From the Guidelines
Treatment for catatonia typically involves a combination of benzodiazepines and electroconvulsive therapy (ECT). The first-line treatment is often lorazepam, given at a dose of 1-2 mg orally or intravenously every 4-6 hours, with a maximum dose of 8-12 mg per day 1. If symptoms persist, ECT can be considered, usually 2-3 times a week, for a total of 6-12 sessions 1.
Key Considerations
- ECT may be used in children and adolescents with catatonia who either are medication nonresponders, cannot tolerate medications, have a medical contraindication to medications, or have a clinical presentation for which ECT may be particularly indicated 1.
- The clinician must balance the relative risks and benefits of ECT treatment against the morbidity of the disorder, the attitudes of the patient and family, and the availability of other treatment options 1.
- Potential side effects of ECT include short-term cognitive impairment, anxiety reactions, disinhibition, and altered seizure threshold 1.
Treatment Approach
- Benzodiazepines: lorazepam is often the first-line treatment, given at a dose of 1-2 mg orally or intravenously every 4-6 hours, with a maximum dose of 8-12 mg per day 1.
- ECT: usually 2-3 times a week, for a total of 6-12 sessions 1.
- Monitoring: vital signs, hydration, and nutrition during treatment, as catatonia can lead to serious medical complications.
- Hospitalization: may be necessary to ensure the patient's safety and provide adequate care in severe cases.
From the Research
Treatment Options for Catatonia
The treatment options for catatonia include:
- Benzodiazepines, such as lorazepam, which can be used as a first-line treatment 2, 3, 4
- Electroconvulsive therapy (ECT), which can be used alone or in combination with benzodiazepines 2, 3, 5, 4
- Antipsychotics, such as aripiprazole, which may be effective in treating catatonic symptoms, particularly in patients with catatonic depression 6
- Combination therapy, which may involve the use of benzodiazepines and antipsychotics, or ECT and benzodiazepines 2, 3, 5
Considerations for Treatment
When considering treatment options for catatonia, the following factors should be taken into account:
- The patient's medical history and comorbidities, such as mood disorders or medical conditions that may be contributing to the catatonia 3, 4
- The severity of the catatonic symptoms and the risk of complications, such as cerebral abnormalities or medical comorbidities 3, 4
- The potential benefits and risks of each treatment option, including the use of ECT and benzodiazepines 2, 3, 5, 4
- The need for rapid treatment, as early intervention is associated with better outcomes 4, 6