Dawkins Eleanor, Cruden-Smith Leola, Carter Ben, Amad Ali, Zandi Michael S, Lewis Glyn, David Anthony S, Rogers Jonathan P
South London and Maudsley NHS Foundation Trust, London, United Kingdom.
Department of Biostatistics and Health Informatics, King's College London, London, United Kingdom.
Front Psychiatry. 2022 May 23;13:886662. doi: 10.3389/fpsyt.2022.886662. eCollection 2022.
The external clinical manifestations (psychopathology) and internal subjective experience (phenomenology) of catatonia are of clinical importance but have received little attention. This study aimed to use a large dataset to describe the clinical signs of catatonia; to assess whether these signs are associated with underlying diagnosis and prognosis; and to describe the phenomenology of catatonia, particularly with reference to fear.
A retrospective descriptive cross-sectional study was conducted using the electronic healthcare records of a large secondary mental health trust in London, United Kingdom. Patients with catatonia were identified in a previous study by screening records using natural language processing followed by manual validation. The presence of items of the Bush-Francis Catatonia Screening Instrument was coded by the investigators. The presence of psychomotor alternation was assessed by examining the frequency of stupor and excitement in the same episode. A cluster analysis and principal component analysis were conducted on catatonic signs. Principal components were tested for their associations with demographic and clinical variables. Where text was available on the phenomenology of catatonia, this was coded by two authors in an iterative process to develop a classification of the subjective experience of catatonia.
Searching healthcare records provided 1,456 validated diagnoses of catatonia across a wide range of demographic groups, diagnoses and treatment settings. The median number of catatonic signs was 3 (IQR 2-5) and the most commonly reported signs were mutism, immobility/stupor and withdrawal. Stupor was present in 925 patients, of whom 105 (11.4%) also exhibited excitement. Out of 196 patients with excitement, 105 (53.6%) also had immobility/stupor. Cluster analysis produced two clusters consisting of negative and positive clinical features. From principal component analysis, three components were derived, which may be termed parakinetic, hypokinetic and withdrawal. The parakinetic component was associated with women, neurodevelopmental disorders and longer admission duration; the hypokinetic component was associated with catatonia relapse; the withdrawal component was associated with men and mood disorders. 68 patients had phenomenological data, including 49 contemporaneous and 24 retrospective accounts. 35% of these expressed fear, but a majority (72%) gave a meaningful narrative explanation for the catatonia, which consisted of hallucinations, delusions of several different types and apparently non-psychotic rationales.
The clinical signs of catatonia can be considered as parakinetic, hypokinetic and withdrawal components. These components are associated with diagnostic and prognostic variables. Fear appears in a large minority of patients with catatonia, but narrative explanations are varied and possibly more common.
紧张症的外部临床表现（精神病理学）和内部主观体验（现象学）具有临床重要性，但很少受到关注。本研究旨在使用一个大型数据集来描述紧张症的临床体征；评估这些体征是否与潜在诊断和预后相关；并描述紧张症的现象学，特别是关于恐惧方面。
采用英国伦敦一家大型二级精神卫生信托机构的电子医疗记录进行回顾性描述性横断面研究。在先前的一项研究中，通过自然语言处理筛选记录并随后进行人工验证来识别紧张症患者。研究人员对布什 - 弗朗西斯紧张症筛查工具的项目存在情况进行编码。通过检查同一发作中木僵和兴奋的频率来评估精神运动交替的存在情况。对紧张症体征进行聚类分析和主成分分析。对主成分与人口统计学和临床变量的关联进行测试。对于有紧张症现象学相关文本的情况，由两位作者在一个迭代过程中进行编码，以建立紧张症主观体验的分类。
检索医疗记录在广泛的人口统计学群体、诊断和治疗环境中提供了1456例经证实的紧张症诊断。紧张症体征的中位数为3（四分位间距2 - 5），最常报告的体征是缄默、不动/木僵和退缩。925例患者存在木僵，其中105例（11.4%）也表现出兴奋。在196例有兴奋表现的患者中，105例（53.6%）也有不动/木僵。聚类分析产生了由阴性和阳性临床特征组成的两个聚类。通过主成分分析得出三个成分，可分别称为运动增多、运动减少和退缩成分。运动增多成分与女性、神经发育障碍和住院时间较长相关；运动减少成分与紧张症复发相关；退缩成分与男性和情绪障碍相关。68例患者有现象学数据，包括49份同期记录和24份回顾性记录。其中35%表达了恐惧，但大多数（72%）对紧张症给出了有意义的叙述性解释，包括幻觉、几种不同类型的妄想以及明显非精神病性的理由。
紧张症的临床体征可被视为运动增多、运动减少和退缩成分。这些成分与诊断和预后变量相关。恐惧在少数紧张症患者中出现，但叙述性解释多种多样且可能更常见。
