McCall WV, Shelp FE, McDonald WM: Controlled investigation of the amobarbital interview for catatonic mutism. Am J Psychiatry 1992; 149:202-206. (Published erratum appears in Am J Psychiatry 1992; 149:720.)
20 inpatients with catatonic mutism were randomly assigned to intravenous saline or a 5% amobarbital solution. Patients were crossed over to the other infusion if the initial infusion had no response. 6 of 10 patients responded to the initial amobarbital infusion and 0 of 10 patients responded to saline. 4 saline non-responders subsequently responded to amobarbital.
Bush G, Fink M, Petrides G, Dowling F, Francis A: Catatonia. II. Treatment with lorazepam and electroconvulsive therapy. Acta Psychiatr Scand 1996; 93:137-143
Prospective, open trial of 21 patients with catatonia of various etiologies (psychotic, affective, or another medical condition) systematically treated with lorazepam 4-8mg/day up to 5 days. 16/21(76%) responded to lorazepam. 4/5 non-responders went on to receive ECT, of which 4/4 improved with ECT.
Payee H, Chandrasekaran R, Raju GV: Catatonic syndrome : treatment response to lorazepam. Indian J Psychiatry 1999; 41:49-53
Prospective, open label trial of 30 patients with catatonia symptoms were systematically treated with oral lorazepam. 21/30 (70%) catatonia resolved with lorazepam (dose range 3-8 mg/day). Most non-responders did well with ECT.
Ungvari GS, Chiu HFK, Chow LY, Lau BST, Tang WK: Lorazepam for chronic catatonia: a randomized, double-blind, placebo-controlled cross-over study. Psychopharmacol (Berl) 1999; 142:393-398
In 17 patients with schizophrenia and chronic catatonia, neither placebo nor lorazepam 6mg/day had any clinically noticeable or statistically significant impact on catatonia or BFCRS scores. The authors noted that the chronic catatonia experienced by these patients with schizophrenia was clinically different from the more conventional acute catatonic syndrome.
Girish K, Gill NS: Electroconvulsive therapy in lorazepam non-responsive catatonia. Indian J Psychiatry 2003; 45(1):21-25
Double-blind trial of 14 patients (3 female) with “non-affective” catatonia (schizophrenia or unspecified psychosis) non-responsive to lorazepam (6-8mg/day) taken from a pool of 68 patients with catatonia. Of note, 50/68 patients responded favorably to lorazepam (73.5%). Non-responders were randomized to three weeks of either bilateral ECT and placebo versus sham ECT versus risperidone 4-6mg/day. Reduction in scores on BFCRS as well as the Positive and Negative Syndrome scale were greater in the ECT group.
Kugler JL, Hauptman AJ, Collier SJ, Walton AE, Murthy S, Funderburg LG, Garcia KS: Treatment of Catatonia With Ultrabrief Right Unilateral Electroconvulsive Therapy: A Case Series. J ECT 2014 Sep 19 [Epub ahead of print]
Retrospective case series of 11/13 cases of catatonia of various etiologies (psychotic disorder, affective disorder, or due to a medical condition) responded well to ultrabrief right unilateral ECT. The 2 non-responders also failed to improve with bilateral ECT.
