Iyer Veeraraghavan, Spurling Benjamin C., Rizvi Abid
Psychiatry Baystate Medical Center
VA
Leopold Bellack described the derivation of the term from the Greek roots (meaning "down") and(meaning "tension" or "tone"). Catatonia was first categorically studied in 1854 by Karl Kahlbaum. Historically, catatonia was considered a subtype of schizophrenia. Catatonia is now understood to be a neuropsychiatric syndrome with diverse etiologies, ranging from primary psychiatric disorders to neurological and medical conditions, characterized by a range of motor, behavioral, and affective abnormalities that can be potentially fatal if untreated. Recent developments have enhanced our understanding of its epidemiology, pathophysiology, diagnostic criteria, and treatment modalities. Including catatonia as an independent diagnosis in the , further highlights its clinical significance.
紧张症是一种神经精神综合征,其特征为异常运动、行为和退缩,最常见于心境障碍,但也可见于精神病性、医学、神经和其他障碍。大多数关于紧张症发病率的研究发现,在急性住院精神科环境中,其发病率在5%至20%之间。大多数紧张症发作可分为激越型、迟缓型或恶性型。在这些发作期间,症状可能会加重、减轻或改变,受影响的患者可能会有退缩期和激越期。研究表明,皮层、基底神经节和丘脑之间的连接通路是这些不同亚型的基础,并导致紧张症症状。紧张症的识别和治疗在精神科和医学治疗中都可发挥重要作用,因为它会妨碍治疗、混淆诊断,若不治疗可能会致命。已经开发了一些不同的紧张症评定量表,用于在发作期间筛查和监测症状进展(例如,布什-弗朗西斯紧张症评定量表和诺托夫紧张症量表),但《精神疾病诊断与统计手册》第五版给出了12种可导致紧张症诊断的症状类别。这些症状包括木僵、蜡样屈曲、缄默症、违拗症、作态、举止、刻板动作、不受外部刺激影响的激越、扮鬼脸、模仿言语和模仿动作。诊断紧张症必须至少出现其中三种症状。布什-弗朗西斯评定量表中使用的其他一些标准包括自动服从、自主神经异常和抓握反射的存在。这些共同呈现了可能出现的各种各样的症状,虽然它们与其他疾病的方面存在交叉,但蜡样屈曲、作态和自动服从等表现对紧张症可能更具特异性。