A Rare Case of Visual Hallucinations Associated With Hyponatremia

Visual hallucinations are rare occurrences in patients presenting with hyponatremia. When they occur, the patient experiences these hallucinations with their eyes closed (vs. opened) and is insightful about the false perception. We present the case of a 64-year-old male diagnosed with hyponatremia caused by a gastrointestinal illness, which led to visual hallucinations. The patient was treated with electrolyte infusion, and the hallucinations were resolved. Detailed history-taking is significant when dealing with such cases as hallucinations to differentiate it from other causes. Hallucination caused by hyponatremia can resolve with prompt correction of sodium, and the patients can be reassured.

The hypnagogic state: A brief update

The hypnagogic state refers to a transitional stage between wakefulness and sleep, in which sensory perceptions can be experienced. In this review, we compile and discuss the recent scientific literature on hypnagogia research regarding the future directions proposed by Schacter (1976; Psychological Bulletin, 83, 452). After a short introduction discussing the terminology used in hypnagogia research and the differentiation of hypnagogic states with other related phenomena, we review the reported prevalence of hypnagogic states. Then, we evaluate the six future directions suggested by Schacter and we propose three further future directions. First, a better understanding of the emotional quality of hypnagogic states is needed. Second, a better understanding of why hypnagogic states occur so frequently in the visual and kinaesthetic modalities is needed. Lastly, a better understanding of the purpose of hypnagogic states is needed. In conclusion, research has made great progress in recent years, and we are one step closer to demystifying the hypnagogic state.

Creativity in Narcolepsy Type 1: The Role of Dissociated REM Sleep Manifestations

PURPOSE

A higher creative potential has been reported in narcoleptic patients and linked to lucid dreaming. The aim of the present study was to explore the role of narcolepsy symptoms (presence and severity) in predicting creativity.

PATIENTS AND METHODS

Sixty-six consecutive type 1 narcolepsy patients (mean age 38.62 ± 17.05, 31 females) took part in this study. Creative achievement in different life domains and creative beliefs were assessed by a self-reported questionnaire and a scale measuring the creative self, respectively; creative performance was measured through a divergent thinking test (generation of alternative original solutions to an open problem).

RESULTS

We found a key effect of hypnagogic hallucinations in modulating creative behaviour. We therefore tested at first whether hypnagogic hallucinations could interact with specific mental states associated with creativity and in particular mind wandering, a factor associated with both creative performance and achievement. Secondly, we verified if hypnagogic hallucinations could influence the definition of creative identity in type 1 narcolepsy patients, which in turn could predict their creative achievement and creative performance. Results showed that spontaneous mind wandering influenced creative achievement through a moderation effect of sleep paralysis and hypnagogic hallucinations. Moreover, sleep paralysis and hypnagogic hallucinations indirectly influenced, through creative identity, both creative achievement and performance (fluency score).

CONCLUSION

Our results highlight the role of hypnagogic hallucinations in triggering the process of mind wandering which leads to greater creative success. In addition, this symptom affects creative identity in narcolepsy, leading in turn to higher creative success and creative potential of narcoleptic patients.

Arousal in Nocturnal Consciousness: How Dream- and Sleep-Experiences May Inform Us of Poor Sleep Quality, Stress, and Psychopathology

The term "sleep experiences," coined by Watson (2001), denotes an array of unusual nocturnal consciousness phenomena; for example, nightmares, vivid or recurrent dreams, hypnagogic hallucinations, dreams of falling or flying, confusional arousals, and lucid dreams. Excluding the latter, these experiences reflect a single factor of atypical oneiric cognitions ("general sleep experiences"). The current study is an opinionated mini-review on the associations of this factor-measured with the Iowa sleep experiences survey (ISES, Watson, 2001)-with psychopathological symptoms and stress. Findings support a strong relation between psychological distress and general sleep experiences. It is suggested that that they should be viewed as a sleep disturbance; they seem to represent involuntary intrusions of wakefulness into sleep, resulting in aroused sleep. These intrusions may stem from excessively thin boundaries between consciousness states (e.g., "transliminality"), or, conversely, they may follow an attempt at disconnecting mental elements (e.g., dissociation), which paradoxically results in a "rebound effect." The extent to which unusual dreaming is experienced as intrusive, rather than controlled, may explain why general sleep experiences are related to psychopathology, whereas lucid dreams are related to psychological resilience. In conclusion, the exploration of the interplay between psychopathology and sleep should be expanded from focusing almost exclusively on quantitative aspects (e.g., sleep efficiency, latency) to including qualitative conscious experiences which may reflect poor sleep quality. Taking into account nocturnal consciousness-including unusual dreaming and permeable sleep-wake boundaries-may unveil rich information on night-time emotional states and broaden our definition of poor sleep quality.

Case report of narcolepsy in a six-year-old child initially misdiagnosed as atypical epilepsy

Summary

This report describes a case of first-onset narcolepsy in a six-year-old female that was misdiagnosed as atypical epilepsy and other diagnoses at eight different hospitals over a period of 10 months before the correct diagnosis was made. The diagnosis of narcolepsy is more difficult in children because very few of them experience all four cardinal symptoms of narcolepsy – paroxysmal sleep, cataplexy, hypnagogic hallucination, and sleep paralysis – and they often have a more prolonged onset and diverse symptoms. To decrease the time lag between initial presentation and accurate diagnosis, we recommend that in all cases in which children report excessive sleep of unknown etiology – regardless of the associated symptoms – that sleep monitoring and sleep latency tests be conducted to rule out the possibility of narcolepsy. The case highlights the wide variety of presentations of uncommon psychiatric conditions, particularly in children, and the need for clinicians to be aware of the atypical presentations of these conditions when collecting medical histories.

Depression: relationships to sleep paralysis and other sleep disturbances in a community sample

Sleep disturbances are important correlates of depression, with epidemiologic research heretofore focused on insomnia and sleepiness. This epidemiologic study's aim was to investigate, in a community sample, depression's relationships to other sleep disturbances: sleep paralysis (SP), hypnagogic/hypnopompic hallucinations (HH), cataplexy - considered rapid eye movement-related disturbances - and automatic behavior (AB). Although typical of narcolepsy, these disturbances are prevalent, albeit under-studied, in the population. Cross-sectional analyses (1998-2002), based on Wisconsin Sleep Cohort Study population-based data from 866 participants (mean age 54, 53% male), examined: depression (Zung Self-Rating Depression Scale), trait anxiety (Spielberger State-Trait Anxiety Inventory, STAI-T >or= 75th percentile), and self-reported sleep disturbances. Descriptive sleep data were obtained by overnight polysomnography. Adjusted logistic regression models estimated depression's associations with each (>few times ever) outcome - SP, HH, AB, and cataplexy. Depression's associations with self-reported SP and cataplexy were not explained by anxiety. After anxiety adjustment, severe depression (Zung >or=55), vis-à-vis Zung <50, increased SP odds approximately 500% (P = 0.0008). Depression (Zung >or=50), after stratification by anxiety given an interaction (P = 0.02), increased self-reported cataplexy odds in non-anxious (OR 8.9, P = 0.0008) but not anxious (OR 1.1, P = 0.82) participants. Insomnia and sleepiness seemed only partial mediators or confounders for depression's associations with self-reported cataplexy and SP. Anxiety (OR 1.9, P = 0.04) partially explained depression's (Zung >or=55) association with HH (OR 2.2, P = 0.08). Anxiety (OR 1.6, P = 0.02) was also more related than depression to AB. Recognizing depression's relationships to oft-neglected sleep disturbances, most notably SP, might assist in better characterizing depression and the full range of its associated sleep problems in the population. Longitudinal studies are warranted to elucidate mediators and causality.