Lee J W, Robertson S
Graylands Hospital, Perth, Western Australia.
Ann Clin Psychiatry. 1997 Sep;9(3):165-9. doi: 10.1023/a:1026230024656.
Catatonia as a clozapine withdrawal syndrome has not been documented. We report a case of excited catatonia with fever, autonomic instability, and delirium--a picture of malignant catatonia (lethal catatonia) after abrupt clozapine withdrawal. The use of conventional neuroleptics transformed the excited malignant catatonia into a stuporous state resembling neuroleptic malignant syndrome (NMS). Such a transformation of excited lethal catatonia into NMS has been described in the literature, providing support for the hypothesis that NMS is a variant of catatonia. Opinions, however, have been conflicting whether lethal catatonia and NMS are indistinguishable. We argue that NMS may be regarded as a neuroleptic-induced retarded (stuporous) subtype of malignant catatonia, clinically indistinguishable from nonneuroleptic retarded malignant catatonia but different from the excited form. To differentiate between the two subtypes of malignant catatonia would help resolve the controversy. The nosological status of excited catatonia, a poorly studied condition, remains unclear. The two subtypes of catatonia may differ in pathophysiology and responses to treatment. Clinicians should be alert to catatonia as a possible clozapine withdrawal phenomenon, and excited catatonia deserves more research attention.
氯氮平戒断综合征导致紧张症的情况尚无文献记载。我们报告一例在突然停用氯氮平后出现伴有发热、自主神经功能不稳定和谵妄的激越性紧张症病例——呈现出恶性紧张症（致死性紧张症）的表现。使用传统抗精神病药物后，激越性恶性紧张症转变为类似抗精神病药物恶性综合征（NMS）的木僵状态。文献中已描述过激越性致死性紧张症向NMS的这种转变，为NMS是紧张症的一种变体这一假说提供了支持。然而，对于致死性紧张症和NMS是否无法区分，观点一直存在分歧。我们认为，NMS可被视为抗精神病药物诱发的恶性紧张症的迟缓（木僵）亚型，临床上与非抗精神病药物所致迟缓性恶性紧张症无法区分，但与激越型不同。区分恶性紧张症的这两种亚型将有助于解决争议。激越性紧张症这一研究较少的病症的疾病分类地位仍不明确。紧张症的这两种亚型在病理生理学和治疗反应方面可能有所不同。临床医生应警惕紧张症作为氯氮平戒断现象的可能性，激越性紧张症值得更多的研究关注。
