紧张症患者症状特征、诊断及短期转归的临床研究

Clinical study of symptoms,diagnosis and short-term outcome in patients with catatonia

目的:探讨紧张症的症状特征、病因诊断及短期转归,为提高紧张症的诊断及治疗有效率提供依据。方法:纳入符合美国精神障碍诊断与统计手册第五版(DSM-5)中紧张症诊断标准的住院患者,使用BushFrancis紧张症量表完成症状及严重程度评估;于12个月后进行电话随访。结果:32例紧张症患者中,最终诊断精神分裂症13例(40. 63%),分裂样精神病6例(18. 75%),抑郁症6例(18. 75%),双相情感障碍抑郁发作3例(9. 38%),痴呆1例(3. 13%),脑梗死1例(3. 13%),精神发育迟滞1例(3. 13%),恶性综合征1例(3. 13%)。最常见的紧张症症状为凝视(29例,90. 6%)、木僵(27例,84. 4%)及持续姿势/强直(27例,84. 4%),18例(56. 25%)患者进行了电休克治疗。12个月随访结果提示2例仍有部分症状,1例诊断分裂样精神病的患者纠正诊断为双相情感障碍,1例患者因紧张症再次发作入院。结论:紧张症最常见的诊断为精神分裂症及分裂样精神病,各类诊断预后差异较大。

Objective: To explore the characteristics of symptoms,causes and short-term outcome in catatonia patients,and to analyze the relevant factors. Methods: Hospitalized patients who met the Fifth Edition of the Diagnostic and Statistical Manual for Mental Disorders( DSM-5) criteria for the diagnosis of catatonia were included.Symptom and severity assessments were performed using the Bush-Francis Catatonia Rating Scale( BFCRS).Telephone follow-up was performed in the 12 th month after discharge. Results: 32 patients were included in the study,13( 46. 3%) patients were diagnosed as schizophrenia,6( 18. 75%) patients of schizophrenic psychosis,6( 18. 75%) patients of depression,3( 8. 38%) patients of bipolar disorder. 2 patients had organic dyslexia,1( 3. 13%) patient had malignant syndrome and 1( 3. 13%) patient had mental retardation. The most common symptoms of catatonia were immobility/stupor( 27 patients,84. 4%), staring( 29 patients,90. 6%) and posturing/catalepsy( 27 patients,84. 4%). 18( 56. 25%) patients were treated with ECT. 12 months follow-up results suggested that 2 patients with organic disease still had some symptoms,1 patient who had diagnosed with schizophrenic psychosis was diagnosed with bipolar disorder,1 patient was hospitalized again. Conclusion: The most common diagnosis in patients with catatonia are schizophrenia and schizophrenic psychosis,the prognosis of various types of diagnosis is quite different.