A 35-year-old catatonic patient is mute, immobile, and has waxy flexibility. He refuses oral intake. After 48 hours, which is the MOST appropriate immediate pharmacological intervention?
- A Oral haloperidol 5 mg
- B IV lorazepam 1-2 mg ✓
- C IM olanzapine 10 mg
- D IV methylprednisolone 500 mg
Correct answer: B. IV lorazepam 1-2 mg
Explanation
Intravenous lorazepam (1-2 mg) is the first-line treatment for catatonia. The benzodiazepine challenge test — rapid response to IV lorazepam — is also diagnostic. Antipsychotics (haloperidol, olanzapine) can worsen catatonia and increase risk of NMS; they should be avoided until catatonia resolves. ECT is used if benzodiazepines fail.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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