University College London, London, UK, and specialty registrar in general adult and old age psychiatry, South London and Maudsley NHS Foundation Trust, London, UK
National Hospital for Neurology and Neurosurgery, London, UK, and honorary associate professor, Queen Square Institute of Neurology, University College London, London, UK.
Clin Med (Lond). 2023 May;23(3):242-245. doi: 10.7861/clinmed.2023-0113.
Catatonia is a severe neuropsychiatric syndrome that affects emotion, speech, movement and complex behaviour. It can occur in a wide range of psychiatric and neurological conditions, including depression, mania, schizophrenia, autism, autoimmune encephalitis (particularly NMDAR encephalitis), systemic lupus erythematosus, thyroid disease, epilepsy and medication-induced and -withdrawal states. This concise guideline highlights key recommendations from the British Association for Psychopharmacology (BAP) Catatonia Guideline, published in April 2023. Important investigations may include neuroimaging, electroencephalography and assessment for neuronal autoantibodies in serum and cerebrospinal fluid. First-line treatment comprises benzodiazepines and/or electroconvulsive therapy. The benzodiazepine of choice is lorazepam, which is sometimes used in very high doses. Multidisciplinary working between psychiatrists and physicians is often essential. The main limitation of the guidelines is the low quality of the underlying evidence, comprising mainly small observational studies and case reports or series.
紧张症是一种严重的神经精神综合征，影响情绪、言语、运动和复杂行为。它可发生于广泛的精神和神经疾病中，包括抑郁症、躁狂症、精神分裂症、自闭症、自身免疫性脑炎（特别是 NMDA 受体脑炎）、系统性红斑狼疮、甲状腺疾病、癫痫和药物引起的及戒断状态。本简明指南重点介绍了 2023 年 4 月发布的英国精神药理学协会（BAP）紧张症指南中的关键建议。重要的检查可能包括神经影像学、脑电图和血清及脑脊液中神经元自身抗体的评估。一线治疗包括苯二氮䓬类药物和/或电惊厥治疗。首选的苯二氮䓬类药物是劳拉西泮，有时会使用极高剂量。精神科医生和内科医生之间的多学科合作通常是必要的。指南的主要局限性是基础证据质量低，主要包括小型观察性研究以及病例报告或病例系列。
