Mahgoub Yassir, Pathare Aum, Hamlin Dallas, Gomaa Hassaan, Nutting Sean, Mormando Charles, Francis Andrew
Department of Psychiatry and Behavioral Health, College of Medicine, The Pennsylvania State University, Hershey, PA, United States.
Department of Psychiatry, Albert Einstein Medical Center - Jefferson Health, Philadelphia, PA, United States.
Front Psychiatry. 2024 Mar 20;15:1372136. doi: 10.3389/fpsyt.2024.1372136. eCollection 2024.
Catatonia has been increasingly associated with mood disorders and is recognized as a specifier in the DSM-5 and DSM-5-TR. The DSM-5-TR recognizes melancholia as a specifier for depressive episodes in major depressive disorder and bipolar disorder. It is characterized by severe anhedonia, lack of reactivity, excessive or delusional guilt, and significant vegetative symptoms. As the conceptualization of melancholia expanded beyond its mood components to include psychomotor disturbances, its overlap with psychomotor symptoms or catatonia becomes evident. This overlap was also described in Kahlbaum's original literature, where he describes the transition between states of melancholia, mania, and catatonia.
Case summary of six patients with major depressive disorder or depressed phase of bipolar disorder who were admitted for severe depression, anhedonia, intense anxiety, psychomotor agitation or retardation, indecisiveness, perseveration, and vegetative symptoms such as poor sleep, appetite, and significant weight loss.
All patients demonstrated rapid and complete resolution of their mood and psychomotor symptoms, indecisiveness, perseveration, as well as psychosis shortly after administration of lorazepam, with recurrence of the above symptoms upon lorazepam discontinuation and resolution upon resumption, in an on-and-off manner.
The present study argues for a closer relationship between melancholia and catatonia based on our case series, historical review, overlap in phenomenology, and response to treatment. We propose provisional [Mahgoub] criteria for patients with severe depression and melancholia. The role of GABA agonists, such as lorazepam, can be explored as an option for patients with treatment-resistant depression who meet these criteria for melancholia.
Absence of a standardized, systematic assessment tool and a small sample size.
紧张症越来越多地与情绪障碍相关联，并在《精神疾病诊断与统计手册》第五版（DSM - 5）和《精神疾病诊断与统计手册》第五版修订版（DSM - 5 - TR）中被确认为一种特定类型。DSM - 5 - TR将 melancholia（ melancholia 可译为“ melancholic 抑郁发作”，一种特定类型的抑郁发作，有严重快感缺失、反应迟钝、过度或妄想性内疚以及明显的躯体症状等特征）确认为重度抑郁症和双相情感障碍中抑郁发作的一种特定类型。它的特征是严重的快感缺失、缺乏反应性、过度或妄想性内疚以及明显的躯体症状。随着 melancholia 的概念从其情绪成分扩展到包括精神运动性障碍，它与精神运动症状或紧张症的重叠变得明显。这种重叠在卡尔鲍姆的原始文献中也有描述，他在其中描述了 melancholia、躁狂和紧张症状态之间的转变。
对6例因重度抑郁、快感缺失、强烈焦虑、精神运动性激越或迟缓、犹豫不决、持续动作以及睡眠差、食欲减退和体重显著减轻等躯体症状而入院的重度抑郁症或双相情感障碍抑郁相患者的病例总结。
所有患者在使用劳拉西泮后不久，其情绪和精神运动症状、犹豫不决、持续动作以及精神病性症状迅速且完全缓解，停用劳拉西泮后上述症状复发，恢复使用后症状再次缓解，呈现出反复的特点。
基于我们的病例系列、历史回顾、现象学重叠以及治疗反应，本研究主张 melancholia 与紧张症之间存在更密切的关系。我们为重度抑郁症和 melancholia 患者提出了临时的[马赫古卜]标准。对于符合这些 melancholia 标准的难治性抑郁症患者，可以探索使用γ - 氨基丁酸（GABA）激动剂，如劳拉西泮作为一种治疗选择。
缺乏标准化、系统的评估工具且样本量小。
