A 35-year-old woman presents in the emergency room with mutism, waxy flexibility, and maintenance of odd postures for extended periods. She stares blankly and does not respond to commands. The MOST appropriate immediate pharmacological intervention is:
- A Lorazepam 2 mg IV with amobarbital test if no response ✓
- B Haloperidol 5 mg IM
- C Olanzapine 10 mg IM
- D Clonazepam 1 mg oral
Correct answer: A. Lorazepam 2 mg IV with amobarbital test if no response
Explanation
Catatonia is first treated with high-dose benzodiazepines (lorazepam IV is preferred in the emergency setting). The lorazepam challenge test (1–2 mg IV) can be both diagnostic and therapeutic — a positive response (partial or full relief within 10 minutes) confirms catatonia. If benzodiazepines fail, ECT is the next definitive treatment. Antipsychotics like haloperidol can paradoxically worsen catatonia and are avoided in the acute phase; they also carry risk of precipitating NMS in catatonic patients.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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