Department of Psychiatry, University of Florida Medical School, Gainesville, FL, USA.
Schizophr Res. 2013 Oct;150(1):26-30. doi: 10.1016/j.schres.2013.04.034. Epub 2013 Jun 24.
Although catatonia has historically been associated with schizophrenia and is listed as a subtype of the disorder, it can occur in patients with a primary mood disorder and in association with neurological diseases and other general medical conditions. Consequently, catatonia secondary to a general medical condition was included as a new condition and catatonia was added as an episode specifier of major mood disorders in DSM-IV. Different sets of criteria are utilized to diagnose catatonia in schizophrenia and primary mood disorders versus neurological/medical conditions in DSM-IV, however, and catatonia is a codable subtype of schizophrenia but a specifier for major mood disorders without coding. In part because of this discrepant treatment across the DSM-IV manual, catatonia is frequently not recognized by clinicians. Additionally, catatonia is known to occur in several conditions other than schizophrenia, major mood disorders, or secondary to a general medical condition. Four changes are therefore made in the treatment of catatonia in DSM-5. A single set of criteria will be utilized to diagnose catatonia across the diagnostic manual and catatonia will be a specifier for both schizophrenia and major mood disorders. Additionally, catatonia will also be a specifier for other psychotic disorders, including schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, and substance-induced psychotic disorder. A new residual category of catatonia not otherwise specified will be added to allow for the rapid diagnosis and specific treatment of catatonia in severely ill patients for whom the underlying diagnosis is not immediately available. These changes should improve the consistent recognition of catatonia across the range of psychiatric disorders and facilitate its specific treatment.
尽管紧张症在历史上与精神分裂症有关，并且被列为该疾病的一种亚型，但它也可能发生在原发性情绪障碍患者中，并与神经疾病和其他一般医疗状况有关。因此，继发于一般医疗状况的紧张症被纳入一种新的状况，在 DSM-IV 中，紧张症被添加为主要情绪障碍的发作特征。然而，在 DSM-IV 中，用于诊断精神分裂症和原发性情绪障碍中紧张症的标准与用于诊断神经/医学状况中的紧张症的标准不同，并且紧张症是精神分裂症的一种可编码亚型，但不是主要情绪障碍的编码特征。部分由于 DSM-IV 手册中这种不一致的治疗方法，紧张症经常未被临床医生识别。此外，紧张症已知发生在除精神分裂症、主要情绪障碍或继发于一般医疗状况之外的几种情况中。因此，在 DSM-5 中对紧张症的治疗进行了四项更改。将使用一套标准在整个诊断手册中诊断紧张症，并且紧张症将是精神分裂症和主要情绪障碍的特征。此外，紧张症也将是其他精神病性障碍的特征，包括分裂情感障碍、分裂样障碍、短暂精神病性障碍和物质所致精神病性障碍。将添加一个新的未特定紧张症残留类别，以允许对潜在诊断立即不可用的重病患者进行快速诊断和特定治疗。这些变化应提高在各种精神障碍中对紧张症的一致识别，并促进其特定治疗。
