Identifying Optimal Treatment for Catatonic States

Catatonia is a state of non-responsiveness to external stimuli. Patients exhibiting catatonia may appear calm or highly excited. Catatonia itself is not a diagnosis, but rather a symptom of a larger problem; therefore, it’s important that doctors quickly treat the condition and identify the possible underlying causes, especially in emergencies. The list of conditions that may result in catatonia includes schizophrenia, psychotic disorders, brain trauma, developmental abnormalities, and toxic shock. Agitated catatonic individuals pose a danger to themselves and others. For example, when individuals don’t respond to food, there is a risk of malnutrition and death.

Researchers in India performed a retrospective study of clinical charts to assess how catatonic patients responded to treatment. The researchers isolated several variables of interest, including length of catatonic state, presence of hallucinations, social background, and flexibility. Two treatment approaches were also of interest to the team: Ativan (lorazepam) and electroconvulsive therapy (ECT). Typically, Ativan or a similar drug from the same class is prescribed as a first-line treatment for catatonia. However, many individuals fail to respond to psychotropic drugs and require more intense therapies, such as ECT. Prior studies have shown a non-response rate among catatonic patients ranging from 20–30%.

In the current study, several factors were discovered to be strong predictors of poor response to Ativan. The single biggest factor was duration of catatonic state. Individuals with catatonia lasting for weeks or months often required additional forms of treatment. Another predictor of poor response was mutism, or the inability to produce speech. On the other hand, muscular flexibility—as opposed to rigidity—predicted good response to Ativan. Researchers noted that even when first-line treatments failed, ECT demonstrated a high rate of response.

Although demographic realities in India and America are vastly different—India is a developing nation and not all of its citizens have ready access to health care—the results of this study are nonetheless important as the speedy resolution of catatonic states is a vital first step in any treatment plan. The research team suggested that genetic differences within the Indian population may also represent a confounding variable and that further investigation is needed.


  1. Catatonia. (n.d.). Medscape: Medscape Access. Retrieved July 19, 2012, from
  2. Lorazepam – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved July 19, 2012, from
  3. Narayanaswamy, J., Tibrewal, P., Zutshi, A., Srinivasaraju, R., & Math, S. (2012). Clinical predictors of response to treatment in catatonia. General Hospital Psychiatry, 34(3), 312-316. Retrieved July 19, 2012, from the ScienceDirect database.

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