Fink Max
State University of New York at Stony Brook, Stony Brook, New York, USA.
Can J Psychiatry. 2009 Jul;54(7):437-45. doi: 10.1177/070674370905400704.
Catatonia is the psychiatric syndrome of disturbed motor functions amid disturbances in mood and thought first described in 1874. It was quickly found in 10% to 38% of psychiatric populations. After it was tied to schizophrenia as a type in the psychiatric classification, its recognition became increasingly limited and by the 1980s questions were asked as to where the catatonics had gone. The decline is largely owing to the change in venue for psychiatric practice from asylum to office, the rejection of physical examination, and the dependence on item rating scales for diagnosis. In the 1970s, broad surveys again showed that catatonia was as common as before among patients with mania and depression, and as a toxic response to neuroleptic drugs. The latter recognition, that the neuroleptic malignant syndrome is the same syndrome as malignant catatonia, and is effectively treated as such, sparked a renewed interest. Clinicians developed rating scales to identify the catatonia syndrome and applied the immediate relief afforded by a barbiturate or a benzodiazepine as a diagnostic test, the lorazepam test. Effective treatments were described as high doses of benzodiazepines and electroconvulsive therapy (ECT). Surveys using catatonia rating scales showed catatonia to have many faces. Catatonia is presently limited to a type of schizophrenia in the psychiatric classification. Its recognition as a disorder of its own, such as delirium and dementia, should now be recognized. This experience reinforced the utility of the medical model for diagnosis. An application for melancholia is described.
紧张症是一种精神综合征，其特征为在情绪和思维紊乱的同时伴有运动功能障碍，于1874年首次被描述。很快人们发现在10%至38%的精神科患者中存在紧张症。在它被列为精神疾病分类中的精神分裂症的一种类型后，其被识别的情况越来越有限，到了20世纪80年代，有人质疑紧张症患者都去哪儿了。这种减少主要归因于精神科诊疗场所从收容所转移到了办公室、体格检查被摒弃以及诊断依赖条目评定量表。在20世纪70年代，广泛的调查再次表明，紧张症在躁狂症和抑郁症患者中与以前一样常见，并且作为对神经安定药物的一种毒性反应。后一种认识，即神经安定药物恶性综合征与恶性紧张症是同一综合征，并且可以如此有效治疗，引发了新的兴趣。临床医生制定了评定量表来识别紧张症综合征，并将巴比妥类药物或苯二氮䓬类药物带来的即时缓解作为一种诊断试验，即劳拉西泮试验。有效的治疗方法被描述为高剂量苯二氮䓬类药物和电休克治疗（ECT）。使用紧张症评定量表的调查表明紧张症有多种表现形式。目前在精神疾病分类中，紧张症仅限于精神分裂症的一种类型。现在应该认识到它是一种独立的疾病，比如谵妄和痴呆。这一经验强化了医学诊断模式的实用性。文中描述了其在忧郁症中的应用。
