Mini Quiz: Medical Catatonia

Author(s):

Key Takeaways

The patient's symptoms and partial response to lorazepam suggest catatonia, despite normal vital signs and brain imaging.
Higher lorazepam doses increase sedation, necessitating alternative management strategies to address catatonia effectively.
Consideration of treatments like ECT or medications such as amantadine or memantine may be appropriate.
Multidisciplinary team collaboration and close monitoring are crucial for achieving optimal patient outcomes.

A patient with lupus presents with rash, arthralgias, and altered mental status. Various symptoms, including stupor and mutism, improve with treatment but higher doses of the drug cause more sedation. How would you proceed?

CASE VIGNETTE

A 37-year-old female with a history of lupus is admitted to the hospital with rash, arthralgias, and altered mental status. On examination, the patient displays stupor, mutism, posturing, and echopraxia while vital signs, creatine kinase, and brain MRI are all normal. Lorazepam 2mg IV q6 partially improves her symptoms, but higher doses cause more sedation. How would you proceed?