Symptoms & Diagnosis of Catatonia | Catatonia Foundation

体征与诊断

紧张症的表现因人而异。它可以呈现多种形式，随时间推移而变化，并出现在多种环境中——精神科、神经科或普通内科。它也可能发生于自闭症和其他发育障碍患者、老年人以及患有内科或神经系统疾病的人群中。

及早发现紧张症有助于进行有效治疗，并有助于预防严重的并发症。

准确诊断需要由熟悉如何评估紧张症的医疗保健专业人员进行系统和协作的评估。

由于症状可能会波动，与其他疾病重叠，并且在不同的环境中表现不同，因此临床医生、家庭和护理人员之间的合作至关重要。

家庭成员通常能最全面地了解一个人的日常功能（基线状态），并描述其随时间推移发生的变化。这些观察结果往往是识别紧张症及其发展背景的关键。

阅读有关症状的描述与在现实生活中观察这些症状是截然不同的。“患者故事”页面上的故事将为您提供紧张症可能出现的真实案例。

查看患者故事

识别这些迹象

Catatonia should be considered as a possible diagnosis when a person exhibits substantially altered levels of motor activity (either subdued or excessive), abnormal speech, and/or abnormal behavior, especially when it is greatly inappropriate to context and/or comes on suddenly.

The signs of catatonia generally fall into four categories — motor or movement, speech and communication, behavior and interaction, and affective and automatic.

It’s important to note that catatonia is not static. The different signs may wax and wane, they may appear to be volitional, and they may be very confusing. These signs are often noticed first by families or caregivers as different from their loved one’s typical baseline.

Motor Signs include:
Immobility or stupor, rigidity, waxy flexibility (limb stays in place when moved), posturing, negativism (resisting without reason), repetitive or purposeless movements (rocking, pacing, tapping), or agitation that isn’t purposeful.

Speech and Communication Signs include:
Not speaking (mutism), whispering, echoing others’ words (echolalia), repeating the same phrases (verbigeration), or looping over the same ideas or worries (perseveration). These can sound like rumination or obsessive thinking, but they often reflect a disruption in how speech and movement are connected.

Behavior and Interaction Signs include:
Withdrawal from others, not eating or drinking, exaggerated gestures (mannerisms), imitating others’ movements (echopraxia), sudden impulsive actions, or exaggerated cooperation (automatic obedience).

Affective and Autonomic Signs include:
Flat or blunted emotion, sudden emotional shifts, or physical signs such as fever, fast heartbeat, or changes in blood pressure.

为什么诊断会充满挑战

Catatonia is often misunderstood or missed—even in medical and psychiatric settings.
Common reasons include:

Limited awareness or training among healthcare professionals about catatonia and how to recognize it
First contact is with internists, emergency room physicians, intensivists, ICU physicians, psychologists, and social workers, who may not be familiar with the signs of catatonia
Overlap with other conditions, such as depression, psychosis, or movement disorders
Time-limited evaluations, which make it hard to see the full range of symptoms
Symptoms that wax and wane, making catatonia appear inconsistent, volitional, or behavioral
Families’ shared observations of changes from baseline—often the first sign that something is wrong—are too often dismissed or minimized
Families are unaware of what’s relevant to report, especially as they are experiencing a crisis
Family members, experiencing overwhelm themselves, may have difficulty communicating what they are observing

紧张症基金会正努力通过提高医护人员和家属/照护者的意识和教育、提供宣传资源以及促进临床医生、研究人员和家属/照护者之间的合作来应对这些挑战。我们携手努力，就能改变紧张症的治疗现状，让患者不必在寻求正确诊断的过程中承受不必要的痛苦。

Structured Assessment Tools

由于紧张症的症状多种多样，且因人而异，因此使用经过验证的评估方法可以大大提高识别和诊断的准确性，从而使患者能够得到适当和及时的治疗。

值得注意的是，紧张症的临床表现多种多样，包括昏睡型（运动不能）、兴奋型（运动亢进）、混合型（既有昏睡又有兴奋）、周期性（呈周期性复发）以及恶性（危及生命）。此外，还需认识到，紧张症可发生于各种人群和各种情况下，包括儿童和青少年、自闭症或其他神经发育障碍患者，以及老年人或患有复杂疾病的患者。如需了解这些临床表现的详细描述，请点击此处。

尽管已开发出多种评定量表，但最常用的有两种——布什-弗朗西斯紧张症评定量表（BFCRS）和诺索夫紧张症评定量表（Northoff Catatonia Rating Scale）。两份近期发布的国际紧张症资源指南普遍推荐这两种量表，并推荐BFCRS作为临床评估和监测的首选结构化测量工具。

1

Bush–Francis Catatonia Rating Scale (BFCRS)

The BFCRS — a 23-sign tool used for identifying and tracking catatonia in medical, neurological, and psychiatric settings.

The first 14 signs are investigated: if two or more signs are present, this is considered a positive screen for catatonia.
Following a positive screen, the 23-item full scale is investigated to measure the severity of the signs and how they change over time with treatment.

Overlap with other conditions should not rule out a diagnosis of catatonia, and it’s important to take into account that the patient’s distress may be attributable to catatonia in these circumstances. For example, a person with catatonia can appear psychotic or delusional (disconnected from reality or distorted beliefs), experience regression of cognitive or developmental abilities, stuck in looped thinking of doom and gloom, or have self-injurious or sudden, unprovoked aggression (even in an individual on the autism spectrum).

For the full list of specific signs (and descriptions) listed on the BFCRS in the order they are presented, click here.

For a copy of the BFCRS and resources on how to use the scale, click here.

2

Northoff Catatonia Rating Scale (NCRS)

NCRS是一个包含 40 个项目的详细量表，常用于研究或神经病学领域。它将症状分为运动、行为和情感三类，并着重强调恐惧、焦虑和情感麻木等情绪特征。

与 BFCRS 不同，NCRS 要求其三个领域（运动、情感和行为）中至少有一个特征。

正式诊断标准（DSM-5-TR）

A formal diagnosis is made when specific diagnostic criteria set forth in the DSM-5-TR are met—three or more characteristic symptoms are present, such as stupor, mutism, posturing, negativism, echolalia, or echopraxia. This framework defines the minimum threshold for recognizing catatonia as a clinical syndrome and allows it to be coded in medical and psychiatric records.

For the full list of specific symptoms (and descriptions) listed on the DSM-5-TR in the order they are presented, click here.

The DSM-5-TR provides three ways catatonia can be coded: catatonia associated with another mental disorder, catatonic disorder due to another medical condition, and unspecified catatonia.

临床医生如何评估紧张症

A careful evaluation helps confirm whether catatonia is present and what might be contributing.

History: Reviewing medical, neurological, and psychiatric background; trauma and recent illness; medications; substance use; and changes from baseline.

Collateral Information: Families and caregivers provide crucial insight beyond what can be observed in a brief clinical encounter. Their observations about changes from the person’s usual behavior, movement, communication, and responsiveness often clarify patterns, identify fluctuations, and highlight early warning signs that might otherwise be missed.

Structured Screening: Clinicians may use standardized tools such as the BFCRS or the NCRS to document and rate catatonic signs in a consistent way.

Clinical Examination: Drawing on items from these scales, clinicians directly test and observe for signs listed on one of the structured screening scales and assess for autonomic instability (e.g., fluctuations in heart rate, blood pressure, or temperature). These assessments help distinguish catatonia from other neurological or psychiatric conditions.

Click here for the full BFCRS list of signs

Medical and Neurological Workup: Exploring possible causes, including metabolic, infectious, or autoimmune conditions such as anti-NMDA receptor encephalitis. Typical investigations may include laboratory studies (e.g., metabolic panels, thyroid function, autoimmune and infectious markers), neuroimaging (CT or MRI), and electroencephalography (EEG). The extent of testing depends on clinical context and is guided by the patient’s presentation.

Lorazepam Challenge: The lorazepam challenge test is often used to help confirm catatonia. It involves giving a small, carefully monitored dose of lorazepam and watching for improvement in symptoms over a short period of time—often within minutes to hours. The test is simple, low-cost, and generally safe, and a positive response (rapid reduction in catatonic signs) provides strong support for the diagnosis. However, a negative or partial response does not rule out catatonia, as clinical judgment and context remain essential in interpreting the results.

Together, these approaches provide a structured yet individualized framework for recognizing catatonia and identifying any underlying causes.