Catatonia. II. Treatment with lorazepam and electroconvulsive therapy

Abstract

Case material and retrospective studies support the use of both lorazepam and ECT in treating catatonia, but few prospective investigations exist and none employ quantitative monitoring of response. In this study we test their efficacy in an open, prospective protocol, and define a "lorazepam test' with predictive value for treatment. Twenty-eight patients with catatonia were treated systematically with parenteral and/or oral lorazepam for up to 5 days, and with ECT if lorazepam failed. Outcome was monitored quantitatively during the treatment phase with the Bush-Francis Catatonia Rating Scale (BFCRS). In 16 of 21 patients (76%) who received a complete trial of lorazepam (11 with initial intravenous challenge), catatonic signs resolved. A positive response to an initial parenteral challenge predicted final lorazepam response, as did length of catatonic symptoms prior to treatment. Neither demographic variables nor severity of catatonia predicted response to lorazepam. Four patients failing lorazepam responded promptly to ECT. It is concluded that lorazepam and ECT are effective treatments for catatonia. The rating scale has predictive value and displays sensitivity to change in clinical status.

Catatonia in Psychotic Patients: Clinical Features and Treatment Response

“…This interesting observation is in line with a previous study reporting 32% of patients had resolution of psychotic symptoms once catatonia was effectively treated. 14 This effect may be explained by the collateral impact of treatments directed at catatonia on psychotic symptoms, or by a worsening in psychotic symptoms by catatonia, which improves secondarily as catatonia is treated.…”

“…14 This is an important issue in treating patients presenting with both psychosis and catatonia. We found that clozapine stood out uniquely as an antipsychotic agent that was uniformly beneficial.…”

Development and validation of the Bush-Francis Catatonia Rating Scale – Brazilian version

“…Catatonia evaluation scales have rarely been used in studies that measure response to treatment. Nevertheless, one study has already shown that the BFCRS is sensitive to the changes in the severity of the catatonic symptoms during treatment with lorazepam and electroconvulsive therapy 26 . Despite being considered valid and widely used, a lack of uniformity and the existence of inaccurate definitions and symptoms are said to be some of its limitations 27 .…”

Treatment of periodic catatonia with atypical antipsychotic, olanzapine

“…Therapeutically, 60-80% of the acute catatonic patients respond to lorazepam, a GABA-A receptor agonist. 4 We report a case of periodic catatonia that responded well to olanzapine.…”