Narcolepsy type 1 can first appear as late as the sixth decade of life, as illustrated by the case of a 64-year-old woman whose main symptom was new-onset visual hallucinations. Diagnosis was confirmed by measuring low orexin (hypocretin-1) levels in cerebrospinal fluid. The authors argue that clinicians should consider narcolepsy type 1 as a possible, though rare, diagnosis in older adults presenting with new neuropsychiatric symptoms such as visual hallucinations, even though the disorder typically begins in the second or third decade.
Nightmare severity in people with posttraumatic stress disorder decreased from severe to mild during a therapy that combined the beta-blocker propranolol with re-exposure psychotherapy. At the start, 85% of patients reported nightmares; after the protocol only 50% still had them. The improvement remained stable two months after the last session. No patient experienced increased nightmare severity, and the protocol was generally well tolerated. The findings suggest memory reconsolidation therapy with propranolol is promising for reducing nightmares, but randomized controlled trials are needed to confirm the results.
Brief behavioral treatment for insomnia (BBTI, 4 sessions) reduced trauma-related nightmares in military veterans from baseline to posttreatment, while progressive muscle relaxation therapy did not. However, these reductions were not sustained at a 6-month follow-up. Neither treatment reduced nontrauma-related bad dreams. Baseline nightmare frequency did not affect how much insomnia severity changed. The study involved 91 veterans with insomnia disorder.