Lorazepam-diazepam protocol for catatonia in schizophrenia: a 21-case analysis

Compr Psychiatry. 2013 Nov;54(8):1210-4. doi: 10.1016/j.comppsych.2013.06.003. Epub 2013 Jul 12.

Abstract

Objectives: Catatonia is a unique clinical phenomenon characterized by concurrent motor, emotional, vegetative and behavioral signs. Benzodiazepines (BZD) and electroconvulsive therapy (ECT) can rapidly relieve catatonic signs. The lorazepam-diazepam protocol presented here has been proven to relieve catatonia in schizophrenia within a day.

Methods: From July 2002 to August 2011, schizophrenic patients requiring psychiatric intervention for catatonia in Kaohsiung Chang Gung Memorial Hospital were studied by medical chart review. The study used the Bush-Francis Catatonia Rating Scale (BFCRS). Patients receiving the lorazepam-diazepam protocol were identified.

Results: The survey included 21 patients (eight males and 13 females) with a mean age of 30.3 ± 12.6 years. Mean duration of schizophrenia was 4.7 ± 5.6 years. Thirteen (61.9%) patients responded within 2 h, 18 (85.7%) responded within one day, and all became catatonia-free within a week. Mean BFCRS score was 9.9 ± 3.0 before treatment. Patients that responded with a single intramuscular lorazepam injection had mean BFCRS score of 8.9 ± 2.8, significantly lower than the mean score (11.6 ± 2.5) of the rest of the patients (p = 0.034).

Conclusions: The lorazepam-diazepam protocol can rapidly relieve retarded catatonia in schizophrenia. Most patients became catatonia-free within one day but some may require up to a week. ECT should be considered if the protocol fails.

Publication types

  • Clinical Trial

MeSH terms

  • Anti-Anxiety Agents / administration & dosage
  • Anti-Anxiety Agents / pharmacology*
  • Catatonia / drug therapy*
  • Catatonia / etiology
  • Clinical Protocols
  • Diazepam / administration & dosage
  • Diazepam / pharmacology*
  • Drug Therapy, Combination
  • Humans
  • Lorazepam / administration & dosage
  • Lorazepam / pharmacology*
  • Schizophrenia / complications
  • Schizophrenia / drug therapy*
  • Treatment Outcome

Substances

  • Anti-Anxiety Agents
  • Lorazepam
  • Diazepam