A patient with Kleine-Levin syndrome experiencing new-onset psychosis complicated by catatonia: A case report

Abstract

Kleine-Levin syndrome is a rare neurological sleep disorder characterized by periodic episodes of hypersomnolence often associated with behavioral manifestations including cognitive impairment, derealization, hyperphagia, and disinhibited behavior. Affected individuals exhibit normal cognitive abilities and social functioning in between episodes. Current literature has documented comorbid psychiatric disorders that have emerged in patients with Kleine-Levin syndrome. While there have been previous case reports of new-onset psychosis in those with Kleine-Levin syndrome, there is little documentation of psychosis complicated by scale-assessed catatonia in Kleine-Levin syndrome patients. Additionally, in the rare literature cases where Kleine-Levin syndrome patients are found to be experiencing catatonia outside of a Kleine-Levin syndrome episode, psychotic symptoms are either absent or unclear. We uniquely present a detailed description illustrating the work-up and treatment of a Kleine-Levin syndrome patient experiencing a new-onset episode of psychosis complicated by catatonia. This patient's catatonic symptoms were evaluated using the Bush Francis Catatonia Rating Scale, and there was remarkable improvement with the administration of lorazepam. Our case shows how catatonia-complicated psychosis can be correctly identified in patients with a history of Kleine-Levin syndrome and subsequently treated with benzodiazepines. Documenting this workflow and the subsequent outcomes will help establish clinical strategies for properly identifying and treating behavioral conditions seen in Kleine-Levin syndrome patients.