CATATONIA .2. TREATMENT WITH LORAZEPAM AND ELECTROCONVULSIVE-THERAPY

Case material and retrospective studies support the use of both loraze pam and ECT in treating catatonia, but few prospective investigations exist and none employ quantitative monitoring of response. In this stu dy we test their efficacy in an open, prospective protocol, and define a 'lorazepam test' with predictive value for treatment. Twenty-eight patients with catatonia were treated systematically with parenteral an d/or oral lorazepam for up to 5 days, and with ECT if lorazepam failed . Outcome was monitored quantitatively during the treatment phase with the Bush-Francis Catatonia Rating Scale (BFCRS). In 16 of 21 patients (76%) who received a complete trial of lorazepam (11 with initial int ravenous challenge), catatonic signs resolved. A positive response to an initial parenteral challenge predicted final lorazepam response, as did length of catatonic symptoms prior to treatment. Neither demograp hic variables nor severity of catatonia predicted response to lorazepa m. Four patients failing lorazepam responded promptly to ECT. It is co ncluded that lorazepam and ECT are effective treatments for catatonia. The rating scale has predictive value and displays sensitivity to cha nge in clinical status.