Psychosomatic Aspects of Narcolepsy

Smith, Colin M (1958) Psychosomatic Aspects of Narcolepsy. MD thesis, University of Glasgow.

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1. After a brief discussion of the nature of psychosomatic illness and of sleep, the literature on narcolepsy was reviewed. The term narcolepsy was defined and its history discussed. 2. It was pointed out that, while most cases of narcolepsy were "idiopathic", there was much evidence suggesting an underlying pathophysiological disturbance probably in the region of the reticular activating system. 3. It was added that there was much evidence suggesting that emotional factors could precipitate if not engender the condition. There seemed to be no justification for regarding the condition as an hysterical one. 4. The literature on neurotic somnolence was discussed. The psychogenic hypersomnias were divided into two groups viz. (a) prolonged trance states in which sleep was probably intermittent. (b) shorter attacks of what was probably genuine sleep, rarely of more than a days duration provoked by extreme weariness in the face of severe neurotic conflicts. It was argued that both groups were quite distinct from true narcolepsy. In addition, much briefer spells of hysterical "sleep" (usually lasting only for minutes) were considered. Evidence was presented for these being trance states rather than physiological sleep. 5. Six narcoleptic cases of my own were then presented; these were contrasted with three of my cases of neurotic somnolence. All six narcoleptics showed excessive, intermittent and inappropriate drowsiness both clinically and in the EEG recordings. In four cases, the EEG was taken under hypoglycaemia and showed a definite diminution in the amount of drowsiness. It was argued that this might have been due to central liberation of adrenaline with stimulation of the adrenaline-sensitive part of the reticular activating system. These four patients also showed mild abnormalities of the Exton Rose glucose tolerance test. Clinically all six cases showed some evidence of emotional disturbance in childhood prior to the onset of narcolepsy, and all showed some personality change after the onset of narcolepsy* Psychological tests were definitely abnormal in five of the cases and showed some slight disturbance in the sixth. In five cases, the symptomatology was markedly aggravated by emotional upset and in particular some relationship was noted between the symptoms and inhibited aggression. The three neurotics did not show typical EEG or clinical features of narcolepsy. Only one showed even light drowsiness in the EEG and this was only occasionally present at a time when he could not be roused. Examination of his reflexes did not support the impression that this was a true sleep. 6. One of ray narcoleptic patients showed paranoid schizophrenia arising in intimate association with the sleep hallucinosis. Such cases are extremely rare. The literature was reviewed and the condition discussed. 7. The EEG in four recordings of cataplexy showed no specific change. Some drowsiness appeared. 8. It would be correct to call narcolepsy a psychosomatic Illness. Both somatic and psychological factors are of importance. The latter are important in two ways: (a) They may greatly increase the symptomatology. (b) They influence the way in which the patient handles his illness. It is essential to treat the patient rather than the disease and in many cases psychotherapy is indicated.

Item Type: Thesis (MD)
Qualification Level: Doctoral
Keywords: Medicine, Psychobiology
Date of Award: 1958
Depositing User: Enlighten Team
Unique ID: glathesis:1958-79279
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 05 Mar 2020 11:07
Last Modified: 05 Mar 2020 11:07

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