Patel Rikinkumar S, Veluri Nikhila, Verma Geetika
Psychiatry, Griffin Memorial Hospital, Norman, USA.
General Medicine, American University of Integrative Sciences, St. Michael, BRB.
Cureus. 2020 Aug 19;12(8):e9863. doi: 10.7759/cureus.9863.
Catatonia is commonly seen in patients with mood disorders and schizophrenia. The treatment of catatonia requires immediate attention as delayed care resulted in malignant catatonia. The first-line treatment for catatonia is benzodiazepines (BZDs) with rapid improvement. First-generation antipsychotics (FGAs) increase the risk of neuroleptic malignant syndrome and so are avoided in catatonic patients. Second-generation antipsychotics (SGAs) are recommended for treatment in catatonic patients. Treatment for catatonia due to depression includes serotonin reuptake inhibitors (SSRIs). When an individual manifests catatonia during an episode of depression with psychotic features, it is valid to administer both SSRIs and SGAs. Relatively very few studies have examined the use of atypical antidepressants, such as mirtazapine, and so we present a case of catatonia due to severe depression with psychotic features that improved significantly after the introduction of mirtazapine. Despite the beneficial effects of mirtazapine in psychotic depression and catatonia, it is underutilized due to the scarcity of literature. We recommend future clinical studies to evaluate mirtazapine's "miracle" effects, particularly in such patients presenting with psychotic depression and catatonia.
紧张症常见于心境障碍和精神分裂症患者。紧张症的治疗需要立即引起关注，因为延迟治疗会导致恶性紧张症。紧张症的一线治疗药物是苯二氮䓬类药物（BZDs），使用后症状可迅速改善。第一代抗精神病药物（FGAs）会增加神经阻滞剂恶性综合征的风险，因此应避免用于紧张症患者。推荐使用第二代抗精神病药物（SGAs）治疗紧张症患者。因抑郁症导致的紧张症的治疗包括5-羟色胺再摄取抑制剂（SSRIs）。当个体在伴有精神病性特征的抑郁发作期间出现紧张症时，同时使用SSRIs和SGAs是有效的。相对而言，很少有研究探讨过使用米氮平这类非典型抗抑郁药，因此我们报告了一例因伴有精神病性特征的重度抑郁症导致紧张症的病例，该患者在使用米氮平后症状显著改善。尽管米氮平对伴有精神病性症状的抑郁症和紧张症有有益作用，但由于相关文献较少，其使用未得到充分重视。我们建议未来开展临床研究，以评估米氮平的“神奇”效果，尤其是对伴有精神病性症状的抑郁症和紧张症患者。
