From the Research
For catatonia in patients aged 65 and older, lorazepam (Ativan) is typically administered intramuscularly at an initial dose of 1-2 mg every 4-6 hours as needed, with a recommended starting dose of 1 mg due to increased sensitivity to benzodiazepines in elderly patients 1. The dose can be cautiously titrated upward based on response and tolerability.
- Treatment should continue until catatonic symptoms resolve, typically within 1-3 days, after which oral benzodiazepines can be considered for maintenance.
- Close monitoring is essential in elderly patients for respiratory depression, excessive sedation, confusion, and fall risk.
- Lorazepam works by enhancing GABA neurotransmission, which helps reduce the abnormal neural activity underlying catatonia. If there is no response after 2-3 days of adequate benzodiazepine treatment, electroconvulsive therapy (ECT) should be considered as an alternative or adjunctive treatment, as it is highly effective for catatonia, particularly in cases resistant to benzodiazepines 2. Some patients may require long-term benzodiazepine maintenance treatment, and sudden discontinuation or non-adherence can lead to loss of response or need for higher doses 1. It is also important to note that cerebral abnormalities, medical comorbidities, and mood disorders are common in patients with catatonia, and these factors should be taken into account when developing a treatment plan 3, 2.