Differential diagnosis of recurrent hypersomnia. Case report of primary narcolepsy and acute transient psychotic attack

Abstract

Introduction

We report a case of 17-year-old boy with excessive daytime sleepiness.

Objectives

Case presented in our study is an example of atypical narcolepsy with coexistence of psychotic symptoms that were especially prominent during the first attack. Excessive daytime sleepiness period was followed by psychotic symptoms including delusions of reference and persecution, as well as visual and acoustic hallucinations. However, during the second attack, negative psychotic symptoms were more prominent.

Aims

Clinicians should not forget that child and adolescent patients, which demonstrate psychotic symptoms and excessive daytime sleepiness component, should be evaluated for a diagnosis of primary hypersomnia.

Method

Patient did not exhibit any comorbidities that would match with secondary hypersomnia. The initial sleep study did however reveal increased REM sleep latency (43% of total sleep time). The result of polysomnographic study was abnormal and suggestive of narcolepsy. In multi-sleep latency test mean REM latency was 1.7 min, sleep-onset REM (SOREM) was observed 3 times. Between the tests he had no episodes of cataplexy.

Result

Patient was diagnosed with primary hypersomnia-narcolepsy without cataplexy. We found that mixed symptoms of narcolepsy and psychotic attack improved with anti-psychotic agent treatment.

Conclusion

Child and adolescent patients, which demonstrate psychotic symptoms and excessive daytime sleepiness component, should be evaluated for a diagnosis of primary hypersomnia following a multidisciplinary cooperation of neurologists, pediatricians and psychiatrists.

Disclosure of interest

The authors have not supplied their declaration of competing interest.