Lorazepam for chronic catatonia: a randomized, double-blind, placebo-controlled cross-over study

Abstract

Acute catatonic syndromes occurring in the context of various medical and neuropsychiatric conditions, including schizophrenia, have been shown to respond well to benzodiazepines (BZD). However, there have been no studies specifically designed to address the BZD treatment response of persistent catatonic states. Eighteen patients with clinically stable chronic schizophrenia, who also displayed enduring catatonic features, underwent a 12-week long, random assignment, double-blind, placebo-controlled cross-over trial with lorazepam (6 mg/day). A comprehensive assessment, including the subjects' clinical and motor (catatonic as well as drug-induced movement disorders) condition, was performed at baseline and four weekly intervals thereafter. Pre-existing medication was kept constant throughout the study. Lorazepam had no effect on the subjects' catatonic signs and symptoms, suggesting that acute and chronic catatonic syndromes associated with schizophrenic illness might have a different neurobiological basis.

Motor Symptoms and Schizophrenia

“…The course of catatonia is heterogeneous. Catatonic symptoms may resolve with treatment in some cases, however persistence or deterioration are also frequently observed [8,34,42,67,108,109,110,111,112]. Finally, intraindividual variations in symptom presentation and severity have been reported for all motor signs in schizophrenia.…”

Catatonia in a woman who is profoundly deaf-mute: case report

“…6,7 Features of individuals who respond poorly to lorazepam include longterm untreated catatonia, 6,8 presence of mutism, 6 a primary diagnosis of schizophrenia (50% response rate), 7 presence of third-person auditory hallucinations and passivity phenomena, 6 and being from a rural background. 6 Features of individuals who respond well include a primary diagnoses of affective disorders (480 response rate), 7 schizoaffective disorders (70% response rate 7 ) and presence of waxy flexibility.…”

Diretrizes da Federação Mundial das Sociedades de Psiquiatria Biológica para o tratamento biológico da esquizofrenia. Parte 1: tratamento agudo

“…Os benzodiazepínicos revelaram eficácia nas reações catatônicas agudas (Rosebush et al, 1990;Ungvari et al, 1994;Bush et al, 1996;Lee et al, 2000) e mostraram benefícios quando adicionados aos antipsicóticos na catatonia crônica (Nível C) (Ungvari et al, 1999).…”

“…Na subamostra de pacientes com catatonia, os benzodiazepínicos oxazepam e clonazepam revelaram eficácia na catatonia aguda. Em contrapartida, o uso do lorazepam não proporcionou benefícios num ECR controlado com placebo em pacientes catatônicos crônicos (Ungvari et al, 1999). Contudo, pode-se dizer que o lorazepam é útil em abordagens combinadas por apresentar boa absorção da preparação oral e menor relaxamento muscular que os outros benzodiazepínicos (APA, 2004).…”