Catatonia. II. Treatment with lorazepam and electroconvulsive therapy

TLDR

Retrospective evidence supports lorazepam and ECT for catatonia, yet prospective studies with quantitative monitoring are lacking. The study prospectively evaluates lorazepam and ECT efficacy and introduces a predictive lorazepam test. Twenty‑eight catatonia patients received systematic lorazepam (up to 5 days) with ECT if needed, and responses were quantified using the Bush‑Francis Catatonia Rating Scale. Lorazepam resolved catatonia in 76% of patients, with initial parenteral response and symptom duration predicting outcome; those who failed lorazepam responded to ECT, confirming both treatments’ efficacy and the rating scale’s predictive value.

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.