Algorithm for acute treatment of catatonia

ECT: electroconvulsive therapy.
* Malignant catatonia is life-threatening and is characterized by fever, autonomic instability, delirium, and rigidity. Catatonia occurs in the context of many mental disorders (eg, unipolar major depression, bipolar disorder, and psychotic disorders) and general medical disorders. Refer to UpToDate content that discusses the clinical features of catatonia.
¶ The initial choice for pharmacotherapy is typically a benzodiazepine, such as lorazepam 1 to 2 mg intravenously three times per day. For patients who are already receiving lorazepam for another indication when they present with catatonia, the starting dose of lorazepam for catatonia (eg, 1 mg three times per day) is added to the existing dose of lorazepam (eg, 1 mg each night for insomnia). Refer to UpToDate content that discusses treatment of catatonia.
Δ Pharmacotherapy is used while preparations are made to administer ECT. The medication is discontinued when ECT commences, unless the patient responds to drug therapy. Refer to the ¶ footnote definition above and UpToDate content that discusses treatment of catatonia.
◊ The goal of treatment is full remission.
§ The same medication regimen continues while preparations are made to administer ECT. Pharmacotherapy is discontinued when ECT commences. Refer to UpToDate content that discusses treatment of catatonia and provides an overview of ECT.
¥ Use the same drug from the initial course of pharmacotherapy. Refer to UpToDate content that discusses treatment of catatonia.
‡ Resume same drug from the initial course of pharmacotherapy used during preparations for ECT.