伴紧张症的精神分裂症与特发性紧张症临床特征比较

A comparison of clinical features between schizophrenia with catatonic symptoms and idiopathic catatonia

目的比较伴紧张症的精神分裂症和特发性紧张症患者在临床特征方面的差异。方法将前期研究筛查出的81例“以精神分裂症为基础疾病”的紧张症患者,按照特发性紧张症的定义,分为伴紧张症的精神分裂症组(S组,51例)和特发性紧张症组(I组,30例)。从病历中提取起病年龄、性别、精神疾病家族史、是否精神病首次发作、既往类似发作经历、发病间期社会功能、紧张症症状和疗效等资料。去除诊断标签后,对复发(非精神病首次发作)患者的相关临床特征进行聚类分析。结果紧张症症状方面,I组“冲动性”比S组更多见(90.0%vs.62.7%,P<0.01)。复发患者(S组35例,I组17例)中,两组发病间期社会功能良好的患者占比差异没有统计学意义(P=0.08),I组既往有类似发作经历的患者占比比S组更高(17/17 vs.16/35,P<0.01)。两步聚类分析将复发患者分为两类,第一类(23例)为疗效治愈、发病间期社会功能正常、无凝视、无退缩、有作态,另一类(29例)为疗效好转、发病间期社会功能较差、有凝视、有退缩、无作态。结论特发性紧张症与伴紧张症的精神分裂症可以从疗效、发病间期社会功能、既往类似发作史以及兴奋型紧张症症状等方面加以鉴别。

Objective To compare the clinical features between schizophrenia patients with catatonic symptoms and those with idiopathic catatonia.Methods Eighty-one patients with“catatonia with an underlying condition of schizophrenia”,who were screened out in a previous retrospective study,were classified according to the definition of idiopathic catatonia into two subgroups,schizophrenia with catatonic symptoms subgroup(Group S,51 cases)and idiopathic catatonia subgroup(Group I,30 cases).Data was extracted from medical records,including onset age,gender,family history,first episode or not,past similar episodes,functioning between episodes,catatonic presentations and treatment efficacy.A clustering analysis was carried out among patients with recurrences after their diagnosis tag removed.Results As catatonic symptoms compared,“impulsivity”was more common in Group I than in Group S(90.0%vs.62.7%,P<0.01).Among patients with recurrences(35 cases in Group S and 17 in Group I),there was no significant difference in the ratio of patients with good functioning between episodes(P=0.08),but the ratio of patients with past similar episodes was much higher in Group I than in Group S(17/17 vs.16/35,P<0.01).A two-step clustering analysis clustered all the patients with recurrences into two categories.In the first category(23 cases)most patients had full recoveries,good functioning between episodes,no staring,no withdrawal and always had mannerisms.In the other(29 cases)most patients had partial recoveries,poor functioning between episodes,no mannerisms,and always had staring and withdrawal.Conclusion Idiopathic catatonia and schizophrenia with catatonic symptoms can be better differentiated from their treatment efficacy,functioning between episodes,past similar episodes and whether there are many excited catatonic symptoms.