CATATONIA - CURRENT THERAPEUTIC RECOMMENDATIONS

It is generally accepted that catatonic symptoms are nonspecific and o ccur under different circumstances. The differential treatment of cata tonic syndromes depends on their aetiology. Organic catatonia (due to an underlying neurological or metabolic condition, or intoxication), a ntipsychotic (neuroleptic)-induced catatonia (including neuroleptic ma lignant syndrome) and psychogenic catatonia (due to schizophrenia, aff ective disorder, neurosis or lethal catatonia) have to be distinguishe d. In all types of catatonia, the early detection of potentially life- threatening conditions is important. Benzodiazepines (such as lorazepa m) an effective as short term treatment for symptoms associated with o rganic catatonia in many patients. Electroconvulsive therapy (ECT) is also effective, but limited by the attitude of the patients to this tr eatment and by its availability. ECT is strongly recommended in patien ts with lethal catatonia. The treatment of other types of psychogenic catatonia should follow the guidelines for the treatment of the underl ying psychiatric condition. Antipsychotic-induced catatonia necessitat es the use of anticholinergics, dose reduction of antipsychotics or ch ange to clozapine. In patients with neuroleptic malignant syndrome, al l antipsychotics must be discontinued immediately. Treatment with brom ocriptine and/or dantrolene is frequently, but not unequivocally, reco mmended.