Case ReportLong-term maintenance lorazepam for catatonia: a case report
Section snippets
Case
Mrs. A, 38 years old, presented with an episodic mental illness since 6 years. The first episode was characterized by refusal to eat, decreased interaction, mutism, negativism, stupor, decreased emotional reactivity, poor self-care and significant weight loss. After about 2 years of being symptomatic, she was treated with electroconvulsive therapy (ECT), imipramine 200 mg/day, risperidone 4 mg/day and trihexyphenidyl 2 mg with which she improved completely. Later, she maintained well on
Discussion
Data with respect to long-term use of lorazepam in recurrent catatonia are sparse Northoff [1] postulated the central role of GABA in catatonia, with down-regulation of GABA-A receptors in orbitofrontal cortex, which further leads to dysregulation of dopamine. This hypothesis may explain the response to lorazepam and the requirement of lorazepam in some of the subjects in the long run. At present, there is no consensus with respect to dosing schedule and duration of treatment of catatonia with
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Cited by (21)
The multi-modal treatment of catatonia: Targeting multiple receptors when GABA-based benzodiazepines fail
2024, Personalized Medicine in PsychiatryThe State of the Catatonia Literature: Employing Bibliometric Analysis of Articles From 1965–2020 to Identify Current Research Gaps
2023, Journal of the Academy of Consultation-Liaison PsychiatryCitation Excerpt :A 1965 review on periodic catatonia with notes regarding a decrease in the number of cases of periodic catatonia at that time “suggests that the great majority of patients suffering from periodic catatonia are helped sufficiently by means of ECT or phenothiazines to escape notice.”53 It is our experience that recurrent catatonia is commonly encountered and that clinicians often struggle with how to prevent relapses, particularly when it comes to the question of standing benzodiazepines on an outpatient basis.54 The field would benefit from further studies of this issue, as well as studies on the use of ECT,55 lithium,56 clozapine,57 and other medications to prevent recurrence and relapse.
The psychopharmacology of catatonia, neuroleptic malignant syndrome, akathisia, tardive dyskinesia, and dystonia
2019, Handbook of Clinical NeurologyCitation Excerpt :There is no consensus on how long benzodiazepines are to be continued, and generally they are discontinued once the underlying illness has remitted. In a number of cases, however, catatonic symptoms will reemerge each time lorazepam is tapered off, urging the clinician to continue benzodiazepines for an extended period of time (Grover and Aggarwal, 2011). Interestingly, lorazepam seems to be effective, regardless of the underlying condition, although catatonia in mood disorders responds more frequently (92%–97%) than catatonia in the context of medical conditions (82%) or schizophrenia (59%) (Sienaert et al., 2014).
Resurgence of catatonia following tapering or stoppage of lorazepam – A case series and implications
2017, Asian Journal of PsychiatryCitation Excerpt :Those patients having multiple resurgences required maintenance dose of 4–6 mg/day of lorazepam for a long period variying from 3 months to 5 years as per existing studies. ( Grover and Aggarwal, 2011; Lin et al., 2016; Sivakumar et al., 2013; Thamizh et al., 2016). Adding to the existing literature, we are reporting case series of seven such patients.
Maintenance lorazepam for treatment of recurrent catatonic states: A case series and implications
2016, Asian Journal of PsychiatryCatatonic syndrome: From detection to therapy
2016, EncephaleCitation Excerpt :One case report describes the evolution of a case of idiopathic periodic catatonia that was unresponsive to most neuroleptics, and required long-term use of lorazepam [46]. However a case of periodic catatonia without symptom return after the progressive discontinuation of lorazepam has also been described [47]. According to a study in 2011, clozapine could be efficacious on catatonic symptoms in schizophrenic spectrum disorders in case of failure of lorazepam and other atypical neuroleptics [31].