Catatonia for Clinicians | Catatonia Foundation

了解紧张症：医疗保健专业人员指南

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以下信息仅供医疗保健专业人员教育使用。它总结了医学文献和临床实践中反映的关键概念，并不构成医疗建议或治疗指导。临床医生在评估或治疗紧张症时应运用独立判断，并参考最新的证据和指南。

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紧张症是一种严重的神经精神综合征，涉及运动、言语、行为和意志的障碍，常伴有矛盾或悖论性特征。它也可能涉及情感和自主神经功能紊乱。紧张症可发生于精神、神经或一般内科疾病的背景下，若未得到识别和治疗，则会导致严重的并发症和死亡。

恶性紧张症病情严重时可发展为恶性紧张症，因此及时识别和干预至关重要。恶性紧张症的特征包括自主神经功能紊乱、发热和临床症状迅速恶化。

紧张症并非罕见病——它是一种有据可查的医学综合征，但在日常临床诊疗中却常常被漏诊。当患者出现无法解释的运动、言语、反应或行为改变时，尤其当症状波动、表现矛盾或伴有自主神经功能紊乱时，应将紧张症纳入鉴别诊断。

“一旦你看到紧张性精神症，
你无法忘记它。

“它改变了你对病人、他们的症状以及表面之下可能真正发生的事情的看法。多年来，我的女儿一直被误诊，直到最终确诊为紧张症，一切才豁然开朗。经过正确的治疗，她和我们的生活都发生了改变。”

——杰弗里·卡德威尔博士，初级保健医生，紧张症基金会理事会成员

Over the past three decades, and especially in recent years, there has been a surge of clinical and research interest in catatonia, resulting in a growing body of literature and deeper understanding of the condition. Yet much remains to be learned, and widespread education and awareness across healthcare disciplines still have a long way to go. Persistent misconceptions and gaps in recognition continue to lead to missed diagnoses and lack of treatment.

It’s important for healthcare professionals to understand:

Catatonia is not schizophrenia nor is it exclusively associated with schizophrenia. Historically viewed as a subtype of schizophrenia, it is now recognized as a distinct clinical syndrome with diverse causes and presentations.
Catatonia is not obsolete. It remains a current and clinically relevant condition recognized in both DSM-5-TR and ICD-11, with recent consensus guidance reinforcing its importance in modern practice.
Catatonia is not just stuporous or akinetic. It can also appear in an excited or agitated (hyperkinetic) form, sometimes alternating between both states. The excited form may include heightened activity, impulsivity, or agitation.
Catatonia is not always a fixed state. Its signs may appear suddenly, fluctuate in intensity, wax and wane, or recur over time. Stuporous and excited features can occur sequentially or even simultaneously, making recognition challenging without careful observation and surveillance.
A patient with catatonia is not acting volitionally. They may appear belligerent, oppositional, or uncooperative, exhibit negativism, or loop in repetitive thought or behavior patterns—but these actions are part of the syndrome, not deliberate choices.
Catatonia is not depression, anxiety, psychosis, delirium, or bipolar disorder. While it can occur alongside these conditions, it is a distinct syndrome that requires its own assessment and treatment.
Catatonia is not the typical behavior of an individual with autism. When it occurs, it reflects a change from the person’s baseline functioning and is a distinct, treatable condition.
Catatonia is not always linked to a psychiatric condition. It can occur in many medical conditions including encephalitis, autoimmune diseases, neurological disorders, metabolic or endocrine disorders, tumors, and stroke.
Catatonia is not always linked to an easily identifiable cause. In some cases, the precipitating factors are not immediately clear. It may occur with substance use or withdrawal, or following the initiation, change, or discontinuation of certain medications. In some individuals, factors such as infection, hormonal changes, lack of sleep, or experiences involving fear or trauma may contribute to its onset.

Catatonia is serious but highly treatable. With timely recognition and intervention, most people respond to benzodiazepines or electroconvulsive therapy (ECT). It’s also important to address the underlying medical, neurologic, or psychiatric condition that triggered the episode.

我们今天对紧张症的认识大多建立在马克斯·芬克博士的开创性工作之上。他重新确立了紧张症作为一种独立且可治疗的综合征的地位。他的研究和倡导表明，紧张症对苯二氮卓类药物和电休克疗法反应良好，这有助于将其纳入现代精神病学分类系统，成为一种正式的诊断。他的贡献通过世界各地临床医生和研究人员的持续努力得以延续。

两个主要的专业机构最近发布了关于识别、诊断、治疗和管理紧张症的临床医生指南。

尽管取得了这些进展，但我们对紧张症的了解仍然十分有限——包括其机制、类型以及最佳的预防和治疗方法。世界各地的临床医生和研究人员都致力于通过合作、研究和教育来增进对紧张症的认识，共同的目标是改善紧张症患者的预后。

点击下载我们的医疗保健专业人员手册

患病率

紧张症的发生率远高于许多临床医生的认知，在精神科、内科和神经发育科等各个领域，都有相当一部分患者受到影响。系统性评估显示，紧张症的检出率远高于常规临床实践。虽然不同人群和检测方法所报告的患病率有所不同，但一些共同的模式已经显现。

精神科住院患者：经系统评估，约有 10-20% 的患者符合紧张症的诊断标准。
内科住院患者：在普通内科病房接受联络精神科服务的患者中，约有 6-9% 符合紧张症的诊断标准，这表明紧张症并不局限于精神科病房。
根据近期综述的汇总估计，患有自闭症谱系障碍的个体中，约有 10% 符合紧张症的全部诊断标准，而高达 20% 的人可能表现出部分或逐渐发展的特征。
接受谵妄评估的患者中，有 13% 至 31% 也符合紧张症的诊断标准，这表明这些综合征之间经常存在重叠和诊断混淆。

在日常临床诊疗中，紧张症常常被漏诊或误诊，这表明其实际患病率可能高于报告数据。尽管紧张症影响着相当一部分精神科和内科患者，但它仍然普遍未被充分认识。

导致认可度不足的原因包括：

Limited education and training:

Catatonia is rarely taught in-depth in medical schools or psychiatry residency programs, leaving many psychiatry clinicians unfamiliar with its features.
Because education is lacking in medical schools, physicians who later specialize in internal medicine, emergency medicine, intensive care, neurology, or infectious disease often receive little to no training in how to recognize or assess catatonia.

Misconceptions and outdated beliefs:

Many clinicians still view catatonia as rare (“a zebra”), obsolete, or confined to schizophrenia, and therefore do not include it in the differential diagnosis.
Some continue to assume catatonia must be secondary to another psychiatric or medical condition, leading to diagnostic hesitation when a clear cause is not found.

Diagnostic overlap and blind spots:

Signs of catatonia are often mistaken for depression, anxiety, psychosis, schizophrenia, delirium, bipolar disorder, dementia or autism.
These overlaps contribute to misattribution of symptoms and delayed treatment.

Cross-disciplinary obstacles:

In emergency rooms, medical floors, and ICUs, non-psychiatric providers may be the first to observe the signs, but may not attribute them to catatonia or may lack confidence or training in recognizing it.

Improper or inconsistent assessment:

Some clinicians are unfamiliar with how to assess catatonia systematically, and others rely solely on the DSM-5, which may miss cases that would be detected by the BFCRS.
Some mental health professionals may misinterpret signs of catatonia—such as mutism, negativism, or refusal to eat—as willful, oppositional, or manipulative.

Failure to perform or misinterpretation of the Lorazepam Challenge Test:

The lorazepam challenge is an easy, inexpensive, and safe bedside test that can help confirm catatonia, yet it is underused or overlooked in both psychiatric and medical settings.
Some clinicians incorrectly believe that if a patient fails to respond immediately, catatonia can be ruled out, when in fact additional dosing of benzodiazepines or ECT may still be effective.

Limited understanding of its presentation and course:

Clinicians may not recognize that catatonia can present in different forms—from stuporous (akinetic) to agitated (hyperkinetic)—or with features of both simultaneously.
Its fluctuating nature and periods of apparent lucidity can obscure recognition, and subtle or early signs may go unnoticed or be dismissed as non-specific.

Communication barriers and lack of collateral information:

Patients with catatonia often cannot describe their experience, and clinicians may not seek input from family members or caregivers who understand the patient’s baseline functioning and changes.
Without family/caregiver input, key behavioral or motor changes may be misinterpreted or minimized.

紧张症基金会如何弥补这些差距

紧张症基金会正致力于通过临床医生教育、以研究为依据的培训和跨学科合作来弥补这些差距。

我们正在开发和传播资源和快速参考工具，以支持在医疗和精神病学环境中进行准确的识别和评估；与教育工作者和专业组织合作，将紧张症纳入医学课程和继续教育；并在专业会议上以及通过学术-临床合作开展有针对性的推广活动。

我们还与患者家属和护理人员分享教育材料和宣传指导，以促进早期识别和与护理团队进行有效沟通，从而促进对紧张症患者的早期诊断、适当治疗和改善治疗效果。

及时识别的重要性

紧张症是一种严重的综合征，但治愈率很高。早期识别有助于及时有效地治疗，并有助于预防可避免的并发症。

高治愈率：
一旦确诊紧张症，一线治疗通常使用劳拉西泮或其他苯二氮卓类药物，疗效显著，但可能需要一些时间来确定合适的剂量和疗效。电休克疗法也被证明对紧张症非常有效，尤其是在苯二氮卓类药物疗效不佳或仅有部分疗效时。
避免病情恶化：
抗精神病药物可能诱发或加重紧张症。非典型抗精神病药物有时需谨慎使用，某些药物的副作用似乎比其他药物小。了解这种风险有助于临床医生避免采取可能加重症状的干预措施。
预防医疗并发症：
未经治疗的紧张症可能导致营养不良、脱水、压疮、感染、血栓形成、攻击行为、自残或自主神经功能紊乱。及时识别和支持治疗在很大程度上可以预防这些并发症。
降低发病率并优化康复：
早期诊断有助于进行适当的治疗，缩短住院时间，获得更好的长期疗效，同时最大限度地减少不必要的抗精神病药物或其他无效干预措施。
及时识别和治疗恶性紧张症：
最严重的类型——恶性紧张症——会导致患者出现发热、自主神经功能紊乱和病情迅速恶化。这是一种真正的医疗紧急情况，需要紧急干预以防止死亡。

“任何一位能够识别紧张症的医生都掌握了有效的治疗方法。所以我认为紧张症是一种可以治疗的疾病。”

——马克斯·芬克，医学博士

由于紧张症可发生于精神科、神经科和内科等多个科室，临床医生应保持高度警惕，尤其当患者出现不符合明确诊断模式的运动、言语、反应或行为改变时。将紧张症纳入鉴别诊断，可确保潜在可治疗的病例不被忽视或误诊为其他疾病。

何时将紧张症纳入鉴别诊断

当患者出现运动、言语、反应或行为方面的突然或无法解释的变化时，应考虑紧张症的可能性。由于其症状可能与许多精神和躯体疾病重叠，因此了解这些体征对于确保准确诊断和及时干预至关重要。

当患者出现以下症状时，可能患有紧张症：

运动活动急性变化——不动、昏迷或不明原因的躁动
言语或反应能力显著下降——缄默、退缩或无反应
看似出于自愿但实际上却具有抵抗性或矛盾性的行为——消极主义、姿态性行为或模仿现象（例如，模仿言语、模仿行为）
症状表现波动或对压力敏感——症状会因压力、疾病或药物变化而加重，或症状会在数小时或数天内发生变化。

临床医生在评估以下情况时应特别考虑紧张症：

内科或外科住院患者的谵妄
患有精神分裂症、双相情感障碍或重度抑郁症的个体出现精神病症状
自闭症伴有新的退行性行为、攻击性行为或自伤行为，其中紧张性精神症可能是行为改变的潜在原因。
神经系统疾病或自身免疫性疾病，例如自身免疫性脑炎、狼疮、癫痫或帕金森病，这些疾病的运动和行为症状相互重叠。

替代方案：紧张症快速筛查 (CQS)

由于紧张症的症状可能不明显、波动不定，或容易被误诊为其他疾病，因此早期准确识别紧张症往往被延误。简短、高灵敏度的筛查工具，例如紧张症快速筛查工具，可以提高临床医生早期识别紧张症的可能性。这有助于及时评估和治疗，避免不必要的或有害的干预措施，并降低严重并发症的风险。

快速紧张症筛查将布什-弗朗西斯紧张症评定量表（BFCRS）简化为四个可观察的体征，这些体征最能预测紧张症的存在。当出现以下任何一项特征时，筛查结果即为阳性：

兴奋——过度、无目的或狂热的运动活动，不受外部刺激的影响
缄默症——语言反应显著减少或丧失
凝视——目光固定或眼球运动减少，通常持续很长时间
姿势——自发地保持一种对抗重力的僵硬或不寻常的姿势

CQS 阳性结果会促使使用经过验证的量表（例如 BFCRS 或 Northoff 紧张症评定量表 (NCRS)）进行全面的紧张症评估。

临床体征和表现

Once catatonia is suspected, recognition depends on systematic observation of characteristic signs—including motor, speech, and behavioral changes that may be accompanied by affective or autonomic dysregulation. Because catatonia can present in many forms and fluctuate over time, familiarity with its core clinical signs and varied clinical presentations is essential for accurate identification and effective management.

Clinical signs

Catatonia is identified based on the presence of specific motor, speech, behavioral, and autonomic signs that reflect disturbances in movement, responsiveness, and emotional expression. These signs can occur across psychiatric, neurologic, and general medical conditions.

Motor: Stupor, catalepsy, waxy flexibility, negativism, posturing, mannerisms, stereotypy, or agitation not influenced by external stimuli
Speech and Behavior: Mutism, echolalia, echopraxia, withdrawal, or reduced oral intake
Affective and Autonomic: Affective blunting, autonomic instability, or ambivalence

Structured Assessment: The Bush–Francis and Northoff Catatonia Rating Scales

1. Bush-Francis Catatonia Rating Scale (For Spanish version, Click here)

BFCRS is the most widely used and validated instrument for identifying and monitoring catatonia across psychiatric, neurologic, and general medical settings. It evaluates motor, speech, behavioral, and autonomic signs across the full spectrum of catatonia.

A positive screen is indicated by the presence of two or more of the first 14 signs listed on the BFCRS.
The 23-item full scale is used to assess severity, guide treatment, and track progress over time.

The Evidence-based consensus guidelines for the management of catatonia: Recommendations from the British Association for Psychopharmacology (2023) and the American Psychiatric Association Resource Document (2025) both recommend the BFCRS as the preferred structured measure for clinical assessment and monitoring.

Additional scoring guidance, instructional videos, and downloadable materials are available through the University of Rochester Medical Center Department of Psychiatry — Bush–Francis Catatonia Rating Scale Assessment Resource:
https://www.urmc.rochester.edu/psychiatry/divisions/collaborative-care-and-wellness/bush-francis-catatonia-rating-scale

2. Northoff Catatonia Rating Scale

The Northoff Catatonia Rating Scale (NCRS) offers the most comprehensive evaluation of signs of catatonia and is particularly valuable in research and neuropsychiatric settings. It includes 40 items divided into three domains:

Behavioral (15 items)
Motor (13 items)
Affective (12 items)

The NCRS uniquely emphasizes affective features—including fear, anxiety, and emotional blunting—which are often underrecognized in other assessments. Unlike BFCRS, the NCRS requires that at least one feature be present in each of its three domains (motor, affective, and behavioral), reflecting its integrative neuropsychiatric model of catatonia.

Diagnostic Criteria: DSM-5-TR

In the DSM-5-TR, catatonia can be diagnosed as:

Catatonia Associated with Another Mental Disorder (specifier)
Catatonia Due to Another Medical Condition
Unspecified Catatonia

Diagnosis requires the presence of three or more characteristic features from a list that substantially overlaps with the BFCRS—such as stupor, mutism, posturing, negativism, echolalia, and echopraxia.

Clinical Presentations

Catatonia can manifest in several forms, ranging from profoundly reduced movement and speech to excessive motor activity.

These presentations may shift during the same episode or appear sequentially, sometimes making recognition difficult.

The signs may appear contradictory or fluctuate in complex ways. A person may show stuporous and excited features simultaneously, alternate between states of withdrawal and agitation, or appear to improve and then relapse as signs come and go, change over time, or vary in intensity.

Recognition relies on careful observation and an openness to reconsider what may at first appear to be psychiatric, behavioral, or volitional in nature. Understanding this spectrum helps clinicians identify catatonia in both psychiatric and medical settings.

演示类型

昏迷（无动）性紧张症

以静止不动、缄默、凝视、姿势僵硬和退缩为特征的昏睡性紧张症，其特点是对环境反应迟钝。患者可能看起来失去意识或漠不关心，但这种状态并非出于自主。若不加以识别，可能会出现脱水、营养不良和压疮等并发症。

兴奋性（高动力性）紧张症

其特征是过度、无目的的活动，常伴有躁动、模仿言语或喋喋不休。由于症状与躁狂症、精神病和谵妄重叠，这种类型的精神病经常被误诊，导致不恰当的抗精神病药物治疗，反而可能加重病情。

兴奋性紧张症也称为躁动性紧张症，尤其是在患有自闭症或其他发育障碍的个体中出现时。

混合型紧张症

昏睡型和兴奋型症状可能交替出现或同时存在，导致临床表现快速变化。例如，患者可能数小时保持沉默和不动，然后突然变得冲动或躁动不安。这凸显了持续观察和/或家属或照护者报告以及重新评估的必要性。

周期性紧张症

有些人会出现间歇性或复发性紧张性精神症症状，这些症状会随着时间推移而时好时坏。发作间隔可能数周、数月甚至数年，有时与情绪障碍或精神障碍有关，也可能在压力、疾病或药物变化后出现。

恶性紧张症

这是一种危及生命的疾病，其特征是出现紧张性精神症症状，并伴有发热、自主神经功能紊乱和病情迅速恶化。及时识别并使用苯二氮卓类药物和/或电休克疗法进行治疗对于预防严重并发症至关重要。

广泛的临床表现/易感人群

紧张症可发生于各种情况下——儿童和青少年、自闭症或其他神经发育障碍患者、老年人或面临复杂疾病的人群。

自闭症及其他神经发育障碍中的紧张症

在患有自闭症或其他神经发育障碍的个体中，紧张症可能表现为动作迟缓、技能丧失、言语减少或出现躁动和自伤行为。这些变化代表着个体与基线状态的偏离，并且常常被误认为是行为问题，而非潜在的医学疾病。

儿童和青少年紧张症

紧张症也可能发生在没有自闭症的儿童和青少年身上，但这种情况经常被低估或误诊为抑郁症、精神病或对抗行为。

老年人和患病人群中的紧张症

在老年人和患有复杂疾病的患者中，紧张症的症状可能不明显，常常与痴呆、谵妄或药物副作用相混淆。住院医师、神经科医师和老年科医师提高对紧张症的认识至关重要，因为及时识别和治疗即使是身体虚弱的患者也能完全康复。

对患者进行紧张症评估

1

历史
详细的病史有助于识别增加易感性的因素或可能诱发紧张症的因素。

精神病史：情绪障碍、精神病、创伤相关疾病和神经发育障碍最为常见。
病史和神经系统病史：通常建议考虑代谢、自身免疫、感染或结构性因素。
用药史和物质使用史：回顾当前用药情况、近期用药变更或停药情况以及物质使用情况（包括酒精、大麻或其他物质），可以提供有价值的背景信息，因为这些因素经常与紧张症的发生或恶化有关。
基线值和随时间的变化：了解患者的典型功能、近期与基线相比的变化以及这些变化发生的时间范围，对于区分紧张症与其他疾病以及识别潜在的诱因至关重要。

2

抵押品信息
来自家庭成员和照护者的辅助信息往往能提供至关重要的见解，帮助我们了解在短暂的临床诊疗过程中可能不易察觉的变化。家庭成员和照护者通常是最先注意到患者早期或细微的动作、反应或行为变化的人，但他们可能并不清楚哪些细节值得分享。由于他们往往处于危机之中，他们可能会用日常语言而非专业术语来描述观察到的情况。

临床医生可能会发现，提出具体、明确的问题比提出宽泛的问题更有帮助。例如：

这个人是否停止说话，或者开始低声说话、重复或回声说一些词语或短语？
他们的食量、饮水量或活动量是否比平时减少？
它们看起来是否僵硬、抗拒移动，或者长时间保持不寻常的姿势？
你有没有注意到自己有重复或无目的的动作？

有针对性的问题可以揭示出家庭没有意识到的重要特征——例如，患者反复询问同一个问题可能表现出模仿言语，这高度提示紧张症。

由于患有紧张症的人通常无法沟通或描述自己的症状，因此来自最了解患者的人的辅助信息对于确定与基线相比有哪些新的或不同的情况以及支持及时识别至关重要。

3

观察与检查
仔细观察仍然是评估的核心。文献强调运动现象（不动、僵硬、姿势异常、刻板行为或怪癖）和言语或行为特征（缄默症、模仿言语、模仿动作、否定倾向）。

一次普通的就诊可能没有足够的时间来充分评估紧张性精神症症状的范围或波动，这些症状可能会在一天中或不同的情况下发生变化。

还需注意的是，目前的药物可能会影响病情表现——有些药物可能会掩盖紧张性精神症的特征，而另一些药物可能会加剧这些特征。

这些因素凸显了持续观察和来自家属的辅助信息的重要性，家属可以描述不同环境和时间段内的变化。教育家属需要注意的事项可以加强早期识别，并有助于确保将相关的观察结果传达给临床团队。

您可以建议患者家属访问紧张症基金会网站，他们可以在那里深入了解紧张症，学习如何有效地进行倡导，并下载患者和家属手册，以获取更多支持和教育。

4

结构化筛选
标准化工具有助于实现更一致的识别。

布什-弗朗西斯紧张症评定量表（BFCRS）包含 14 个筛查项目；两个或两个以上阳性项目的存在通常被描述为紧张症的征兆。
文献中也出现了诺斯霍夫紧张症评定量表（NCRS），该量表更广泛地关注情感和行为维度。

使用结构化工具可以为记录和监测症状提供一个共同的框架。

如需了解更多信息和可下载工具，请访问上面的“筛查和评级量表”部分。

5

Medical and Neurological Workup
Medical evaluation plays an essential role in understanding both the underlying causes and potential complications of catatonia. The literature emphasizes that most patients with catatonia are assessed within secondary or inpatient care settings, reflecting the condition’s complexity and associated medical risks (Evidence-Based Consensus Guidelines for the Management of Catatonia, 2023).

According to the Consensus Guidelines, any first-episode presentation of catatonia should prompt a thorough medical and neurological workup to identify potential contributing or causative conditions. Even in recurrent episodes, clinicians are encouraged to confirm that a complete prior evaluation was performed, as new or evolving medical factors may emerge over time. These recommendations underscore the importance of a systematic approach to ruling out underlying causes and identifying concurrent medical issues that may influence management.

The Consensus Guidelines further advise that investigations be guided by the patient’s history, examination findings, and likely differential diagnoses. Commonly discussed components include:

Laboratory studies: Basic metabolic and endocrine panels, inflammatory markers, and serum iron; additional testing as indicated for metabolic, infectious, or autoimmune conditions.
Toxicology screening: Urine drug screens may help identify substances that could contribute to presentation.
Neuroimaging: CT or MRI of the brain is often considered for first-episode catatonia or when the diagnosis is uncertain, to evaluate for structural, inflammatory, or neoplastic processes.
Electroencephalography (EEG): Particularly valuable when seizures, encephalitis, or altered consciousness are possible contributors; continuous monitoring can be helpful when available.
Autoimmune and paraneoplastic testing: In suspected autoimmune encephalitis, serum and CSF testing for NMDA-receptor and other relevant autoantibodies may be indicated.

The Consensus Guidelines also emphasize that any hospital workup should weigh the potential risks and benefits of detailed investigation. Extensive medical testing may heighten anxiety, and catatonia itself has been closely associated with heightened physiological and psychological arousal. In some patients, prolonged uncertainty or repeated investigations may intensify distress or worsen catatonic features.

A well-considered medical and neurological workup therefore serves not only to identify or rule out underlying causes but also to inform care planning, monitoring, and prevention of complications such as dehydration, malnutrition, or autonomic instability.

6

劳拉西泮挑战
劳拉西泮激发试验在文献中经常被提及，它既是一种诊断工具，也是一种治疗手段。该试验包括谨慎地给予劳拉西泮（通常为1-2毫克，可通过静脉、肌肉或口服给药），同时观察紧张症症状的短期改善情况。阳性反应通常在静脉给药后数分钟内或口服给药后一小时内出现，可支持紧张症的诊断，并有助于指导后续治疗方案的制定。

该操作应始终在受监控的临床环境下进行，因为患者可能存在合并症，或需要观察镇静剂或呼吸系统反应。即使是部分缓解也能提供有价值的诊断信息。需要注意的是，虽然症状迅速改善强烈提示紧张症，但无反应并不能排除紧张症的诊断。

如需了解该过程在实践中的具体描述，请参阅以下内容：精神药理学研究所紧张症系列——劳拉西泮挑战。

治疗

Once a diagnosis of catatonia has been established following appropriate medical and neurological work-up, treatment should begin promptly. Catatonia is a serious but highly treatable condition. Timely recognition and intervention can be life-saving and often result in rapid recovery.

Benzodiazepines
Benzodiazepines are the first-line treatment for catatonia. Lorazepam is most commonly used, and dosing is guided by clinical response rather than conventional limits. Higher-than-usual doses may be required, and published literature describes effective treatment with lorazepam doses as high as 30–40 mg per day.

Other benzodiazepines, such as diazepam or clonazepam, are considered when lorazepam is unavailable, poorly tolerated, or when a longer-acting agent is preferred. Clinical reasons for selecting these alternatives include reducing the number of daily doses, providing steadier coverage between administrations, managing adverse effects or tolerance, accommodating different routes of administration, or facilitating transition to maintenance treatment once acute symptoms have improved.

In the United States, prescribing benzodiazepines at higher doses may draw increased scrutiny from the FDA and other regulatory agencies, given their classification as controlled substances. It may also result in increased scrutiny from pharmacies and insurance companies. Prior authorization or additional verification may be required before it is dispensed. Clear documentation of medical necessity and diagnosis helps prevent treatment delays and ensures regulatory compliance.

Stigma surrounding benzodiazepine use—particularly concerns about sedation or dependence—can lead to undertreatment. In the context of catatonia, these medications serve as a restorative intervention that targets the underlying syndrome rather than functioning primarily as a sedative.
Electroconvulsive Therapy (ECT)
ECT is highly effective, generally safe, and often life-saving—particularly when symptoms are severe, prolonged, or unresponsive to benzodiazepines. It is also indicated when malignant features or medical instability are present. Early consideration of ECT is warranted, as delays in treatment may increase morbidity and mortality.

Despite robust evidence for its safety and efficacy, ECT remains stigmatized and misunderstood. Modern ECT is performed under anesthesia with muscle relaxation and continuous monitoring, bearing little resemblance to outdated depictions in media or public perception. In catatonia, ECT consistently produces high rates of remission and should not be withheld when clinically indicated.
Other Options
When response to benzodiazepines and ECT is incomplete, contraindicated, or unavailable, medications such as amantadine, memantine, or zolpidem have been reported to provide benefit in selected cases.
Antipsychotics
Antipsychotic medications have been shown to worsen catatonia in some patients. Atypical antipsychotics are sometimes used but the literature suggests they should be used with caution.
Treatment of the Underlying Condition
Catatonia is often secondary to another medical, neurological, or psychiatric condition. Identifying and treating the underlying cause is essential for full recovery and relapse prevention. Management of the precipitating illness should occur alongside catatonia-directed therapy.

In autoimmune encephalitis such as anti-NMDAR encephalitis, immunotherapy (e.g., corticosteroids, intravenous immunoglobulin, or plasmapheresis) may be used in conjunction with benzodiazepines or ECT. Coordinated, multidisciplinary care—often involving psychiatry, neurology, and internal medicine—is critical to ensure comprehensive treatment.
Ongoing Care and Relapse Prevention
Some patients require maintenance treatment to prevent relapse, particularly those with recurrent or chronic catatonia or ongoing psychiatric or medical comorbidity. Maintenance benzodiazepines or continuation/maintenance ECT may be indicated. Ongoing monitoring and coordinated interdisciplinary care are essential to support long-term stability and recovery.