Management of relapsing catatonia after lorazepam discontinuation: systematic review of published case reports.

Abstract

Introduction: Lorazepam is the mainstay of pharmacological treatment of catatonia. It is recommended that lorazepam, when effective, be tapered and gradually stopped depending upon maintenance of clinical improvement. This recommendation is not supported by any controlled studies. There are case reports on relapses of catatonia while tapering lorazepam; these patients required long-term maintenance treatment for sustained symptomatic management. This is a review of published literature focusing on relapse of catatonia following lorazepam discontinuation after maintenance treatment.

Methods: A comprehensive literature search, with full text review and data extraction undertaken for eligible studies following screening of titles and abstracts. After review, 18 full texts describing 47 individual patients, were analyzed.

Results: Forty-seven individual patients are described; age range: 14 to 74 years, with a nearly equal numbers of males and females. The common psychiatric comorbidity was a psychotic episode (mostly relapse of schizophrenia). Medical comorbidity was less common with 31/47 patients having no comorbid medical condition. Treatment descriptions were at times missing specific information. No firm conclusions could be drawn from the literature about length of maintenance, lorazepam dose nor discontinuation parameters.

Conclusions: The absence of trials and prospective studies, and the sparsity of details for many of the published case series and case studies, highlight the need for further research in the catatonia field. At present we propose gradual tapering of lorazepam, once catatonia and the underlying illness has been fully treated and maintenance lorazepam regimen is established, in line with existing benzodiazepine discontinuation guidelines, to minimize the risk of catatonia re-emergence.