Ohta Masataka, Kano Yukiko, Nagai Yoko
Center for the Research and Support of Educational Practice, Tokyo Gakugei University, Koganei-Shi, Tokyo, Japan.
Int Rev Neurobiol. 2006;72:41-54. doi: 10.1016/S0074-7742(05)72003-1.
The objective is to cast light on diagnosis and catastasis, course, and comorbidity as concerned with catatonia in patients with autism spectrum disorders (ASDs) with respect to long-term prospective follow-up. Eleven patients (all male) were enrolled. The mean age and the mean follow-up duration were 27.6 years (standard deviation (SD) 5.5) and 18.7 years (SD 8.7), respectively. The mean IQ was 27 (SD 16.4). Information was garnered from medical case records; current examination and observation of patients, interview of parents, and questionnaires completed by parents or other caretakers. Informed consent was obtained from the parents. Criteria for catatonia in this study were: (1) abrupt stop of movements and maintenance of immobility or bizarre posture beginning in adolescence and early adult life, (2) such a cataleptic state had continued for at least several minutes and appeared many times a day to the point of interfering with daily activities. We described two typical catatonic cases of ASDs. The average onset age was 19 years (SD 6). In all cases, our diagnostic criteria of catatonia evaluating at worse are fully compatible with those of Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-VI). In 8 out of 11, the onset of catatonia was clearly preceded by the appearance of slowness in movements accompanying the exacerbation of obsessive-compulsive symptoms. Catatonia was also found to have some connection with Tourette syndrome (3 cases), adjustment disorders (N=1), and depressive mood disorders (N=1). In one case, the manifestations of catatonia had to be distinguished from parkinsonism caused by antipsychotics. Catatonia in ASDs seems to be a chronic condition in most cases. However, there were also a few cases in which catatonia repeatedly aggravated over short spans of time. Catatonia in ASDs may be considered an epiphenomenon of ASDs or a manifestation of comorbidity in adolescence or early adulthood.
目的是通过长期前瞻性随访，阐明自闭症谱系障碍（ASD）患者中与紧张症相关的诊断、病情缓解、病程及共病情况。纳入了11例患者（均为男性）。平均年龄和平均随访时长分别为27.6岁（标准差（SD）5.5）和18.7岁（SD 8.7）。平均智商为27（SD 16.4）。信息来自医疗病例记录、对患者的当前检查与观察、对家长的访谈以及家长或其他照料者填写的问卷。已获得家长的知情同意。本研究中紧张症的标准为：（1）青春期及成年早期开始出现动作突然停止并保持不动或怪异姿势，（2）这种僵住状态持续至少数分钟，且每天出现多次，达到干扰日常活动的程度。我们描述了两例典型的ASD紧张症病例。平均发病年龄为19岁（SD 6）。在所有病例中，我们评估病情严重程度时使用的紧张症诊断标准与《精神疾病诊断与统计手册》第4版（DSM - VI）完全相符。11例中有8例，紧张症发作之前明显出现了强迫症状加重伴随的动作迟缓。还发现紧张症与抽动秽语综合征（3例）、适应障碍（N = 1）及抑郁情绪障碍（N = 1）有一定关联。在1例中，紧张症的表现必须与抗精神病药物引起的帕金森症相鉴别。ASD中的紧张症在大多数情况下似乎是一种慢性病。然而，也有少数病例紧张症在短时间内反复加重。ASD中的紧张症可被视为ASD的一种附带现象或青少年期或成年早期共病的一种表现。
