title: Clonazepam withdrawal-induced catatonia.
abstract: BACKGROUND
  Catatonia is a often a complex syndrome. It has been divided into categories of simple and malignant, with the latter being a more severe form involving autonomic instability and/or fever and having a higher mortality rate.
  
  
  OBJECTIVE
  There have been only two cases presented in the literature postulating benzodiazepine-withdrawal as a possible trigger for malignant catatonia. Here, the authors present a case of catatonia likely caused by abrupt benzodiazepine discontinuation; they also discuss neurobiological mechanisms relating to catatonia.
  
  
  METHODS
  The authors report on a 60-year-old man with a history of depression and posttraumatic stress disorder who was brought to the emergency department with acute confusion, grimacing, stereotypy, refusal of food and water, muscle rigidity, mutism, and extreme negativism. He had recently and abruptly discontinued all psychotropic medication.
  
  
  RESULTS
  After administration of lorazapam, the patient was re-started on clonazepam, after which there was a complete and sustained resolution of catatonic symptoms and autonomic instability.
  
  
  CONCLUSIONS
  Catatonia may result from a wide variety of etiologies. Catatonia due to benzodiazepine-withdrawal is a rare but serious condition that may be difficult to distinguish from other causes of catatonia. The mechanism by which catatonia may be precipitated by benzodiazepine-withdrawal is unknown, but likely involves a rapid decrease in GABA transmission in the central nervous system.
authors: Dept. of Psychiatry, Univ. of Arizona, 1501 N. Campbell Ave., P.O. Box 245002, Tucson, AZ 85724, USA. markbrownmd@gmail.com
authors: Mark
authors: M
authors: Brown
authors: Scott
authors: S
authors: Freeman
mesh_terms: D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects*; D001008:Anxiety Disorders / Q000188:drug therapy*; D002389:Catatonia / Q000139:chemically induced* / Q000188:drug therapy; D002998:Clonazepam / Q000008:administration & dosage / Q000009:adverse effects*; D003865:Major Depressive Disorder / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D018757:GABA Modulators / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy*; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000927:Anticonvulsants; D018757:GABA Modulators; D002998:Clonazepam