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A Case of Schizophrenia With Catatonia Resistant to Lorazepam and Olanzapine Monotherapy But Responsive to Combination Treatment

Is It Time to Consider Using Select Second-Generation Antipsychotics Earlier in the Treatment Algorithm for This Patient Type?

Spiegel, David R., MD; Glad, Rachel, MD; Smith, Melanie, MD; Raja, Uzair, MD; Wade, Ryan, MD; Johnson, Kelsey, MD

doi: 10.1097/WNF.0000000000000327
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Objective Catatonia is a distinct psychomotor syndrome that involves a constellation of up to 40 different symptoms. Although conventionally responsive to benzodiazepines, the catatonic syndrome is much more resistant to benzodiazepine treatment when a feature of schizophrenia.

Method We present a patient with schizophrenia with catatonic symptoms, marginally responsive to lorazepam challenge, lorazepam, and olanzapine monotherapy, but ultimately began combination treatment with these 2 medications.

Results Our patient's score on the Bush-Francis Catatonia Rating Scale significantly decreased after 2 weeks of combination lorazepam and olanzapine without adverse effects.

Conclusion We propose a modification to the standard treatment protocol for catatonia, especially in those patients with schizophrenia with catatonic features.

Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA.

Address correspondence and reprint request to David R. Spiegel, MD, Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, 825 Fairfax Ave, Norfolk, VA 23507; E-mail: SpiegeDR@evms.edu

Conflict of Interest and Source of Funding: The authors' received no support, including pharmaceutical and industry support, in preparation of this article.

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