Gazdag Gábor, Takács Rozalia, Ungvari Gabor S
Szent István and Szent László Hospitals Budapest, 1097 Budapest, Hungary.
School of Doctoral Studies, Semmelweis University, 1085 Budapest, Hungary.
World J Psychiatry. 2017 Sep 22;7(3):177-183. doi: 10.5498/wjp.v7.i3.177.
Kahlbaum was the first to propose catatonia as a separate disease following the example of general paresis of the insane, which served as a model for establishing a nosological entity. However, Kahlbaum was uncertain about the nosological position of catatonia and considered it a syndrome, or "a temporary stage or a part of a complex picture of various disease forms". Until recently, the issue of catatonia as a separate diagnostic category was not entertained, mainly due to a misinterpretation of Kraepelin's influential views on catatonia as a subtype of schizophrenia. Kraepelin concluded that patients presenting with persistent catatonic symptoms, which he called "genuine catatonic morbid symptoms", particularly including negativism, bizarre mannerisms, and stereotypes, had a poor prognosis similar to those of paranoid and hebephrenic presentations. Accordingly, catatonia was classified as a subtype of dementia praecox/schizophrenia. Despite Kraepelin's influence on psychiatric nosology throughout the 20 century, there have only been isolated attempts to describe and classify catatonia outside of the Kraepelinian system. For example, the Wernicke-Kleist-Leonhard school attempted to comprehensively elucidate the complexities of psychomotor disturbances associated with major psychoses. However, the Leonhardian categories have never been subjected to the scrutiny of modern investigations. The first three editions of the DSM included the narrow and simplified version of Kraepelin's catatonia concept. Recent developments in catatonia research are reflected in DSM-5, which includes three diagnostic categories: Catatonic Disorder due to Another Medical Condition, Catatonia Associated with another Mental Disorder (Catatonia Specifier), and Unspecified Catatonia. Additionally, the traditional category of catatonic schizophrenia has been deleted. The Unspecified Catatonia category could encourage research exploring catatonia as an independent diagnostic entity.
卡尔鲍姆是第一个效仿早发性痴呆（general paresis of the insane）将紧张症（catatonia）作为一种独立疾病提出的人，早发性痴呆为建立一种疾病分类实体提供了模型。然而，卡尔鲍姆对紧张症的疾病分类位置并不确定，认为它是一种综合征，或者“是各种疾病形式的复杂图景中的一个暂时阶段或一部分”。直到最近，紧张症作为一个独立诊断类别的问题才开始被考虑，主要是因为对克雷佩林关于紧张症作为精神分裂症一个亚型的有影响力的观点存在误解。克雷佩林得出结论，那些表现出持续紧张症症状的患者，他称之为“真正的紧张症病态症状”，特别是包括违拗症、怪异的行为举止和刻板动作，其预后与偏执型和青春型精神分裂症患者相似，都很差。因此，紧张症被归类为早发性痴呆/精神分裂症的一个亚型。尽管克雷佩林在整个20世纪对精神病学分类学有很大影响，但在克雷佩林体系之外，仅有个别尝试对紧张症进行描述和分类。例如，韦尼克-克莱斯特-莱昂哈德学派试图全面阐明与主要精神病相关的精神运动障碍的复杂性。然而，莱昂哈德学派的分类从未经过现代研究的审视。《精神疾病诊断与统计手册》（DSM）的前三版包含了克雷佩林紧张症概念的狭义和简化版本。紧张症研究的最新进展反映在《精神疾病诊断与统计手册》第五版（DSM-5）中，其中包括三个诊断类别：由另一种躯体疾病所致的紧张症、与另一种精神障碍相关的紧张症（紧张症说明符）和未特定的紧张症。此外，传统的紧张型精神分裂症类别已被删除。未特定的紧张症类别可能会鼓励将紧张症作为一个独立诊断实体进行探索的研究。
