Catatonia Treatment — MRCPsych Paper B MCQ

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ModerateSchizophrenia & PsychosisCatatonia TreatmentMRCPsych Paper B

A 25-year-old woman with schizophrenia develops mutism, immobility, waxy flexibility and negativism over 2 days. She is afebrile and haemodynamically stable, with no autonomic instability or immediate severe medical compromise. Which treatment is the most appropriate initial specific intervention for her catatonia?

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Correct answer: A — Lorazepam

Lorazepam is the most appropriate initial treatment for this medically stable, non-malignant catatonic syndrome. A lorazepam challenge may support the diagnosis when uncertainty remains, and repeated doses are commonly required for treatment. ECT is highly effective and should be considered promptly when catatonia is life-threatening, severe, or insufficiently responsive to benzodiazepines, but those features are absent here. Catatonia should not be treated simply as worsening schizophrenia: haloperidol, olanzapine and clozapine are not first-line treatments for the acute catatonic syndrome. Dopamine-blocking antipsychotics, particularly high-potency agents such as haloperidol, may worsen catatonia or contribute to neuroleptic malignant syndrome. Treatment of the underlying psychotic illness can be reviewed once catatonia has been addressed.

Reference: Rogers JP et al. The diagnosis and treatment of catatonia. Clinical Medicine. 2023;23(3):242–246. https://pubmed.ncbi.nlm.nih.gov/37236789/