What is an appropriate initial approach when catatonia is suspected in a patient with schizophrenia?

• A. Administer benzodiazepines (lorazepam) and assess response, while ruling out medical causes.
• B. Immediately increase antipsychotic dosage.
• C. Administer antidepressants.
• D. Observe without intervention.

Answer: (A)

Catatonia in schizophrenia is an urgent situation, so the initial approach centers on a rapid, targeted response with a benzodiazepine while ruling out medical causes. Giving lorazepam and observing for a quick improvement serves two purposes: it can relieve the catatonic symptoms due to its action on the GABA-A system, and a positive response supports the diagnosis of catatonia. At the same time, a thorough medical workup is essential because medical conditions—electrolyte disturbances, infections, metabolic issues, or CNS problems—can masquerade as or trigger catatonia and require separate treatment. If there’s a clear, rapid response to lorazepam, continue with that plan and monitor closely. If there’s no improvement or if malignant features emerge, escalate care with electroconvulsive therapy and treat any underlying medical issues. Avoid increasing antipsychotics initially, since they can worsen catatonia, and antidepressants aren’t the appropriate first-line approach for this presentation.