发作性睡病1型共病精神分裂症病例报告并文献复习

Narcolepsy Type 1 with Comorbid Schizophrenia: A Case Report and Literature Review

摘要: 此文献报告了1例发作性睡病1型共病精神分裂症的老年女性患者的临床资料。患者临床症状主要为：青少年时期即出现日间过度思睡伴猝倒，症状持续至今，现新增幻觉、妄想、异常言行等精神病性症状。脑脊液下丘脑分泌素明显降低。MSLT试验提示平均睡眠潜伏期2.8 min，出现SOREM 4次。脑脊液下丘脑泌素-1水平测得为12.6 pg/mL。临床诊断为：1) 发作性睡病1型；2) 精神分裂症。予以抗精神病药物及行为治疗后患者幻觉、妄想、异常言行等症状减轻，日间嗜睡时间明显减少。1型发作性睡病与精神分裂症的临床症状存在部分相同或相似，对临床鉴别及诊断造成一定困扰。该文献对两者共病病例进行讨论，以期为两者共病时的临床诊断及治疗提供借鉴。

Abstract: This paper presents a clinical case of a 77-year-old female patient diagnosed with both narcolepsy type 1 and schizophrenia. The patient initially experienced excessive daytime sleepiness (EDS) and cataplexy during adolescence, followed by the onset of hallucinations, delusions, and abnormal behaviors after 60 years. Two MSLT tests were conducted, revealing an average sleep latency of 2.8 minutes and four occurrences of SOREM. The cerebrospinal fluid hypocretin-1 level was measured at 12.6 pg/mL. Clinical diagnoses are: 1) narcolepsy type 1; 2) schizophrenia. Consequently, the patient received antipsychotic medication along with behavioral therapy, resulting in significant improvements in hallucinations, delusions, abnormal behaviors, and daytime sleepiness reduction. Given the overlapping symptoms between type 1 narcolepsy and schizophrenia, accurate diagnosis can be challenging in clinical practice, leading to potential misdiagnosis or missed diagnoses. This case study aims to provide valuable insights for clinicians regarding the diagnosis and treatment approaches for patients presenting with comorbid narcolepsy-schizophrenia.