A 28-year-old woman with schizophrenia is brought catatonic — mute, posturing, with waxy flexibility. Which of the following is the FIRST-LINE pharmacological treatment for acute catatonia?
- A Haloperidol 5 mg IM
- B Olanzapine 10 mg IM
- C Lorazepam 2 mg IV/IM ✓
- D Clonazepam 2 mg orally
Correct answer: C. Lorazepam 2 mg IV/IM
Explanation
Benzodiazepines, particularly lorazepam 1–2 mg IV or IM, are the first-line treatment for catatonia regardless of the underlying cause. A positive lorazepam challenge (improvement within 5–10 minutes) also confirms the diagnosis. Antipsychotics (haloperidol, olanzapine) can worsen catatonia and precipitate NMS; they should be avoided or used with extreme caution until the catatonia resolves. If benzodiazepines fail, ECT is the definitive treatment.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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