Psych Vivas · Specialty psychiatry — sleep medicine interface
Narcolepsy and hypersomnolence — structured clinical viva
Fellowship viva on NT1: cataplexy vs conversion, MSLT, modafinil/oxybate, driving, psychiatric mislabeling.
On this page
Study tools
Target exams
FRANZCPMRCPsychABPNMD-DNB
Prompt
You are the psychiatry registrar. A 28-year-old with residual MDD is referred for 'conversion collapses' and 'psychotic visual experiences at night.' History reveals laughter-triggered bilateral atonia with preserved awareness, irresistible daytime sleep attacks, hypnagogic images with insight, and two occupational near-misses. Discuss diagnostic hierarchy, orexin pathophysiology, MSLT rules, first-line EDS and cataplexy treatment with doses/monitoring, driving advice, and traps that lead to antipsychotic over-treatment.
Interpretation
Reveal interpretationShowHide
This is narcolepsy type 1 until proven otherwise: EDS plus classic cataplexy, hypnagogic hallucinations with insight, and occupational risk. “Conversion” and “psychosis” are mislabels until the sleep diagnosis is confirmed. Immediate priorities: driving safety, sleep-medicine work-up, and targeted wake/cataplexy therapy — not depot antipsychotics for sleep-bound phenomena.[1][2]
References8ShowHide
- [1]Scammell TE Narcolepsy N Engl J Med, 2015.PMID 26716917
- [2]Dauvilliers Y, Arnulf I, Mignot E Narcolepsy with cataplexy Lancet, 2007.PMID 17292770
- [3]Littner MR, Kushida C, Wise M, et al. Practice parameters for clinical use of the multiple sleep latency test and the maintenance of wakefulness test Sleep, 2005.PMID 15700727
- [4]Maski K, Trotti LM, Kotagal S, et al. Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine clinical practice guideline J Clin Sleep Med, 2021.PMID 34743789
- [5]Bassetti CLA, Kallweit U, Vignatelli L, et al. European guideline and expert statements on the management of narcolepsy in adults and children J Sleep Res, 2021.PMID 34173288
- [6]Nishino S, Ripley B, Overeem S, et al. Hypocretin (orexin) deficiency in human narcolepsy Lancet, 2000.PMID 10615891
- [7]US Modafinil in Narcolepsy Multicenter Study Group Randomized trial of modafinil as a treatment for the excessive daytime somnolence of narcolepsy Neurology, 2000.PMID 10720292
- [8]US Xyrem Multicenter Study Group A randomized, double blind, placebo-controlled multicenter trial comparing the effects of three doses of orally administered sodium oxybate with placebo for the treatment of narcolepsy Sleep, 2002.PMID 11833860