精神科急性入院患者中紧张症的识别和治疗  

Identification and treatment of catatonia in acute psychiatric inpatients

作　　者：游欢 彭祖来 何德平 刘兴兰 李清均[1] YOU Huan;PENG Zulai;HE Deping;LIU Xinglan;LI Qingjun(Eighth Ward,Chongqing Mental Health Center.NO.51 Kuangshanpo,Gele Mountain,Shapingba District,Chongqing 400036,China)

机构地区：[1]重庆市精神卫生中心金紫山院区,重庆400036 [2]重庆市精神卫生中心歌乐山院区八病区 [3]重庆市彭水康馨精神病医院女病区

出　　处：《中国神经精神疾病杂志》2020年第2期85-89,共5页Chinese Journal of Nervous and Mental Diseases

基　　金：重庆市精神卫生中心院级科研项目(编号:2019-yjkt-08)。

摘　　要：目的回顾性分析精神科急性入院患者中紧张症的识别和治疗情况。方法对2017年10月1日至2018年10月1日我院重症精神病房急性入院患者1020例的病历资料进行回顾性分析,根据《美国精神障碍诊断与统计手册第5版》(Diagnostic and Statistical Manual of Mental Disorders,5th Edition,DSM-5)紧张症的诊断标准进行诊断,参照Bush-Francis紧张症评定量表(Bush-Francis catatonia rating scale,BFCRS)的症状定义归类确诊病例的临床表现,并比较不同治疗方案的疗效。结果确诊紧张症91例,占调查患者的8.92%。81例(89.01%)紧张症患者的基础疾病为精神分裂症。患者最常见的紧张症症状为缄默(81.32%)、兴奋(72.53%)、冲动性(71.43%)、静止/呆滞(65.93%)和作态(51.65%),另外先占观念(92.30%)和怪异念头(58.24%)也较常见。仅有7例(7.69%)患者的病历资料中曾提及“(亚)木僵”、“紧张症/综合征”等词。30例患者仅用抗精神病药治疗,治愈率为83.33%(25例),仅用抗精神病药治疗者与抗精神病药联合苯二氮 类和/或改良电休克治疗者的治愈率差异无统计学意义(X^2=1.75,P=0.63)。1例患者在肌注氟哌啶醇后出现恶性综合征。结论精神科急性入院患者中紧张症并不少见,但识别率低。抗精神病药能有效治疗紧张症,但存在出现恶性综合征的风险。Objective To retrospectively analyze how catatonia was recognized and treated in acute psychiatric inpatients.Methods Retrospective analysis was conducted on medical records of 1020 acute inpatients,who were admitted to psychosis wards from Oct 1st 2017 to Oct 1st 2018.All subjects were re-diagnosed using the criteria for catatonia according to the Diagnostic and Statistical Manual of Mental Disorders 5th edition(DSM-5).Clinical manifestations of these patients with catatonia were classified by the definitions from Bush-Francis Catatonia Rating Scale(BFCRS)and efficacy between different treatment regimens was compared.Results Ninety-one people were identified as catatonia,accounting for 8.92%of the acute psychiatric inpatients investigated.Eighty-one patients with catatonia(89.01%)had an underlying condition of schizophrenia.Mutism(81.32%),excitement(72.53%),impulsivity(71.43%),immobility/stupor(65.93%)and mannerisms(51.65%)were the most frequently described catatonic presentations,while symptoms such as preoccupation(92.30%)and odd beliefs(58.24%)also prevailed.Only 7 cases(7.69%)were mentioned as"stupor/stuporous state"or"catatonia/catatonic syndrome"in their medical records.Treatment with antipsychotics alone showed efficacy in 83.33%of catatonia.There was no difference in remission rate between antipsychotics alone and combinations with benzodiazepines and/or Modified Electroconvulsive Therapy(X^2=1.75,P=0.63).One patient developed neuroleptic malignant syndrome(NMS)after an intramuscular injection of haloperidol.Conclusion Catatonia is not rare in acute psychiatric inpatients,but are less recognized.Treatment with antipsychotics is effective but has a risk of NMS.

关 键 词：紧张症 识别 治疗 

分 类 号：R749[医药卫生—神经病学与精神病学]