A 26-year-old woman admitted with acute psychosis becomes mute, resists passive movement of her limbs which then hold the imposed position, and refuses food. She has been febrile for one day. Which intervention provides the fastest diagnostic and therapeutic response?
- A Electroconvulsive therapy after 2 failed medication trials
- B Intravenous lorazepam challenge test ✓
- C Serum creatine kinase and initiation of dantrolene
- D Trial of high-dose risperidone for catatonic schizophrenia
Correct answer: B. Intravenous lorazepam challenge test
Explanation
Waxy flexibility, mutism, negativism, and refusal of food indicate catatonia, which responds dramatically to benzodiazepines; the lorazepam challenge is both diagnostic and therapeutic within hours. Dantrolene addresses neuroleptic malignant syndrome, but rigidity and severe hyperthermia are absent here. Antipsychotics can worsen catatonia and precipitate malignant catatonia, so escalating risperidone is hazardous. ECT is reserved for benzodiazepine-refractory cases, not the first step.
Reference: Kaplan and Sadock's Synopsis of Psychiatry, 12th ed.
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