Iserson K V
Ann Emerg Med. 1980 Oct;9(10):513-7. doi: 10.1016/s0196-0644(80)80189-2.
Patients infrequently present to the general emergency department with what appears to be a severe psychiatric condition needing rapid differentiation from urgent and emergency medical problems for proper initial disposition and treatment. These include patients with both acute conversion reactions and those in acute catatonic or pseudocatatonic states. Fifteen consecutive patients (11 women and four men ranging in age from 17 to 62) with these symptoms underwent interviews under intravenous amobarbital in the emergency department. Five of these patients presented with acute paralysis of extremities. Ten presented in a state of vigilant awareness similar to, or identical with, catatonia. Using this technique, all 15 patients had the presumptive psychiatric nature of their underlying condition quickly confirmed. The five patients with conversion reactions have no recurrence to date. Four of the 10 catatonia-type patients had resolution of their symptoms without recurrence. All 15 patients responded to 500 mg or less of amobarbital. There were no complications. Two cases are discussed.
患者很少因看似严重的精神疾病前往综合急诊科，这类疾病需要与紧急医疗问题迅速鉴别，以便进行恰当的初步处置和治疗。这些患者包括急性转换反应患者以及处于急性紧张症或类紧张症状态的患者。15例有这些症状的连续患者（11名女性和4名男性，年龄在17至62岁之间）在急诊科接受了静脉注射异戊巴比妥后的访谈。其中5例患者出现急性肢体麻痹。10例表现出与紧张症相似或相同的警觉意识状态。使用这种技术，所有15例患者潜在病情的推测性精神本质很快得到证实。5例转换反应患者至今未复发。10例紧张症型患者中有4例症状缓解且未复发。所有15例患者对500毫克或更少的异戊巴比妥有反应。无并发症。讨论了2个病例。
