精神科急诊紧张症临床特征分析

doi:10.3969/j.issn.1006-7795.2019.05.005

首都医科大学学报 ›› 2019, Vol. 40 ›› Issue (5): 688-692.doi: 10.3969/j.issn.1006-7795.2019.05.005

• 临床心理研究进展与实践 • 上一篇下一篇

精神科急诊紧张症临床特征分析

何笑笑^1,2, 周福春^1,2, 王传跃^1,2, 朱辉^1,2, 及晓^1,2, 关鸿志³

1. 首都医科大学附属北京安定医院国家精神心理疾病临床医学研究中心精神疾病诊断与治疗北京市重点实验室, 北京 100088;
2. 首都医科大学人脑保护高精尖创新中心, 北京 100069;
3. 中国医学科学院北京协和医院神经科, 北京 100730

收稿日期:2019-09-26 出版日期:2019-09-21 发布日期:2019-12-16
通讯作者: 周福春 E-mail:psychosomatist@163.com
基金资助:
北京市医管局青年人才项目（QML20161902）。

Analysis of clinical characteristics of catatonia in psychiatric emergency

He Xiaoxiao^1,2, Zhou Fuchun^1,2, Wang Chuanyue^1,2, Zhu Hui^1,2, Ji Xiao^1,2, Guan Hongzhi³

1. Beijing Anding Hospital, Capital Medical University & the National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing 100088, China;
2. Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, China;
3. Department of Neurology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China

Received:2019-09-26 Online:2019-09-21 Published:2019-12-16
Supported by:
This study was supported by Beijing Municipal Administration of Hospitals' Youth Program (QML20161902)

摘要/Abstract

摘要： 目的分析精神科急诊紧张症的临床特征，提高临床识别及诊治能力。方法将2018年3月至2019年2月在首都医科大学附属北京安定医院急诊留院观察的123名患者作为研究对象，包括46名紧张症患者和77名非紧张症急性精神障碍患者，使用精神障碍诊断与统计手册第5版（The Diagnostic and Statistical Manual of Mental Disorders 5th edition，DSM-5）紧张症诊断标准确定紧张症诊断，使用Bush-Francis紧张症评定量表（Bush-Francis Catatonia Rating Scale，BFCRS）评估紧张症严重程度，使用阳性与阴性症状量表（Positive and Negative Syndrome Scale，PANSS）评估精神症状。结果 ①与非紧张症相比，紧张症患者前驱感染更常见（19.6%vs 1.3%），需要留院观察时间更长［（4.3±2.7）vs（2.1±1.5）］d，阴性症状评分更高［（26.6±8.6）vs（10.52±5.7）］，伴随尿失禁/潴留（5.2%vs 1.3%）以及便失禁/便秘（58.7%vs 23.4%）的比率更高，白细胞总数升高（47.8%vs 26.0%）、肌酸激酶增高（58.7%vs 28.6%）比率更高，以上差异均有统计学意义（P<0.05）。②主要诊断包括精神分裂症18例（39.1%），情感障碍10例（21.7%），器质性紧张症患者6例（13.0%）。最常见的紧张症症状为违拗、缄默、木僵、激越、僵住。结论紧张症患者常首先就诊于急诊，前驱感染、躯体问题更多见，需使用急诊资源的时间更长，精神症状更重，在临床中容易被评估为阴性症状，容易误诊及延误治疗。

关键词: 紧张症, 急诊室, 精神分裂症, 心境障碍, N-甲基-D-天冬氨酸受体, 脑炎

Abstract: Objective To analysis the clinical characteristics of catatonia in psychiatric emergency department. Methods Patients were recruited from the psychotic emergency observation ward in Beijing Anding Hospital, Capital Medical University, between March 2018 and February 2019. The study sample consisted of 123 patients, including 46 catatonic patients and 77 psychotic patients without catatonia features. They were assessed at the admission to determine their catatonia diagnosis and the severity of psychiatric symptoms. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) were used to establish the diagnosis; the Bush-Francis Catatonia Rating Scale (BFCRS) and the Positive and Negative Syndrome Scale (PANSS) were used to determine the severity of catatonic and other psychiatric symptoms, respectively. Results ①The prodromal infection is more common in patients with catatonia (19.6% vs 1.3%). Catatonia patients also had longer stay in hospital[(4.3±2.7) vs (2.1±1.5)]d, higher score on PANSS negative subscale[(26.6±8.6) vs (10.52±5.7)], more urinary incontinence/retention (5.2% vs 1.3%) and incontinence/constipation (58.7% vs 23.4%), higher number of total white blood cells (47.8% vs 26.0%) and higher plasma creatine kinase level (58.7% vs 28.6%). The difference was statistically significant. ② The primary diagnosis included 18 (39.1%) cases of schizophrenia, 10 (21.7%) cases of mood disorder in the group with catatonia, 6 patients (13.0%) with organic catatonia. Negativism, mutism, stupor, agitation, and stereotype were the most common catatonic signs in our sample. Conclusion Patients with catatonia were often brought to psychiatric emergency room as their initial treatment. Catatonia patients presented more severe symptoms, which were often rated as negative symptoms, and were often comorbid with mental and general medical conditions.

Key words: catatonia, emergency department, schizophrenia, mood disorder, N-methyl-D-aspartate receptor (NMDAR), encephalitis

中图分类号:

R749

何笑笑, 周福春, 王传跃, 朱辉, 及晓, 关鸿志. 精神科急诊紧张症临床特征分析[J]. 首都医科大学学报, 2019, 40(5): 688-692.

He Xiaoxiao, Zhou Fuchun, Wang Chuanyue, Zhu Hui, Ji Xiao, Guan Hongzhi. Analysis of clinical characteristics of catatonia in psychiatric emergency[J]. Journal of Capital Medical University, 2019, 40(5): 688-692.

参考文献

[1] American Psychiatric Association. Diagnostic and statistical manual of mental disorders[M]. 5th ed. Arlington:American Psychiatric Publishing, 2013:119-121.
[2] 宋旭辉,张日昇,吕仁慧. 紧张症的研究进展及争议[J]. 中华精神科杂志, 2018, 3(51):204-208.
[3] Solmi M, Pigato G G, Roiter B, et al. Prevalence of catatonia and its moderators in clinical samples:results from a meta-analysis and meta-regression analysis[J]. Schizophr Bull, 2018, 44(5):1133-1150.
[4] Ungvari G S, Gerevich J, Takács R, et al. Schizophrenia with prominent catatonic features:a selective review[J]. Schizophr Res, 2018, 200:77-84.
[5] Oldham M A. The probability that catatonia in the hospital has a medical cause and the relative proportions of its causes:a systematic review[J]. Psychosomatics, 2018, 59(4):333-340.
[6] Fink M, Fricchione G, Rummans T, et al. Catatonia is a systemic medical syndrome[J]. Acta Psychiatr Scand, 2016, 133(3):250-251.
[7] Jaimes-Albornoz W, Serra-Mestres J. Catatonia in the emergency department[J]. Emerg Med J, 2012, 29(11):863-867.
[8] Spitzer R L, Endicott J, Robins E. Research diagnostic criteria:rationale and reliability[J]. Arch Gen Psychiatry, 1978, 35(6):773-782.
[9] Bush G, Fink M, Petrides G, et al. Catatonia. I. Rating scale and standardized examination[J]. Acta Psychiatr Scand, 1996, 93(2):129-136.
[10] Kay S R, Fiszbein A, Opler L A. The positive and negative syndrome scale (PANSS) for schizophrenia[J]. Schizophr Bull, 1987, 13(2):261-276.
[11] Insel T R. The NIMH research domain criteria (RDoC) project:precision medicine for psychiatry[J]. Am J Psychiatry, 2014, 171(4):395-397.
[12] Pariante C M. Psychoneuroimmunology or immunopsychiatry?[J]. Lancet Psychiatry, 2015, 2(3):197-199.
[13] Dhossche D, Fink M, Shorter E, et al. Anti-NMDA receptor encephalitis versus pediatric catatonia[J]. Am J Psychiatry, 2011, 168(7):749-750.
[14] Akanji A O, Ohaeri J U, Al-Shammri S, et al. Association of blood levels of C-reactive protein with clinical phenotypes in Arab schizophrenic patients[J]. Psychiatry Res, 2009, 169(1):56-61.
[15] Ungvari G S, Goggins W, Leung S K, et al. Schizophrenia with prominent catatonic features ('catatonic schizophrenia'). Ⅱ. Factor analysis of the catatonic syndrome[J]. Prog Neuropsychopharmacol Biol Psychiatry, 2007, 31(2):462-468.
[16] Rasmussen S A, Mazurek M F, Rosebush P I. Catatonia:our current understanding of its diagnosis, treatment and pathophysiology[J]. World J Psychiatry, 2016, 6(4):391-398.
[17] Warren N, Siskind D, O'gorman C. Refining the psychiatric syndrome of anti-N-methyl-d-aspartate receptor encephalitis[J]. Acta Psychiatr Scand, 2018, 138(5):401-408.
[18] 何笑笑, 薄琳, 关鸿志, 等. 抗N-甲基-D-天冬氨酸受体脑炎精神症状特点[J]. 中国神经精神疾病杂志, 2019, 45(1):37-41.
[19] Valenstein M, Maltbie A, Kaplan P. Catatonia in the emergency department[J]. Ann Emerg Med, 1985, 14(4):359-361.

精神科急诊紧张症临床特征分析

Analysis of clinical characteristics of catatonia in psychiatric emergency

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	廉思源, 吴涵, 韩金祥, 肖存利, 任艳萍, 金文青, 王雯, 马辛. 影响精神分裂症自我报告康复效果的因素[J]. 首都医科大学学报, 2022, 43(2): 233-238.
[2]	李莉, 刘超猛, 任艳萍, 杨春林, 马辛. 改良电休克治疗首发精神分裂症的研究进展[J]. 首都医科大学学报, 2022, 43(2): 249-253.
[3]	郭城伟, 周娇娇, 冯媛, 杨蕴萍. 精神分裂症患者与正常人自尊水平的对照研究[J]. 首都医科大学学报, 2022, 43(2): 294-298.
[4]	陈溪, 马登磊, 李林. 淫羊藿苷对cuprizone诱导精神分裂症样小鼠模型行为学变化、髓鞘脱失及神经炎性反应的影响[J]. 首都医科大学学报, 2021, 42(5): 761-767.
[5]	迟博闻, 王佳伟. 单纯疱疹病毒感染后自身免疫性脑炎的研究进展[J]. 首都医科大学学报, 2021, 42(3): 341-346.
[6]	宁艳哲, 朱虹, 宋楠, 郑思思, 李自艳, 李佳佳, 马睿, 贾竑晓. 石珍安神颗粒改善精神分裂症前驱期患者认知损害的临床观察[J]. 首都医科大学学报, 2021, 42(3): 404-407.
[7]	仪玉伟, 闫芳, 靳玉宏, 肖存利. 精神分裂症住院患者危险行为的影响因素分析[J]. 首都医科大学学报, 2021, 42(2): 323-327.
[8]	沙莎, 赵希希, 韩传亮, 彭兴, 张培, 董雯, 尹晶晶, 王长明. 精神分裂症静息态下alpha活动和认知水平的相关性[J]. 首都医科大学学报, 2021, 42(1): 117-124.
[9]	张颖, 王若梅, 李刚. 稳定期精神分裂症患者认知功能、情绪管理水平及其影响因素分析[J]. 首都医科大学学报, 2021, 42(1): 143-147.
[10]	刘鑫垚, 马超, 贾竑晓. 精神分裂症认知损害动物模型的研究现状[J]. 首都医科大学学报, 2020, 41(1): 50-54.
[11]	马超, 贺毅, 孙作厘, 刘鑫垚, 冯正田, 陈沛, 宁艳哲, 朱虹, 尹冬青, 贾竑晓. 基于16S rRNA技术分析石珍安神汤对脱髓鞘小鼠肠道菌群多样性的影响[J]. 首都医科大学学报, 2020, 41(1): 64-70.
[12]	庄文旭, 张伟波, 朱有为, 朱益, 蔡军. 对精神分裂症躯体健康问题的生活方式干预[J]. 首都医科大学学报, 2019, 40(5): 698-702.
[13]	马超, 贾竑晓. 精神分裂症的神经炎性反应研究现状[J]. 首都医科大学学报, 2019, 40(2): 205-208.
[14]	吴燕, 孙作厘, 马超, 朱虹, 尹冬青, 贾竑晓. 中药益肾平肝方对脱髓鞘模型小鼠社会交互行为的影响及作用靶点[J]. 首都医科大学学报, 2019, 40(2): 209-213.
[15]	尹冬青, 黄芳, 赵安全, 王群松, 马雁冰, 陈进东, 李宝君, 都弘, 贾竑晓. 精神分裂症中医证候要素诊断量表初步研究[J]. 首都医科大学学报, 2018, 39(6): 821-827.