Boyarsky B K, Fuller M, Early T
Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch at Galveston 77555, USA.
J ECT. 1999 Sep;15(3):232-6.
A 47-year-old acutely psychotic schizophrenic man was diagnosed with malignant catatonia. Because of a history of neuroleptic malignant syndrome (NMS), traditional neuroleptics were avoided, and the patient had been treated with reserpine for a period of 10 years. Symptomatically, severe agitation alternated with severe retardation. The syndrome progressed, despite early termination of any neuroleptic medications, to marked catatonic rigidity and dehydration. Worsening was associated with transfer to a medical intensive care unit, intubation, and subsequently a tracheostomy. Dantrolene and bromocriptine were unhelpful. Lorazepam produced muscular relaxation and resulting decreases in creatine phosphokinase levels but elicited no other improvement. Eleven bilateral electroconvulsive treatments, however, resolved the respiratory impairment and catatonia and improved the psychosis. This report highlights the efficacy of ECT in lethal catatonia despite respiratory impairment and tracheostomy.
一名47岁的急性精神病性精神分裂症男性被诊断为恶性紧张症。由于有抗精神病药物恶性综合征（NMS）病史，避免使用传统抗精神病药物，该患者已接受利血平治疗10年。症状上，严重的激越与严重的迟缓交替出现。尽管早期停用了所有抗精神病药物，但综合征仍进展为明显的紧张性木僵和脱水。病情恶化与转至内科重症监护病房、插管以及随后的气管切开有关。丹曲林和溴隐亭均无效。劳拉西泮产生了肌肉松弛并导致肌酸磷酸激酶水平下降，但未带来其他改善。然而，11次双侧电休克治疗解决了呼吸障碍和紧张症，并改善了精神病症状。本报告强调了尽管存在呼吸障碍和气管切开，电休克治疗在致死性紧张症中的疗效。
