Catatonia (#3): Treatment with Benzodiazepines.

FIRST LINE MEDICATION: BENZODIAZEPINES (LORAZEPAM).

Route of administration:

  • IV or IM preferred over oral.

Initiating dose of lorazepam:

  • 2 mg (Lorazepam Challenge Test)

Examine patient after:

  • 5 minutes (if IV lorazepam was used) ==> if no improvement noted ==> give another dose of lorazepam.
  • 15 minutes (if IM lorazepam was used) ==> if no improvement noted ==> give another dose of lorazepam.
  • 30 minutes (if Oral lorazepam was used) ==> if no improvement noted ==> give another dose of lorazepam.

Lorazepam dosing:

  • Initiate at 1-2 mg Q4-12 hourly and adjust dose based on response.
  • Dose of 8-24 mg/day may be needed.
  • Monitor for side effects including sedation and respiratory depression.

Response time with benzodiazepines: 3-7 days.

Remission rates with benzodiazepines: 70-80%.

Which patient subtype have poor response to benzodiazepines:

  • chronic catatonia associated with schizophrenia.

Next step if patient not responding to highest tolerable doses of benzodiazepines for 72 hr:

  • ECT (Electroconvulsive therapy): GOLD STANDARD TREATMENT.

FIRST LINE TREATMENTBenzodiazepines (Lorazepam)
GOLD STANDARD TREATMENTElectroconvulsive therapy (ECT)

REFERENCES:

  1. Front Psychiatry. 2014; 5: 181.
  2. Current Psychiatry. 2018 December;17(12):45-49.

Please do post your questions or comments below. 


Dr. Harvinder Singh, M.D. (Admin)


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