Chen Ruei-An, Huang Tiao-Lai
Department of Psychiatry, Chang Gung Memorial Hospital- Kaohsiung Medical Center, Chang Gung University College of Medicine, 123, Ta-Pei Rd, Niao-Sung, Kaohsiung, 833, Taiwan.
BMC Psychiatry. 2017 Sep 29;17(1):337. doi: 10.1186/s12888-017-1497-6.
Periodic catatonia has long been a challenging diagnosis and there are no absolute guidelines for treatment when precipitating factors are also unclear. We report a schizophrenia patient with periodic catatonia with a 15-year treatment course. A possible correlation between decreased daylight exposure and periodic attacks has been observed.
We describe a 49-year-old woman with periodic catatonia associated with schizophrenia with 15 years of follow-up. The patient was treated with the antipsychotics risperidone, haloperidol, loxapine and quetiapine, but catatonia still relapsed once per year during the first few years of her disease course. The treatment was consequently been switched to clozapine due to fluctuated psychotic illness, and a longer duration of remittance was achieved. Lorazepam-diazepam protocol was used for rapid relief of catatonic symptoms, and was able to significantly shorten the duration of the symptoms. In addition, we observed a possible correlation between catatonic episodes and decreased daylight exposure during the 15-year duration.
Successful treatment of acute periodic catatonia was achieved with a lorazepam-diazepam protocol, and the patient remained in remission for a longer duration under clozapine treatment. Besides, the possibility of decreased daylight exposure acting as a precipitating factor was observed during our 15 years of follow-up.
周期性紧张症长期以来一直是一个具有挑战性的诊断，当诱发因素也不清楚时，没有绝对的治疗指南。我们报告一例患有周期性紧张症的精神分裂症患者，其治疗过程长达15年。已观察到日照减少与周期性发作之间可能存在关联。
我们描述了一名49岁患有与精神分裂症相关的周期性紧张症的女性，随访15年。患者接受了抗精神病药物利培酮、氟哌啶醇、洛沙平及喹硫平治疗，但在病程的最初几年中，紧张症仍每年复发一次。由于精神病性症状波动，治疗因此改为氯氮平，并实现了更长时间的缓解。使用劳拉西泮-地西泮方案快速缓解紧张症症状，并能够显著缩短症状持续时间。此外，在15年期间，我们观察到紧张症发作与日照减少之间可能存在关联。
使用劳拉西泮-地西泮方案成功治疗了急性周期性紧张症，患者在氯氮平治疗下缓解时间更长。此外，在我们15年的随访中观察到日照减少作为诱发因素的可能性。
