title: Lorazepam-diazepam protocol for catatonia in schizophrenia: a 21-case analysis.
abstract: OBJECTIVE
  Catatonia is a unique clinical phenomenon characterized by concurrent motor, emotional, vegetative and behavioral signs. Benzodiazepines (BZD) and electroconvulsive therapy (ECT) can rapidly relieve catatonic signs. The lorazepam-diazepam protocol presented here has been proven to relieve catatonia in schizophrenia within a day.
  
  
  METHODS
  From July 2002 to August 2011, schizophrenic patients requiring psychiatric intervention for catatonia in Kaohsiung Chang Gung Memorial Hospital were studied by medical chart review. The study used the Bush-Francis Catatonia Rating Scale (BFCRS). Patients receiving the lorazepam-diazepam protocol were identified.
  
  
  RESULTS
  The survey included 21 patients (eight males and 13 females) with a mean age of 30.3 ± 12.6 years. Mean duration of schizophrenia was 4.7 ± 5.6 years. Thirteen (61.9%) patients responded within 2 h, 18 (85.7%) responded within one day, and all became catatonia-free within a week. Mean BFCRS score was 9.9 ± 3.0 before treatment. Patients that responded with a single intramuscular lorazepam injection had mean BFCRS score of 8.9 ± 2.8, significantly lower than the mean score (11.6 ± 2.5) of the rest of the patients (p = 0.034).
  
  
  CONCLUSIONS
  The lorazepam-diazepam protocol can rapidly relieve retarded catatonia in schizophrenia. Most patients became catatonia-free within one day but some may require up to a week. ECT should be considered if the protocol fails.
authors.affiliation: Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Chin-Chuen
authors.initials: CC
authors.lastname: Lin
authors.forename: Tiao-Lai
authors.initials: TL
authors.lastname: Huang
mesh_terms: D014151:Anti-Anxiety Agents / Q000008:administration & dosage / Q000494:pharmacology*; D002389:Catatonia / Q000188:drug therapy* / Q000209:etiology; D002985:Clinical Protocols; D003975:Diazepam / Q000008:administration & dosage / Q000494:pharmacology*; D004359:Drug Therapy, Combination; D006801:Humans; D008140:Lorazepam / Q000008:administration & dosage / Q000494:pharmacology*; D012559:Schizophrenia / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D014151:Anti-Anxiety Agents; D008140:Lorazepam; D003975:Diazepam