Pemoline administration was discontinued and haloperidol (3 mg) was added. When the patient was 53 years of age, she was hospitalized because of aggravated auditory hallucinations and delusion of observation. In the patient’s clinical course, the delusional state, especially delusion of reference, tended to be aggravated in correlation with her hypnopompic hallucinations and cataplexy. After medication, no SOREMP was observed by PSG, and there were no symptoms of narcolepsy. 1) although the patient refused to take them. Human leukocyte antigen (HLA) typing showed DR15, DQ1, and DR1.Ģ Pemolin and clomipramine were recommended (įig. Multiple sleep latency test (MSLT) showed shortened average sleep latency (< 5 min) and REM latency (< 20 min). Polysomnography (PSG) performed on the first visit to our department showed sleep-onset rapid eye movement (REM) period (SOREMP). Her narcoleptic symptoms, including excessive daytime sleepiness and cataplexy, had developed since the age of 20 years. 1 Her past history was remarkable for psychotic episodes as she had experienced auditory hallucinations and delusion of observation, which improved immediately with haloperidol administration at the age of 41 years. CASE REPORTĪ 51-year-old female was referred to our psychiatric clinic because of sleep attacks, sleep paralysis and hypnopompic hallucinations, and cataplexy. The following provides a report of the therapeutic and diagnostic process. We encountered a patient with narcolepsy in whom hallucinations and delusion recurred during the treatment course. Hallucinations and delusion in narcoleptic patients have been considered to be a state secondary to hypnagogic hallucinations, a side-effect of central nervous system stimulant medication or a complication of schizophrenia. Hallucinations and delusion are sometimes seen in narcoleptic patients. No severe side effects were observed.Narcolepsy is characterized by symptoms including excessive daytime sleepiness, cataplexy, hypnagogic hallucinations and sleep paralysis. Venlafaxine has proven to be an effective treatment of cataplexy and hypnagogic hallucinations in 6 children with narcolepsy. No major aggressive or suicidal thoughts and no raised blood pressure were recorded. Side effects included an increase of disturbed nocturnal sleep when venlafaxine was taken after 2:00 p.m. In 2 cases, hypnagogic hallucinations, described by the patients as nightmares, were the most troubling symptom and were successfully treated with only 37.5 mg of venlafaxine daily. A third patient with partial cataplexy was treated with 75 mg of venlafaxine daily. However, during the first year, the dose had to be increased to 112.5 mg daily to avoid cataplexy. In 2 cases with up to 50 daily cataplectic attacks, an initial effect of 37.5 mg of venlafaxine was initially observed. We describe clinical case reports of venlafaxine treatment in 6 children aged 7-12 years old when diagnosed with narcolepsy-cataplexy. These drugs have become our choice in treating children with cataplexy and nightmares as a symptom in narcolepsy. Recently, new drugs that block the reuptake of norepineprine and serotonin (e.g., venlafaxine) have been suggested as first-line treatment. So far, pharmacotherapy of cataplexy and hypnagogic hallucinations has been predominantly based on tricyclic antidepressants. Cataplexy is marked by episodes of muscular weakness and may cause the patient to collapse to the ground. The main symptoms are excessive daytime sleepiness, cataplexy, hypnagogic hallucinations, and disturbed nocturnal sleep. Narcolepsy with cataplexy is a chronic neuropsychiatric disorder associated with inappropriate control of rapid eye movement (REM) sleep.
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