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A 20-year-old male presents with excessive daytime sleepiness for the past year. He reports sudden episodes of muscle weakness triggered by laughing (his knees buckle, he drops objects). He also describes vivid hallucinations when falling asleep and episodes of being unable to move for seconds upon waking. A sleep study confirms shortened REM latency. What is the MOST likely diagnosis?
Explanation
Narcolepsy type 1 features the classic tetrad: excessive daytime sleepiness, cataplexy, hypnagogic hallucinations, and sleep paralysis. Cataplexy (emotion-triggered muscle weakness) is the distinguishing feature from type 2. Hypnagogic hallucinations are sleep-related, not psychotic — misdiagnosis is a recognized clinical error PMHNPs must avoid.
Key Takeaway
Narcolepsy type 1 = excessive daytime sleepiness + cataplexy (emotion-triggered muscle weakness). Type 2 = sleepiness without cataplexy. Hypnagogic hallucinations and sleep paralysis are narcolepsy features, not psychotic symptoms. The PMHNP must differentiate narcolepsy from psychiatric conditions.