Benzodiazepines for the Treatment of Catatonia

Benzodiazepines are the first-choice treatment for catatonia, regardless of the underlying condition. Benzodiazepines are positive allosteric modulators of GABA-A receptors and will correct deficient GABA-ergic function in the orbitofrontal cortex.

Following a positive Lorazepam Challenge Test, repeated doses of benzodiazepines can a treatment. Their use is safe, easy, and effective, with remission rates reported to be as high as 70–80%.

About 65% Rates in a Naturalistic Study

In a naturalistic study of 66 children and adolescents with catatonia, they found that benzodiazepines improved catatonia in 65% of cases, that there was no relation between dose and level of improvement, that the dose was higher sometimes (up to 15 mg of lorazepam) than the dose recommended in pediatric patients, and that side effects were few.

Two-thirds Improved in a Trial of 107 adults

In a recent trial in 107 adult inpatients (49% with a psychotic disorder; 44% with a mood disorder), lower success rates they reported lower success rates: two-thirds responded but only one-third of patients remitted. The authors argue that a delay between illness onset and treatment could explain the lower remission rate) but the doses used in the trial (3–6 mg per day) were inadequately low. As described above, studies have repeatedly shown that chronic catatonia associated with schizophrenia is less responsive to benzodiazepines.

Beckmann and Colleagues Found them Ineffective

Beckmann and colleagues, in a 5-year follow-up study, found benzodiazepines ineffective in the treatment of chronic catatonic schizophrenia. Another study reported a comparable poor response (to lorazepam 6 mg per day); it was a randomized double-blind, placebo-controlled trial in 18 patients with chronic catatonia in schizophrenia.

Efficacy Depends on Dose

Efficacy of benzodiazepines in catatonia depends on dosage, and doses from 8 to 24 mg lorazepam per day are common and are tolerated without ensuing sedation, especially when instituted using daily incremental dosages. Most authors suggest starting at 1–2 mg of lorazepam every 4–12 h and adjusting the dose in order to relieve catatonia without sedating the patient. With an adequate dose, we usually see a response within 3–7 days, but sometimes, the response can be gradual. If we use high dosages of lorazepam, patients should be monitored carefully for excessive sedation and respiratory compromise. Whether some benzodiazepines are more efficacious in catatonia is not clear yet.

Clinicians accept lorazepam to be the first-choice drug, demonstrating a 79% remission rate and the highest frequency of use. Studies have also reported the successful use of diazepam, oxazepam, or clonazepam. There is no consensus on how long benzodiazepines to continue benzodiazepines, and we discontinue them once the underlying illness has remitted. In several cases, however, catatonic symptoms will emerge each time lorazepam is tapered off, urging the clinician to continue benzodiazepines for an extended period.

ADVOKATE: A Mnemonic Tool for the Assessment of Eyewitness Evidence

ADVOKATE: A Mnemonic Tool for Assessment of Eyewitness Evidence A tool for assessing eyewitness ADVOKATE is a tool designed to assess eyewitness evidence and how much it is reliable. It requires the user to respond to several statements/questions. Forensic psychologists, police or investigative officer can do it. The mnemonic ADVOKATE stands for: A = amount of time under observation (event and act) D = distance from suspect V = visibility (night-day, lighting) O = obstruction to the view of the witness K = known or seen before when and where (suspect) A = any special reason for remembering the subject T = time-lapse (how long has it been since witness saw suspect) E = error or material discrepancy between the description given first or any subsequent accounts by a witness. Working with suspects (college.police.uk)

ICD-11 Criteria for Anorexia Nervosa (6B80)

ICD-11 Criteria for Anorexia Nervosa (6B80) Anorexia Nervosa is characterised by significantly low body weight for the individual’s height, age and developmental stage that is not due to another health condition or to the unavailability of food. A commonly used threshold is body mass index (BMI) less than 18.5 kg/m2 in adults and BMI-for-age under 5th percentile in children and adolescents. Rapid weight loss (e.g. more than 20% of total body weight within 6 months) may replace the low body weight guideline as long as other diagnostic requirements are met. Children and adolescents may exhibit failure to gain weight as expected based on the individual developmental trajectory rather than weight loss. Low body weight is accompanied by a persistent pattern of behaviours to prevent restoration of normal weight, which may include behaviours aimed at reducing energy intake (restricted eating), purging behaviours (e.g. self-induced vomiting, misuse of laxatives), and behaviours aimed at incr

ICD-11 Criteria for Schizophrenia (6A20 )

ICD-11 Criteria for Schizophrenia (6A20 ) Schizophrenia is characterised by disturbances in multiple mental modalities, including thinking (e.g., delusions, disorganisation in the form of thought), perception (e.g., hallucinations), self-experience (e.g., the experience that one's feelings, impulses, thoughts, or behaviour are under the control of an external force), cognition (e.g., impaired attention, verbal memory, and social cognition), volition (e.g., loss of motivation), affect (e.g., blunted emotional expression), and behaviour (e.g., behaviour that appears bizarre or purposeless, unpredictable or inappropriate emotional responses that interfere with the organisation of behaviour). Psychomotor disturbances, including catatonia, may be present. Persistent delusions, persistent hallucinations, thought disorder, and experiences of influence, passivity, or control are considered core symptoms. Symptoms must have persisted for at least one month in order for a diagnosis of schi

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