The Psychiatric Manifestation of Creutzfeldt-Jakob Disease

Creutzfeldt-Jakob Disease之精神症狀表現

10.6452/KJMS.199704.0263

顏正芳(Cheng-Fang Yen)；林瑞泰(Ruey-Tay Lin)；劉景寬(Ching-Kuan Liu)；李培聞(Pei-Wen Lee)；陳正宗(Cheng-Chung Chen)；張育萍(Yu-Ping Chang)

Creutzfeldt-Jakob disease ； organic mental disorder

The Kaohsiung Journal of Medical Sciences

13卷4期（1997 / 04 / 01）

263 - 267

英文

為了解Creutzfeldt-Jakob Disease（簡稱CJD）病人病程中可能出現的精神症狀，作者以病歷回顧方式蒐集過15年間住進某醫學中心神經內科病房，其臨床病程、症程、腦波檢查和腦組織切片所呈現之特殊變化支持為罹患CJD之個案共8位（男2位女6位），年齡分佈自46歲至75歲，住院的主要症狀包括記憶退化併認知功能下降（8/8）、頭痛及暈眩（5/8）、話量及內容改變（3/8）、意識障礙（2/8）、大小便失禁（2/8）、幻覺及妄想（2/8）、人格及行為改變（2/8）、情緒波動（1/8）、步伐不穩（1/8）、視覺模糊（1/8）、和肌抽躍（1/8）。所有個案均在短時間內出現癡呆症狀，而最初症狀出現到最終死亡時間從3個月到18個月不等。其中5位個案在病程中曾出現精神症狀，包括被妄想（2/5）、怪異行為（3/5）、自言自語（2/5）、憂鬱（2/5）、視幻覺（1/5）、精神活動遲滯（1/5）和阻抗傾向（1/5）。有4位曾接受精神醫療單位之診治，所獲得之暫時診斷包括器質性腦症候群（2/4）、憂鬱症（2/4）、疑先老期老年癡呆症（1/4）和急性精神症狀併僵直狀態（1/4）。因上述症狀個案曾接受電氣痙戀治療。CJD病患易轉介精神科求助，基於以上經驗，建議如有以下情況則需考慮CJD之可能性：（1）當記憶等認知功能短時間惡化；（2）精神狀態未因治療藥物而改善，甚至惡化時；（3）精神症狀伴有神經異常症狀出現時。若有懷疑則需安排EEG，並照會神經內科醫師協助評估。

Creutzfedt-Jakob disease (CJD) is considered to be very rare in the population, and the psychiatric manifestation of the disease even with only one report in the past few years in Taiwan. To clarify whether the psychiatric manifestation of CJD is really rare or whether it is neglected in Taiwan, the authors reviewed the discharge notes of patients who has been admitted to a neurological unit in the past 15 years and conducted a chart review of the patients of CJD supported by the clinical courses, EEG finding and brain biopsies. An inquiry was made by telephoning their families to follow up their condition after discharge. Five of the 8 cases with CJD had psychiatric symptoms including changes of mood, thought, behavior and perception during their course of illness. Four cases had been sent to the psychiatric unit and received treatment under several kinds of psychiatric diagnoses. Two patients had been admitted to the psychiatric unit and one had received electroconvulsive treatment. Two of the patients had been suspected to be the victims of neuroleptic malignant syndrome. It is likely that it is psychiatrists who will meet CJD patients first in the early stages of disease. CJD should be kept in mind and EEGs with detailed neurological checkups should be completed, if the cognitive functions of the patients with unusual neurological symptoms deteriorate quickly and their psychiatric symptoms fail to respond to any treatment.