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?

Abstract

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. 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. Our patient's score on the Bush-Francis Catatonia Rating Scale significantly decreased after 2 weeks of combination lorazepam and olanzapine without adverse effects. We propose a modification to the standard treatment protocol for catatonia, especially in those patients with schizophrenia with catatonic features.