How do you approach a case of apparent worsening catatonia despite high-dose benzodiazepines and ongoing ECT?  

In my experience, this may reflect an incorrect or incomplete diagnosis, comorbid medical problems, or side effects of medications. ECT is a great treatment for catatonia, and I start to have doubts about everything, but ECT, if ECT doesn't work. I think re-evaluating diagnosis, ensuring that we kno...

Keep pushing the benzo if they aren't being too sedated by it - I've had one patient on Ativan 32 mg a day. Another patient, Valium 20 mg IV bid and Ativan 16 IV QID. There are some resistant cases to benzos, so then the next step is Ambien. If the catatonia is secondary to a psychotic disorder, the...

It is definitely important to evaluate for other neurologic/medical conditions that may be exacerbating the catatonia. I had a patient with hyperparathyroidism and refractory catatonia who needed a parathyroidectomy to get control of the catatonia. In a previous inpatient position, we saw many case...

Because I often work with people with trauma and dissociation, the people I have seen with catatonia are often reenacting their traumatic state of mind just after the abuse occurred. Often, they feel very trapped and become suicidal, not to die but as an escape from the terrifying situation that has...

We try to push the BZD dose up as much as we can to get as much benefit as possible, but sometimes it does not do the trick. Then we change to ECT, and we must taper down the BZDs in order to get a good quality seizure. If neither of these works, then something is probably off; look at the diagnosis...