The Arguments for Standardized Diagnostic Procedures

Abstract

The diagnosis of full-blown narcolepsy with cataplexy can be established by medical history. There are very few diseases with the symptom cataplexy. If so—as in Coffin-Lowry syndrome—they can easily be identified by their course or the presence of other key symptoms. Mimics of cataplexy are only few. Isolated cataplexy (without narcolepsy) is very rare. However, many of our narcolepsy patients do not report the simple type of emotionally triggered cataplexy. They either grew up with the symptom and considered it as normal, or they thought is was physiological. If nobody in the patient's environment has seen the cataplexies, or if cataplexy attacks are rare, we run into trouble with our diagnosis. The same applies for patients who report excessive daytime sleepiness (EDS) and maybe one or two accessory symptoms (such as sleep paralysis or hypnagogic hallucination), or those who just report associated sleep disorders such as fragmented nocturnal sleep. Excessive daytime sleepiness is an unspecific symptom of all types of sleep-wake and other disorders (e.g., Parkinson's disease, Niemann-Pick disease, and hypothyreosis). Even experienced clinicians have diagnostic problems when the medical history is diffuse. Problematic are particularly patients who report symptoms which meet the clinical criteria for narcolepsy without cataplexy. And finally, what to do with patients who could have secondary forms of narcolepsy? How are we to understand the underlying pathology if we do not have standardized diagnostic procedures? (PsycINFO Database Record (c) 2016 APA, all rights reserved)