From the Research
For autistic catatonia, a lorazepam trial typically starts with a low dose of 0.5-1mg daily, gradually increasing by 0.5-1mg every 3-7 days until symptom improvement is observed or side effects occur, with a mean dose of 24 mg per day in lorazepam equivalents as reported in the most recent study 1. The dose of lorazepam for autistic catatonia should be individualized, with the goal of achieving symptom improvement while minimizing side effects.
- The maximum daily dose is usually 8-12mg, divided into 3-4 doses throughout the day, although higher doses may be necessary in some cases, as seen in the study where patients were prescribed high doses of benzodiazepines for treatment of catatonia, with a mean dose of 24 mg per day in lorazepam equivalents 1.
- The trial should last 2-3 weeks to properly assess effectiveness, during which time the patient should be closely monitored for sedation, respiratory depression, and paradoxical agitation.
- Regular assessment of catatonic symptoms using standardized scales, such as the Bush-Francis Catatonia Rating Scale, helps track progress and adjust the treatment plan as needed.
- Lorazepam works by enhancing GABA neurotransmission, which reduces excessive neuronal excitation that may contribute to catatonic symptoms, and is considered first-line treatment for catatonia regardless of underlying cause, including in autistic individuals where catatonia may present as increased slowness, difficulty initiating movements, increased passivity, or worsening of repetitive behaviors.
- The use of lorazepam in autistic catatonia has been supported by recent studies, including one that found that 97.8% of patients were treated with benzodiazepines, with a mean maximal daily dose of 17.4 mg lorazepam equivalents 2.
- However, it is essential to note that the effectiveness of lorazepam may vary, and some patients may require alternative treatments, such as electroconvulsive therapy, as reported in the study where 16 patients (35.6%) received electroconvulsive therapy 2.