Department of Psychopathology, Gifu University Graduate School of Medicine, Gifu, Japan.
Int J Psychiatry Clin Pract. 2005;9(4):230-7. doi: 10.1080/13651500500240670.
Catatonia in geriatric patients has been insufficiently investigated. We reviewed 71 case descriptions from 45 studies to clarify the phenomenology, diagnosis, etiology, and treatment of catatonia in the elderly. In elderly patients, catatonia is frequently observed in association with general medical conditions. In patients with a history of depression or schizophrenia, physicians occasionally overlook the medical conditions because they believe the previous psychosis to be the cause of the catatonic features. Despite historical discussions of a relation between the disorders, the number of patients with catatonia and a prior diagnosis of schizophrenia or another psychotic disorder is not large. A diagnosis of catatonia should be considered in cases of atypical "collapse" in elderly patients with a previous psychiatric history of mood disorder. Catatonia due to anxiety/adjustment disorder is quite rare, whereas catatonia in association with neuroleptic malignant syndrome is fairly common. For early commencement of treatment, early detection of catatonia in the elderly is important. In studies of psychotropic drug treatment, many authors observed a beneficial response to lorazepam in catatonic patients. For medication-refractory patients, electroconvulsive therapy should be considered. It is important to prevent the development of venous thrombosis as a serious complication in stuporous catatonic patients.
老年患者的紧张症研究不足。我们回顾了 45 项研究中的 71 个病例描述，以阐明老年人紧张症的表现、诊断、病因和治疗。在老年患者中，紧张症常与一般躯体疾病有关。在有抑郁或精神分裂症病史的患者中，医生有时会忽略躯体疾病，因为他们认为以前的精神病是紧张症特征的原因。尽管历史上讨论了这些疾病之间的关系，但患有紧张症和以前被诊断为精神分裂症或其他精神病性障碍的患者数量并不多。对于有心境障碍既往精神病史的老年患者出现非典型“崩溃”的情况，应考虑紧张症的诊断。焦虑/适应障碍引起的紧张症相当罕见，而与神经阻滞剂恶性综合征相关的紧张症则相当常见。为了尽早开始治疗，早期发现老年患者的紧张症很重要。在精神药物治疗的研究中，许多作者观察到氯硝西泮对紧张症患者有良好的反应。对于药物难治性患者，应考虑电惊厥治疗。预防昏迷性紧张症患者出现静脉血栓形成这一严重并发症很重要。
