y se administraron antipsicoticos. El unico que tolero fue el haloperidol 1 mg/dia, con mejoria del delirio, las alucinaciones y los sintomas disforicos, pero con empeoramiento de los sintomas narcolepticos. La polisomnografia mostro un sueño nocturno muy fragmentado, y en la prueba de latencias multiples del sueño, la latencia de sueño fue de un minuto, y tuvo cinco adormecimientos directos en la fase del sueño REM. Presentaba HLA-DQB1*06:02 positivo y nivel de hipocretina-1 en el liquido cefalorraquideo indetectable. La entrevista diagnostica para estudios geneticos adaptada para narcolepsia (DIGSAN) ayudo a confirmar que presentaba una doble patologia de NT1 y sintomas psicoticos. La ultima revision de su sueño con tratamiento psicofarmacologico muestra un aumento del indice de eficacia del sueño. Clinicamente presenta somnolencia diurna excesiva, ataques parciales de cataplejia y una obesidad muy importante. No muestra alteraciones del humor, pero tiene fracaso escolar y aislamiento social. Conclusion. La coexistencia de narcolepsia con psicosis es una entidad clinica rara, mas frecuente en adolescentes que en adultos. La comorbilidad de ambas enfermedades tiene un mal pronostico clinico y terapeutico, y sugiere hipotesis fisiopatologicas interesantes.

Cannibalism in paranoid schizophrenia: a case report.

In ancient times, cannibalism was deemed acceptable for reasons of survival when faced with extreme need or for religious or magic reasons. In today's society, these cases are extremely rare and are generally associated with severe mental illness. We present a case of cannibalism in an individual with schizophrenia. The patient who lacked insight into his illness admitted to committing acts of cannibalism and offered in-depth explanations of the procedures used to prepare the bodies. He made statements on television and to the press and was given the nickname of "the people-eater", an identity he readily accepted and integrated into his system of delusions. Cases of this nature are exceedingly unusual, but the fact that people with schizophrenia commit uncommon, unpredictable crimes attracts the media. This circumstance not only interferes with the natural course of the disease, but also affects the therapeutic behavior and how the patient is perceived by society.