Saito Shinnosuke, Yamaga Kuniaki, Kobayashi Toshiyuki, Kato Satoshi
Department of Psychiatry, Jichi Medical University.
Seishin Shinkeigaku Zasshi. 2011;113(3):241-7.
We report the case of an adolescent male who presented with mutism, immobility, catalepsy, and mannerisms. The patient was admitted to our hospital with suspected catatonic schizophrenia; however, he was subsequently diagnosed with catatonia due to Asperger's disorder. The patient was a 16-year-old male. More than six months before presentation, his grandfather displayed bizarre and violent behavior. Subsequently, he began to experience catatonia, which eventually led to hospitalization. Treatment with diazepam improved his condition and, as no causal disorders other than Asperger's disorder were identified, he was diagnosed with catatonia. The patient had experienced persistent abuse by his mother during childhood; therefore, it is important to consider reactive attachment disorder (DSM-IV-TR) as a differential diagnosis. Among child and adolescent psychiatrists, catatonia is considered to occur at a high frequency among patients with autistic spectrum disorders. In contrast, general psychiatrists tend to consider catatonia as related to schizophrenia, which may be the reason why the diagnosis of our patient was difficult. We assume that the pathogenesis of catatonia in this case was death mimicry due to the subjective perception of a life-threatening situation. For the treatment of catatonia with autistic spectrum disorders, the efficacy of benzodiazepines and electroconvulsive therapy has been established. When a patient with an autistic spectrum disorder presents with motor functional disturbances, it is important to consider these disturbances as catatonia. Furthermore, it is also important to begin the treatment mentioned above even in the presence of definite psychogenic or situational factors.
我们报告了一例患有缄默症、不动症、僵住症和怪癖行为的青少年男性病例。该患者因疑似紧张型精神分裂症入住我院；然而，他随后被诊断为阿斯伯格障碍所致的紧张症。患者为一名16岁男性。在出现症状的六个多月前，他的祖父表现出怪异和暴力行为。随后，他开始出现紧张症，最终导致住院。地西泮治疗改善了他的病情，由于未发现除阿斯伯格障碍以外的病因，他被诊断为紧张症。该患者童年时期曾遭受母亲的持续虐待；因此，将反应性依恋障碍（《精神疾病诊断与统计手册第四版修订版》）作为鉴别诊断很重要。在儿童和青少年精神科医生中，紧张症被认为在自闭症谱系障碍患者中高发。相比之下，普通精神科医生倾向于认为紧张症与精神分裂症有关，这可能是我们患者诊断困难的原因。我们推测该病例中紧张症的发病机制是由于对生命威胁情况的主观感知而出现的假死现象。对于自闭症谱系障碍所致紧张症的治疗，苯二氮䓬类药物和电休克治疗的疗效已得到证实。当自闭症谱系障碍患者出现运动功能障碍时，将这些障碍视为紧张症很重要。此外，即使存在明确的心理或情境因素，开始上述治疗也很重要。
