Diagnostic test for catatonia, the lorazepam challenge test
Benzodiazepines are the mainstay of the treatment of catatonia and are also helpful as a diagnostic probe.
- A positive Lorazepam Challenge Test validates the diagnosis of catatonia.
- After we examine the patient for signs of catatonia, 1 or 2 mg of lorazepam is administered intravenously.
- After 5 minutes, the patient is re-examined. If there has been no change, a second dose is given, and the patient is again reassessed (46, 78).
- A positive response is a marked reduction (e.g., at least 50%) of catatonic signs and symptoms, measured with a standardized rating scale.
- Favourable responses usually occur within 10 min (46). If lorazepam is given intramuscularly or per os, the interval for the second dose should be longer: 15′ and 30′, respectively. Many clinicians will share the experience that a “lorazepam test” not only confirms the diagnosis of catatonia but that it also makes the underlying psychopathology apparent “by permitting mute patients to speak” (79).
- Analogous to the lorazepam test, a Zolpidem Challenge Test was proposed (80, 81). In this test, 10 mg of zolpidem is administered per os, and after 30 minutes, we examine the patient.
- A positive response is a reduction of at least 50% of the BFCRS score. After a positive response, we can start treatment.
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