Northoff G, Koch A, Wenke J, Eckert J, Böker H, Pflug B, Bogerts B
Department of Psychiatry, Otto-von-Guericke University of Magdeburg, Germany.
Mov Disord. 1999 May;14(3):404-16. doi: 10.1002/1531-8257(199905)14:3<404::aid-mds1004>3.0.co;2-5.
Catatonia was first described by Kahlbaum as a psychomotor disease with motor, behavioral, and affective symptoms. In keeping with this concept, we developed a rating scale for catatonia (Northoff Catatonia Scale [NCS]) with three different categories of symptoms (i.e., motor, behavioral, affective). Furthermore, the question of the relationship among catatonic symptoms, extrapyramidal motor symptoms, and neuroleptics was addressed in the present study.
34 acute catatonic patients and 68 age-, sex-, diagnosis-, and medication-matched psychiatric control subjects were investigated on days 0, 1, 3, 7, and 21 with the NCS, with other already validated catatonia rating scales by Rosebush, Bush (BFCRS), and Rogers (MRS), as well as with scales for hypokinetic (SEPS) and dyskinetic (AIMS) extrapyramidal motor features. Validity and reliability of the new scale, factor analysis, correlational analysis, and differences between catatonic patients and psychiatric control subjects were statistically calculated.
NCS showed high validity (i.e., significant positive correlations [p <0.0001] with the other scales, significant differences between catatonic and control subjects), high intra-and interrater reliabilities (r = 0.80-0.96), and high affective subscores. Factor analysis revealed four factors best characterized as affective, hypoactive, hyperactive, and behavioral. Catatonic scores in NCS correlated significantly with AIMS on day 0 and SEPS on days 7 and 21. There were no significant differences in catatonic (i.e., NCS, MRS, BFCRS) and extrapyramidal (i.e., AIMS, SEPS) scores between neuroleptically treated and untreated catatonic subjects.
The following conclusions were drawn: (1) the NCS has to be considered as a valid and reliable rating instrument for catatonia; (2) catatonia can be characterized by psychomotor symptoms encompassing motor, affective, and behavioral alterations; and (3) extrapyramidal hyperkinesias like dyskinesias are apparently closely related to catatonic symptoms which, in general, seem to be relatively independent of previous neuroleptic medication.
紧张症最初由卡尔鲍姆描述为一种具有运动、行为和情感症状的精神运动性疾病。基于这一概念，我们开发了一种紧张症评定量表（诺托夫紧张症量表[NCS]），该量表包含三种不同类型的症状（即运动、行为、情感）。此外，本研究探讨了紧张症症状、锥体外系运动症状和抗精神病药物之间的关系。
对34例急性紧张症患者和68例年龄、性别、诊断及用药相匹配的精神科对照受试者，在第0、1、3、7和21天使用NCS进行调查，同时使用罗斯布什、布什（BFCRS）和罗杰斯（MRS）等其他已验证的紧张症评定量表，以及用于评定运动不能（SEPS）和运动障碍（AIMS）的锥体外系运动特征量表。对新量表的效度和信度、因子分析、相关性分析以及紧张症患者与精神科对照受试者之间的差异进行了统计学计算。
NCS显示出高效度（即与其他量表呈显著正相关[p <0.0001]，紧张症患者与对照受试者之间存在显著差异）、高内部和评分者间信度（r = 0.80 - 0.96）以及高情感子分数。因子分析揭示了四个因子，最能表征为情感、活动减退、活动亢进和行为。NCS中的紧张症评分在第0天与AIMS显著相关，在第7天和第21天与SEPS显著相关。接受抗精神病药物治疗和未接受治疗的紧张症患者在紧张症（即NCS、MRS、BFCRS）和锥体外系（即AIMS、SEPS）评分方面没有显著差异。
得出以下结论：（1）NCS必须被视为一种有效且可靠的紧张症评定工具；（2）紧张症可表现为包括运动、情感和行为改变的精神运动症状；（3）像运动障碍这样的锥体外系运动亢进显然与紧张症症状密切相关，而紧张症症状总体上似乎相对独立于先前的抗精神病药物治疗。
