From the FDA Drug Label
More severe acute withdrawal signs and symptoms, including life-threatening reactions, have included catatonia, convulsions, delirium tremens, depression, hallucinations, mania, psychosis, seizures, and suicidality Yes, a patient with delirium tremens (DT) can develop catatonia, as it is listed as one of the possible severe acute withdrawal signs and symptoms associated with benzodiazepines, which can include delirium tremens 1 2.
From the Research
Yes, patients with delirium tremens (DTs) can potentially develop catatonia, though this is not a common progression. Delirium tremens is a severe form of alcohol withdrawal characterized by confusion, tremors, hallucinations, and autonomic instability, while catatonia is a neuropsychiatric syndrome featuring abnormal movements, behaviors, and withdrawal. The connection exists because both conditions involve dysregulation of GABA and glutamate neurotransmitter systems. When treating a patient with DTs who shows catatonic features (such as mutism, stupor, posturing, or waxy flexibility), clinicians should first stabilize the alcohol withdrawal with benzodiazepines like diazepam (10-20mg) or lorazepam (2-4mg) every 1-2 hours until symptoms improve, as suggested by 3. For catatonic symptoms that persist after withdrawal is managed, higher doses of benzodiazepines may be needed, with lorazepam 1-2mg every 4-6 hours being the first-line treatment. In treatment-resistant cases, electroconvulsive therapy (ECT) may be considered, as it has been shown to be effective in treating catatonia, with response rates of about 80 to 100% 4. Importantly, both conditions represent medical emergencies requiring close monitoring in an inpatient setting with vital sign checks, hydration, electrolyte management, and nutritional support. Some key points to consider when managing these conditions include:
- The use of benzodiazepines as the mainstay of treatment for DTs and catatonia 3, 5
- The potential for ECT to be effective in treating catatonia, especially in treatment-resistant cases 4
- The importance of close monitoring and supportive care in managing both conditions 6, 7
- The need to consider the underlying etiology of catatonia and to remove any offending agents or treat the underlying medical condition 5