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Warfarin-Associated Bleeding — PSA MCQ

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HardHaematologyWarfarin-Associated BleedingPSAMRCEM SBAMRCP Part 1UKMLA

A patient with severe depression becomes mute and immobile, resists passive movement, maintains imposed postures and intermittently echoes the examiner. Observations are stable, there is no lead-pipe rigidity and initial investigation finds no metabolic cause. Which bedside intervention best supports the suspected diagnosis while treatment planning continues?

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Correct answer: A — Give a monitored lorazepam challenge and reassess a standardised catatonia score

The best answer is “Give a monitored lorazepam challenge and reassess a standardised catatonia score”. Multiple motor and behavioural signs make catatonia likely. The BAP guideline supports a lorazepam challenge, commonly 1–2 mg intravenously or intramuscularly, or 2 mg orally, followed by timed reassessment with a standardised instrument; a marked reduction supports the diagnosis but is not perfectly specific. Investigation for the underlying psychiatric, neurological or medical cause proceeds in parallel. Dopamine antagonists can worsen catatonia and are not a diagnostic probe.

Reference: British Association for Psychopharmacology: Evidence-based consensus guidelines for catatonia: https://pmc.ncbi.nlm.nih.gov/articles/PMC10101189/