sodium-oxybate and Psychotic-Disorders

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.. 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.. 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.. 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.

Topics: Adolescent; Antipsychotic Agents; Attention Deficit Disorder with Hyperactivity; Benzhydryl Compounds; Female; Food Addiction; Hallucinations; Haloperidol; HLA-DQ beta-Chains; Humans; Learning Disabilities; Methylphenidate; Modafinil; Narcolepsy; Orexins; Pediatric Obesity; Polysomnography; Psychotic Disorders; Risperidone; Sleep Deprivation; Sleep Latency; Social Isolation; Sodium Oxybate; Suicidal Ideation

Sodium oxybate (brand name Xyrem) is a sodium salt of gamma-hydroxybutyric acid (GHB), an endogenous CNS depressant, which is an effective treatment of narcolepsy. As a drug of abuse, GHB produces severe psychiatric side effects and withdrawal. However, there are no reports of these effects when using clinically recommended doses. This paper presents a case of a patient who developed altered mental status while taking the recommended dose of sodium oxybate and subsequently became psychotic upon abrupt discontinuation of the medication. It is important for prescribers of sodium oxybate to be aware of the possibility of significant psychiatric side effects of this medication, as well as withdrawal symptoms, even at clinical doses.

Topics: Adult; Central Nervous System Depressants; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Narcolepsy; Psychotic Disorders; Risk Assessment; Severity of Illness Index; Sodium Oxybate; Substance Withdrawal Syndrome

Topics: 3-Hydroxybutyric Acid; Cerebrovascular Circulation; Dementia; Drug Therapy; Electric Impedance; Electroencephalography; Geriatrics; Humans; Hydroxybutyrates; Intracranial Arteriosclerosis; Niacin; Nicotinic Acids; Plethysmography; Plethysmography, Impedance; Psychotic Disorders; Sodium; Sodium Oxybate; Vasodilator Agents