Question
A psychotic patient presented with voluntary purposeless movements was once observed to stand still in the ward with negativism and waxy flexibility. What is appropriate medical management?
| A. |
Haloperidol
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| B. |
Lorazepam
|
| C. |
Clonidine
|
| D. |
Risperidone
|
Show Answer
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Correct Answer � B
Explanation
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Ans. B. Lorazepam
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Condition described here is Catatonia.
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Catatonia is a clinical syndrome characterized by a distinct constellation of psychomotor disturbances.
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Two subtypes have been described: Retarded and excited.
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Catatonia of the retarded type is associated with signs reflecting a paucity of movement, including immobility, staring, mutism, rigidity, withdrawal and refusal to eat, along with more bizarre features such as posturing, grimacing, negativism, waxy flexibility, echolalia or echopraxia, stereotypy, verbigeration, and automatic obedience.
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Excited catatonia, on the other hand, is characterized by severe psychomotor agitation, potentially leading to life-threatening complications such as hyperthermia, altered consciousness, and autonomic dysfunction.
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This so-called “malignant” or “lethal” catatonia can be rapidly fatal if not appropriately treated.
Treatment:
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A characteristic feature of catatonia is its striking responsiveness to benzodiazepine treatment.
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We recommend an initial dose of 1-2 mg Lorazepam, administered sublingually or intramuscularly.
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The ability to administer lorazepam intramuscularly is a major advantage, since many catatonic patients refuse to eat or take medication by mouth.
