Case report of a rare case of Kleine Levin Syndrome in Schizophrenia
Keywords:Hypersomnia, Kleine Levin, catatonia, schizophrenia, sleeping beauty syndrome
AbstractKleine Levine syndrome is classically described with hypersomnia, hyperphagia, psychotic features and disinhibited behavior. The patient in question demonstrated several months of psychosis and then presented with features consistent with KLS to the tertiary care center. Extensive evaluation was undertaken to rule out organic causes of the patientâ€™s condition. With features consistent with KLS, the patient was initiated on Lithium with improvement in clinical condition over a course of 2 weeks. In patients presenting with features of KLS it is important to have a high degree of suspicion and initiate therapy with lithium.
Arnulf I, Zeitzer JM, File J, Farber N, Mignot E. Kleine-Levin syndrome: A systematic review of 186 cases in the literature. Brain 2005;128:2763-76.
American Academy of Sleep Medicine. International classification of
sleep disorders, revised: Diagnostic and coding manual. Chicago, Illinois: American
Academy of Sleep Medicine, 2001
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).Jun 21, 2016
Cheung, G. et al. Posttraumatic Kleineâ€“Levin syndrome. General Hospital Psychiatry 28 (2006) 443â€“445
Fenzi F, Simonati A, Crosato F, Ghersini L, Rizzuto N. Clinical features of
Kleineâ€“Levin syndrome with localized encephalitis. Neuropediatrics 1993;
Lobzin VS, Shamrei RK, Churilov Iu K. Pathophysiologic mechanisms of
periodic sleep and the Kleineâ€“Levin syndrome. Zh Nevropatol Psikhiatr
Im S S Korsakova 1973; 73: 1719â€“24
Murthy VS, Kelkar AD, Sonavane SS. Psychosis in a case of Kleine-Levin syndrome: A diagnostic challenge. Indian J Psychol Med 2014;36:192-4.
Sadock, Benjamin J., Harold I. Kaplan, and Virginia A. Sadock. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/clinical Psychiatry. Philadelphia: Wolter Kluwer/Lippincott Williams & Wilkins, 2007. Print.
Takrani LB, Cronin D. Kleineâ€“Levin syndrome in a female patient. Can
Psychiatr Assoc J 1976; 21: 315â€“8.
Testa S, Opportuno A, Gallo P, Tavolato B. A case of multiple sclerosis with
an onset mimicking the Kleineâ€“Levin syndrome. Ital J Neurol Sci 1987;
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