Catatonic syndrome in a general psychiatric inpatient population: frequency, clinical presentation, and response to lorazepam.

In a prospective open trial conducted on a general psychiatric ward, the authors diagnosed catatonic syndrome 15 times in 12 patients over a 1-year period. These 12 patients represented 9% of all admissions. The following signs were present in two thirds or more of the episodes studied: immobility (100%), staring (92%), mutism (85%), withdrawal/refusal to eat (78%), posturing/grimacing (73%), and rigidity (66%). Other signs of catatonia were seen less frequently. Lorazepam 1 to 2 mg was administered in every case, and patients were evaluated at hourly intervals. Of the 15 episodes, 12 responded completely and dramatically to lorazepam treatment within 2 hours, 1 responded partially, and 2 had no response. Adverse effects were infrequent. A CNS abnormality or dysfunction was evident in 8 of the 12 responders, suggesting that a beneficial response to lorazepam is not limited to patients with pure psychogenic catatonia. The prompt recognition and treatment of catatonia may reduce morbidity in and length of stay for hospitalized psychiatric patients.