Anxiety and mood disorders in narcolepsy: a case–control study
Received 12 May 2009; accepted 31 August 2009. published online 05 October 2009.
Abstract
Introduction
Narcolepsy is a primary sleeping disorder with excessive daytime sleepiness and cataplexy as core symptoms. There is increasing interest in the psychiatric phenotype of narcolepsy. Although many authors suggest an overrepresentation of mood disorders, few systematic studies have been performed and conflicting results have been reported. Anxiety disorders in narcolepsy have only received little attention.
Methods
We performed a case–control study in 60 narcolepsy patients and 120 age- and sex-matched controls from a previous population study. The Schedules for Clinical Assessment in Neuropsychiatry were used to assess symptoms and diagnostic classifications of mood and anxiety disorders.
Results
Symptoms of mood disorders were reported by about one third of patients. However, the prevalence of formal mood disorder diagnoses — including major depression — was not increased. In contrast, more than half of the narcolepsy patients had anxiety or panic attacks. Thirty-five percent of the patients could be diagnosed with anxiety disorder (odds ratio=15.6), with social phobia being the most important diagnosis. There was no influence of age, sex, duration of illness or medication use on the prevalence of mood or anxiety symptoms and disorders.
Discussion
Anxiety disorders, especially panic attacks and social phobias, often affect patients with narcolepsy. Although symptoms of mood disorders are present in many patients, the prevalence of major depression is not increased. Anxiety and mood symptoms could be secondary complications of the chronic symptoms of narcolepsy. Recent studies have shown that narcolepsy is caused by defective hypocretin signaling. As hypocretin neurotransmission is also involved in stress regulation and addiction, this raises the possibility that mood and anxiety symptoms are primary disease phenomena in narcolepsy.
aDepartment of Psychiatry, Nijmegen Centre for Evidence-Based Practice, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
bDepartment of Social Medicine, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
cDepartment of Clinical Health Psychology, Tilburg University, P.O. Box 90153, Tilburg, The Netherlands
dInstitute for Mental Health Care Breburg Group, P.O. Box 770, 5000 AT, Tilburg, The Netherlands
eDepartment of Neurology, Canisius Wilhelmina Ziekenhuis, P.O. Box 9015, 6500 GS Nijmegen, The Netherlands
fDepartment of Neurology, Donders Institute for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
gSleep Medicine Centre ‘Kempenhaeghe’, P.O. Box 61, 5590 AB, Heeze, The Netherlands
ABSTRACT