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.
- 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 TREATMENT||Benzodiazepines (Lorazepam)|
|GOLD STANDARD TREATMENT||Electroconvulsive therapy (ECT)|
- Front Psychiatry. 2014; 5: 181.
- Current Psychiatry. 2018 December;17(12):45-49.
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Dr. Harvinder Singh, M.D. (Admin)
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