A case of malignant catatonia successfully diagnosed and treated with intravenous lorazepam

Abstract

Malignant catatonia is a syndrome characterized by psychomotor disorder with autonomic symptoms and hyperthermia. A 53-year-old woman with schizophrenia presented hyperthermia, immobility, mutism and rigidity, and was transported to our emergency room. After admission to the psychiatric ward, she developed respiratory failure. She was brought to the ICU and intensive care was initiated. After the exclusion of neuroleptic malignant syndrome and other physical diseases, we suspected malignant catatonia due to an exacerbation of schizophrenia. Thus, we administered lorazepam (1 mg, intravenously). Three minutes after the administration of lorazepam, her immobility, mutism and rigidity were ameliorated. When malignant catatonia is suspected, malignant catatonia should be differentially diagnosed from other physical diseases, while general care is provided to prevent complications. Then, a therapeutic diagnosis with lorazepam should be considered. Because lorazepam has a rapid onset, it is appropriate for the diagnosis and treatment of malignant catatonia.