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Psychiatric comorbidity, cognitive profile, narcolepsy, and H1N1 influenza vaccination

The neuropsychiatric complication is not widely mentioned. Szakács et al. evaluated “psychiatric comorbidity and the cognitive profile in children and adolescents with narcolepsy” and found that “the most frequent psychiatric symptom was temper tantrums, which occurred in 94% of the patients in the PHV group and 71% of the patients in the nPHV narcolepsy group.”[1] Considering that study,[1] it can be seen that the problem was evident in both post-H1N1 vaccination (PHV) and non-post-H1N1 vaccination (nPHV) groups; however, Szakács et al. did not further statistically analyze whether there was any difference between the two groups. The relationship between narcolepsy and H1N1 influenza vaccination is an interesting topic. Duffy et al. recently reported no association between narcolepsy and H1N1 influenza vaccination.[2] However, Montplaisir et al. mentioned that there might be increased risk but that the increase might be due to the “confounding effect of the influenza infection.”[3] In the previous reports,[1-3] the possible higher rate of psychiatric symptoms in the PHV group may have some implications that should be further studied. Some hypothesized about immunopathogenesis leading to cognitive impairment and narcolepsy.[4] However, this is not approved for PHV cases.[5] The problem of the confounding effect of influenza infection is thus widely mentioned in the present day. Van der Most et al. wrote that “evidence of a mimicry-based mechanism could also explain the association between narcolepsy and A(H1N1)pdm09 influenza infection.”[6] However, Melén et al. noted “No serological evidence of influenza A H1N1pdm09 virus infection as a contributing factor in childhood narcolepsy after Pandemrix vaccination campaign in Finland.”[7] Hence, the effect of the possible “confounding effect of the influenza infection” should also be further assessed. Psychiatric comorbidity, cognitive profile, narcolepsy, and H1N1 influenza vaccination