Catatonia – Lorazepam First-Line — SCE Neurology MCQ

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ModerateNeuropsychiatryCatatonia – Lorazepam First-LineSCE Neurology

A 60-year-old woman with dementia develops catatonia — she is mute, immobile, with waxy flexibility and catalepsy. She stares blankly and does not respond to verbal or physical stimuli. She has no signs of infection. What is the first-line pharmacological treatment for catatonia?

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Correct answer: A — Lorazepam

Lorazepam (a benzodiazepine) is the first-line treatment for catatonia regardless of the underlying cause (psychiatric, medical, or neurological). A trial of IV or IM lorazepam (1–2 mg) produces a dramatic response in ~60–80% of catatonic patients within minutes to hours. Antipsychotics (particularly typical agents like haloperidol) should be avoided as they can worsen catatonia and precipitate neuroleptic malignant syndrome. If benzodiazepines fail, electroconvulsive therapy (ECT) is the most effective second-line treatment. A: Haloperidol can worsen catatonia and precipitate NMS. C: Olanzapine has limited evidence. D: Valproate is not first-line. E: Lithium is not first-line.

Reference: NICE CG178 Psychosis (2014); Bush et al. Catatonia Rating Scale; EAN Catatonia Guidelines