Expert Perspectives on the Management of Narcolepsy and its Comorbidities - Episode 10

Role of Neurologists and Psychiatrists in Narcolepsy Management

Debra Stultz, MD

,
Stephen Stahl, MD, PhD

In this custom video series, experts in sleep and neuroscience discuss the role of neurologists, psychiatrists, and sleep specialists in the treatment of narcolepsy and comorbid conditions.

Debra Stultz, MD: Let me ask you this as we’re closing. What do you think the role is in treating narcolepsy for psychiatrists and neurologists?

Stephen Stahl, MD, PhD: They have a high index of suspicion.

Debra Stultz, MD: If you’re part of the team, we have the opportunity to see these patients and screen and look for these questions. Then if you’re not comfortable with managing narcolepsy, find you a sleep doctor who is, but work with them because psychiatry and neurology needs to be involved. Psychiatrists really need to help. Once you have the diagnosis of narcolepsy, there’s some grieving about the 10 years that you didn’t know when you had all these failures. There are also some changes in the family. Suddenly these people with narcolepsy wake up and say, “Here I am,” and they want to change the routines and schedules for everybody, and that’s different. The dynamics are different. There are lots of reasons for psychiatrists to be involved, even if they don’t want to be the frontline person. But proper screening by the neurologists and psychiatrists would be a huge advancement for the disorder of narcolepsy. What do you think?

Stephen Stahl, MD, PhD: Often you can stabilize this situation if you’re a sleep specialist. And the other role that can happen is psychiatrists should get enough comfort so that they continue the prescription. They may not want to initiate the prescription, and they may not want to decide among the options, but they should be able to move and accept referral back. Maybe they’re treating an underlying depression, as you said, or some other disorder, but they can facilitate the access to medicines by re-prescribing.

Debra Stultz, MD: Right, and diagnosing and treating the anxiety too. This has been a great discussion. It’s my pleasure to be working with you. I feel honored. I’m a superfan of yours. This has been great for me. I hope we’ve helped to educate some people about narcolepsy, and treatment options, and some of the behavioral things you have to consider with narcolepsy.

I would like to thank you all for watching this Psychiatric Times® program. I hope you found it beneficial.

Transcript edited for clarity.

Disclosures:

Dr Stephen Stahl is clinical professor of psychiatry and neuroscience at the University of California Riverside, adjunct professor of psychiatry at the University of California San Diego, and honorary fellow in psychiatry at the University of Cambridge. Over the past 12 months (January 2020 - December 2020), Dr Stahl has served as a consultant to Acadia, Alkermes, Allergan, AbbVie, Arbor Pharmaceuticals, Axovant, Axsome, Celgene, Concert, Clearview, EMD Serono, Eisai Pharmaceuticals, Ferring , Impel NeuroPharma, Intra-Cellular Therapies, Ironshore Pharmaceuticals, Janssen, Karuna, Lilly, Lundbeck, Merck, Otsuka, Pfizer, Relmada, Sage Therapeutics, Servier, Shire, Sunovion, Takeda, Taliaz, Teva, Tonix, Tris Pharma, and Viforpharma; he is a board member of Genomind; he has served on speakers bureaus for Acadia, Lundbeck, Otsuka, Perrigo, Servier, Sunovion, Takeda, Teva, and Vertex; and he has received research and/or grant support from Acadia, Avanir, Braeburn Pharmaceuticals, Eli Lilly, Intra-Cellular Therapies, Ironshore, ISSWSH, Neurocrine, Otsuka, Shire, Sunovion, and TMS NeuroHealth Centers.

Dr Debra Stultz is the Director and Owner of Stultz Sleep and Behavioral Health in Barboursville, West Virginia. Dr Stultz earned her medical degree from Marshall University School of Medicine in Huntington, West Virginia. She completed a residency in psychiatry and a fellowship in child and adolescent psychiatry through West Virginia University at their Charleston Division through Charleston Area Medical Center in Charleston, West Virginia. She is board certified in psychiatry, sleep medicine, and behavioral sleep medicine. With a special interest in Narcolepsy, she treats a variety of sleep disorders and psychiatric issues. She is also the editor for the Clinical TMS Society newsletter, on their Board of Directors, and the chairman of the TMS and Sleep Disorders Affinity Group. Dr Stultz is on the advisory committee for Harmony Biosciences and is a speaker for Harmony Biosciences and Jazz Pharmaceuticals.