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发作性睡病与精神分裂症均可起病于青少年期,睡眠相关幻觉、行为异常与精神病性症状存在一定重叠,易造成误诊或漏诊。本文报道1例15岁男性发作性睡病共病精神分裂症患者,主要表现为日间不可控思睡、睡眠相关幻觉及清醒期精神病性症状。经整夜多导睡眠监测及日间多次睡眠潜伏期试验支持发作性睡病诊断,同时结合持续性幻觉、妄想及社会功能受损等表现,诊断为发作性睡病共病精神分裂症。予替洛利生联合利培酮、阿立哌唑及呼吸机治疗后,患者日间思睡及精神病性症状均较前改善。本例提示,青少年顽固性日间思睡伴精神病性症状时,应重视睡眠障碍与精神病性障碍的鉴别及共病可能,必要时完善PSG/MSLT等客观检查,并在兼顾觉醒改善和精神症状控制的基础上制定个体化治疗方案。
Abstract：Both narcolepsy and schizophrenia may have their onset during adolescence.Considerable clinical overlap exists between sleep-related hallucinations,behavioral disturbances,and psychotic symptoms,which frequently leads to misdiagnosis or missed diagnosis.This case report presents a 15-year-old male patient diagnosed with comorbid narcolepsy and schizophrenia,who presented primarily with excessive daytime sleepiness,sleep-related hallucinations,and waking psychotic symptoms.The diagnosis of narcolepsy was confirmed by overnight polysomnography(PSG) and the Multiple Sleep Latency Test(MSLT).Given the patient' s persistent hallucinations,delusions,and impaired social functioning,the final diagnosis of comorbid narcolepsy and schizophrenia was established.After treatment with pitolisant,risperidone,aripiprazole,and ventilatory support,the patient showed improvements in both excessive daytime sleepiness and psychotic symptoms relative to baseline.This case underscores the importance of differentiating sleep disorders from psychotic disorders and considering potential comorbidity when adolescents present with persistent excessive daytime sleepiness and concurrent psychotic symptoms.Objective assessments including PSG and MSLT should be performed when clinically indicated,and individualized treatment strategies should be developed to address both wakefulness promotion and psychiatric symptom management.
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基本信息:
中图分类号:R749.3;R740
引用信息:
[1]马湘雲,陈颖,王三旺,等.发作性睡病共病精神分裂症1例[J].中国药物依赖性杂志().
基金信息:
上海陈天桥脑健康研究所发作性睡病和精神分裂症共病病例随访研究项目
2026-08-18
2026-08-18
2026-08-18