A double-blind comparison of lorazepam and oxazepam in psychomotor retardation and mutism.
BACKGROUND
An increasing number of case reports indicate a superior therapeutic response of catatonialike symptoms, such as severe psychomotor disturbance and mutism, associated with psychiatric disorder to the benzodiazepine lorazepam (LO). Equivocal results, however, are also reported with regard to other benzodiazepines for the treatment of this syndrome. The purpose of this study was to compare the effects of LO and oxazepam (OX), benzodiazepines with comparable pharmacokinetics, on psychomotor retardation and mutism associated with psychiatric disorder.


METHODS
Twenty-one hospitalized patients with severe psychomotor retardation and mutism were treated with 2 mg LO and 60 mg OX in a double-blind crossover study design.


RESULTS
Both benzodiazepines significantly reduced psychomotor symptoms. When administered for the first time, 4 of 7 patients with LO and 6 of 10 patients with OX improved at least 50% on visual analog scale (VAS) rating. Reduction in symptoms was significant with LO and OX treatment on either day of treatment. The second time, however, LO was significantly better compared with OX in alleviating the target symptoms.


CONCLUSIONS
Both OX and LO are effective for the treatment of psychomotor retardation. Thus, the beneficial effect of LO on psychomotor retardation and mutism is not a unique pharmacodynamic property but more likely due to its pharmacokinetic profile. The differential effect of the two benzodiazepines on the second day of treatment warrants further clarification. Several hypotheses are evaluated.
Schmider
J
J
Max Planck Institute of Psychiatry, Clinical Institute, Munich, Germany.
Standhart
H
H
Deuschle
M
M
Drancoli
J
J
Heuser
I
I
D000328:Adult; D000368:Aged; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D010054:Brief Psychiatric Rating Scale; D002389:Catatonia / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D018592:Cross-Over Studies; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008140:Lorazepam / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009155:Mutism / Q000150:complications* / Q000188:drug therapy*; D010076:Oxazepam / Q000627:therapeutic use*; D011597:Psychomotor Performance / Q000187:drug effects; D012720:Severity of Illness Index
D014151:Anti-Anxiety Agents; D010076:Oxazepam; D008140:Lorazepam