Taylor Michael Alan, Fink Max
Department of Psychiatry, finch University of Health Sciences, North Chicago, Ill., USA.
Am J Psychiatry. 2003 Jul;160(7):1233-41. doi: 10.1176/appi.ajp.160.7.1233.
The authors assess the present position of catatonia in diagnostic classification systems and consider the merits of designating catatonia as a separate diagnostic category with defined criteria.
Following the logical steps to establish diagnostic validity when the etiology of a syndrome is unknown, the authors review the literature on the features that delineate catatonia as a syndrome, the prevalence and response to treatment of catatonia, and the conditions that are associated with catatonia.
Catatonia is a well-defined syndrome that can be reliably ascertained. Although more than 40 motor signs of catatonia are known, the presence of two prominent features for 24 hours or longer is sufficient to identify the syndrome. Catatonia is found in about 10% of acutely ill psychiatric inpatients and is more commonly observed in persons with mood disorder than in those with schizophrenia. It is found in many conditions and presents mainly as retarded-stuporous or excited-delirious forms. Catatonia responds to specific treatments, including sedative anticonvulsants (barbiturates and benzodiazepines) and ECT.
Catatonia can be distinguished from other behavioral syndromes by a recognizable cluster of clinical features. Catatonia is sufficiently common to warrant classification as an independent syndrome. It can be reliably identified, has a typical course when appropriately treated, responds to specific treatments, and is worsened by other treatments. It is associated with many pathophysiologic processes and most often with mood disorder. These findings, which are consistent with established methods of defining distinct diagnostic groupings, support consideration of catatonia as an individual category in psychiatric diagnostic systems.
作者评估紧张症在诊断分类系统中的当前地位，并考虑将紧张症指定为具有明确标准的单独诊断类别的优点。
遵循在综合征病因不明时建立诊断有效性的逻辑步骤，作者回顾了关于将紧张症描述为一种综合征的特征、紧张症的患病率和治疗反应以及与紧张症相关的病症的文献。
紧张症是一种定义明确的综合征，可以可靠地确定。虽然已知有40多种紧张症的运动体征，但存在两种突出特征达24小时或更长时间就足以识别该综合征。紧张症在约10%的急性病精神科住院患者中出现，在情绪障碍患者中比在精神分裂症患者中更常见。它在许多病症中出现，主要表现为迟缓-木僵或兴奋-谵妄形式。紧张症对特定治疗有反应，包括镇静抗惊厥药（巴比妥类和苯二氮䓬类）和ECT。
紧张症可通过一组可识别的临床特征与其他行为综合征区分开来。紧张症足够常见，值得分类为独立综合征。它可以可靠地识别，在适当治疗时有典型病程，对特定治疗有反应，而其他治疗会使其恶化。它与许多病理生理过程相关，最常与情绪障碍相关。这些发现与定义不同诊断分组的既定方法一致，支持将紧张症视为精神科诊断系统中的一个单独类别。
