SCHIZOPHRENIA, NARCOLEPSY, AND HLA-DR15, DQ6

A strong association between HLA-DR2, DQ1 and narcolepsy-cataplexy has been known since 1986. In 1990 a subdivision (HLA-DR15, DQ6) was show n to be equally associated. Narcolepsy symptoms include rapid eye move ment (REM)-sleep intrusion hallucinations during the day. Some narcole ptics may be so hallucinated that they become delusional and receive a diagnosis of schizophrenia. Fifty-six inpatient schizophrenics and 56 normal controls were compared to see if there was an excess of the na rcolepsy-associated antigens (NAA) among schizophrenics. Patients had frequency of the NAA 3.89 times higher than controls. After a subset w as studied by night (n = 9) and day (n = 7) polysomnography, two patie nts were found to be true narcoleptics. Their psychosis improved with treatment for narcolepsy. When NAA(+) and NAA(-) schizophrenics were c ompared, the NAA(+) subgroup had significantly higher Brief Psychiatri c Rating Scale (BPRS) scores and more hospitalizations. There were no effects attributable only to gender or race. We conclude that narcolep sy can simulate schizophrenia in some cases, and that even in nonnarco leptic patients, the HLA-DR15,DQ6 antigens mark a group of severe schi zophrenics that merits further study.