A case of agitated catatonia

Agitation is one of the diagnostic features of catatonia in the DSM IV clas sification, but permanent forms of agitated catatonia have occasionally bee n described. We report the case of a 43-year-old man who had already suffer ed from undifferentiated schizophrenia for 7 years, and in whom we diagnose d agitated catatonia. While our patient was being treated with a neurolepti c during a second episode of paranoia, a state of agitation was observed wh ich persisted for a further 8 months. During this period, he was treated wi th several different neuroleptics and benzodiazepines, either alone or in a ssociation, without any improvement. No organic cause was found. He was the n transferred to our electroconvulsive therapy (ECT) unit, with a diagnosis of schizophrenic agitation resistant to drug therapy. ECT was begun, and h e was only given droperidol in case of agitation and alimemazine for insomn ia, neither of which had any effect. In view of his persistent agitation wi thout any purpose, echolalia and echopraxia, stereotyped movements with man nerisms and marked mimicking and grimacing, we diagnosed him as having agit ated catatonia. After the fourth session of ECT, we decided to stop all tre atment and gave him lorazepam at a dose of 12.5 mg daily. Twenty-four hours later, all symptoms of agitation had disappeared. In our opinion, permanen t catatonic agitation is not rare. In our case, the neuroleptic treatment m aintained and may even have worsened the symptomatology. Lorazepam can be u sed as a therapeutic test for this type of agitation, especially if it does not respond to neuroleptics. This also allows the patient to be sedated ra pidly and effectively, thus preventing him from injuring himself further.