Connell Jennifer, Oldham Mark, Pandharipande Pratik, Dittus Robert S, Wilson Amanda, Mart Matthew, Heckers Stephan, Ely E Wes, Wilson Jo Ellen
Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA.
12327Vanderbilt University School of Medicine, Nashville, TN, USA.
J Intensive Care Med. 2023 Feb;38(2):137-150. doi: 10.1177/08850666221114303. Epub 2022 Jul 21.
Catatonia is a clinical syndrome characterized by psychomotor, neurological and behavioral changes. The clinical picture of catatonia ranges from akinetic stupor to severe motoric excitement. Catatonia can occur in the setting of a primary psychiatric condition such as bipolar disorder or secondary to a general medical illness like autoimmune encephalitis. Importantly, it can co-occur with delirium or coma. Malignant catatonia describes catatonia that presents with clinically significant autonomic abnormalities including change in temperature, blood pressure, heart rate, and respiratory rate. It is a life-threatening form of acute brain dysfunction that has several motoric manifestations and occurs secondary to a primary psychiatric condition or a medical cause. Many of the established predisposing and precipitating factors for catatonia such as exposure to neuroleptic medications or withdrawal states are common in the setting of critical illness. Catatonia typically improves with benzodiazepines and treatment of its underlying psychiatric or medical conditions, with electroconvulsive therapy reserved for catatonia refractory to benzodiazepines or for malignant catatonia. However, some forms of catatonia, such as catatonia secondary to a general medical condition or catatonia comorbid with delirium, may be less responsive to traditional treatments. Prompt recognition and treatment of catatonia are crucial because malignant catatonia may be fatal without treatment. Given the high morbidity and mortality associated with malignant catatonia, intensivists should familiarize themselves with this important and under-recognized condition.
紧张症是一种以精神运动、神经和行为改变为特征的临床综合征。紧张症的临床表现范围从运动不能性木僵到严重的运动兴奋。紧张症可发生于原发性精神疾病如双相情感障碍的背景下，或继发于自身免疫性脑炎等一般躯体疾病。重要的是，它可与谵妄或昏迷同时出现。恶性紧张症指伴有包括体温、血压、心率和呼吸频率改变等临床上显著自主神经异常的紧张症。它是一种危及生命的急性脑功能障碍形式，有多种运动表现，继发于原发性精神疾病或躯体病因。许多已确定的紧张症易感和促发因素，如接触抗精神病药物或戒断状态，在危重病情况下很常见。紧张症通常用苯二氮䓬类药物及治疗其潜在的精神或躯体疾病来改善，电休克治疗则用于对苯二氮䓬类药物难治的紧张症或恶性紧张症。然而，某些形式的紧张症，如继发于一般躯体疾病的紧张症或与谵妄共病的紧张症，可能对传统治疗反应较差。及时识别和治疗紧张症至关重要，因为恶性紧张症若不治疗可能致命。鉴于恶性紧张症相关的高发病率和死亡率，重症监护医生应熟悉这种重要且未得到充分认识的病症。
