B - 95 A Case Study of Suspected Klein-Levin Syndrome and Associated Anxiety.

Abstract

Neuropsychological assessment of ethnoracially diverse patients can be challenging for various reasons, including limited normative data, differing worldviews, stigma, and mental health service utilization and access. This case study describes the use of a comprehensive neuropsychological assessment to assist with differential diagnosis and treatment recommendations. The patient was a 25-year-old Asian and White female who was referred to rule out attention deficit hyperactivity disorder (ADHD). Her history included homeschooling through 8th grade, uncommon sleep disturbances, seasonal allergies, and a diagnosis of major depressive disorder. Regarding sleep disturbance, she endorsed monthly episodes of sleeping for up to 12hours at a time, sometimes sleeping and waking on the floor or elsewhere not in her bedroom. She underwent a comprehensive neuropsychological evaluation. The patient's cognitive profile was generally intact, with relative cognitive inefficiencies in visuospatial/visuoconstructional abilities, working memory, and processing speed domains. She also endorsed clinically significant levels of anxiety. These findings, in conjunction with family history and sleep disturbance, raised concern for Klein-Levin Syndrome (KLS) and the impact of co-occurring anxiety. A sleep study, educational/vocational accommodations, psychotherapy, and follow up evaluation in one year were recommended. While sleep-wake disorders and ADHD can co-occur, sleep-wake disorders can be overlooked by mental health professionals, thus increasing the likelihood of misdiagnosis and potential for harm. Adding additional complexity, expressions of psychological distress vary cross-culturally. Taken together, neuropsychological training must include frameworks that attend to cultural and contextual factors. These cases may frequently be seen in the context of educational or vocational concern referrals.