Managing Catatonia: From Clinical Assessment to Effective Intervention

This expert consultation covers the clinical assessment and treatment of catatonia. Key topics include: lorazepam titration protocol with increases of no more than 25% at a time, typically starting at 6-8 mg/day IV after a positive challenge; IV diazepam at 5:1 conversion ratio as an alternative when lorazepam is unavailable; and NMDA antagonists (amantadine, memantine) as next-line options when ECT is inaccessible. The discussion addresses how to identify and diagnose catatonia using validated assessment tools, distinguish it from severe psychosis and schizophrenia negative symptoms, implement evidence-based treatment protocols, and develop individualized treatment plans incorporating ECT referral criteria and relapse prevention strategies.