Lesko Aquila, Kalafat Naciye, Enoh Khadijah, Teltser Warren K
Psychiatry, Medical College of Wisconsin Green Bay, Green Bay, USA.
Psychiatry, Bellin Psychiatric Center, Green Bay, USA.
Cureus. 2022 Jan 27;14(1):e21662. doi: 10.7759/cureus.21662. eCollection 2022 Jan.
Catatonia syndrome is characterized by motor, behavioral and affective abnormalities in association with psychiatric and medical illnesses and delirium syndrome is defined as acute brain dysfunction caused by an underlying medical condition or toxic exposure. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) contains a caveat that limits diagnosing catatonia in patients during delirium. However, the literature has shown that up to 31% of patients have co-occurring catatonia and delirium when using the Bush Francis Catatonia Rating Scale and 12.7% of patients with delirium meet DSM-5 criteria for catatonia. The authors present a case of a patient with concomitant delirium and catatonia. Diagnosing catatonia in this patient, even in the setting of delirium, was necessary for appropriate treatment and clinical improvement. Typical treatment for patients with delirium, antipsychotic medication, contributes to the worsening of catatonia while first-line treatment for catatonia, benzodiazepines, has been shown to exacerbate delirium. Delayed recognition of the patient's catatonia resulted in inadequate treatment that worsened her catatonic symptoms and prolonged hospitalization. The potential contraindications to treatment interventions call for an appropriate diagnosis of catatonia when co-occurring with delirium despite the DSM-5 limitation. The World Health Organization (WHO) ICD-11 code for catatonia allows for less exclusivity in assessing for clinical catatonia in that the limitations to diagnosis only include harmful effects of drugs, medicaments or biological substance, not elsewhere classified - a more collaborative definition for catatonia criteria in the DSM-5 and the ICD-11 codes can provide a way forward with more flexibility in symptom interpretation and treatment.
紧张症综合征的特征是与精神疾病和躯体疾病相关的运动、行为和情感异常，而谵妄综合征被定义为由潜在的躯体疾病或接触毒物引起的急性脑功能障碍。《精神疾病诊断与统计手册》第5版（DSM - 5）中有一项警告，限制在谵妄患者中诊断紧张症。然而，文献表明，使用布什 - 弗朗西斯紧张症评定量表时，高达31%的患者同时存在紧张症和谵妄，12.7%的谵妄患者符合DSM - 5紧张症标准。作者报告了一例同时患有谵妄和紧张症的患者。对该患者进行紧张症诊断，即使是在谵妄的情况下，对于恰当治疗和临床改善也是必要的。谵妄患者的典型治疗药物抗精神病药物会导致紧张症恶化，而紧张症的一线治疗药物苯二氮䓬类药物已被证明会加重谵妄。对患者紧张症的识别延迟导致治疗不足，使她的紧张症症状恶化并延长了住院时间。尽管有DSM - 5的限制，但治疗干预的潜在禁忌证要求在谵妄同时出现时对紧张症进行恰当诊断。世界卫生组织（WHO）国际疾病分类第11版（ICD - 11）中紧张症的编码在评估临床紧张症时允许较少的排他性，因为诊断限制仅包括药物、药剂或生物物质的有害作用，未在其他处分类——DSM - 5和ICD - 11编码中紧张症标准的更具协作性的定义可以为症状解释和治疗提供更灵活的前进方向。
