A 26-year-old woman with schizophrenia has been mute and immobile for 5 days, with waxy flexibility and refusal to eat. Intravenous lorazepam up to 8 mg per day over 72 hours produced minimal improvement. What is the most appropriate next step in management?

• A Switch to oral olanzapine
• B Start intramuscular haloperidol
• C Add memantine to the current regimen
• D Proceed with electroconvulsive therapy ✓

Explanation

Catatonia is first treated with benzodiazepines, but cases unresponsive to adequate lorazepam dosing respond well to electroconvulsive therapy, which is the standard next step and is life-saving when catatonia causes dehydration or malnutrition. Antipsychotics such as haloperidol carry a risk of worsening catatonia into neuroleptic malignant syndrome and are avoided until catatonia resolves. Memantine is experimental and not guideline supported.

Reference: Kaplan and Sadock's Synopsis of Psychiatry, 12th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.