Risperidone and lorazepam concomitant use in clonazepam refractory catatonia: a case report

The DSM-IV recognizes catatonia as a subtype of schizophrenia characterized by at least two of the following: motor immobility, excessive motor activity not influenced by external stimuli, and peculiarities of voluntary movement. Catatonia may also occur secondary to mania, depression, or a general medical condition including encephalitis, focal neurological lesions, metabolic disturbances, and drug intoxications and withdrawals. Benzodiazepines remain the first line of treatment; up to 80% of patients respond promptly to Lorazepam challenge; failure to respond to lorazepam may be followed by electroconvulsive therapy. Atypical antipsychotics may be a new alternative in the treatment of catatonia. Successful reduction of the catatonic symptoms has been demonstrated with atypical antipsychotics. A possible mechanism of action for the efficacy of this class of drugs involves the antagonism of the 5-HT2A receptor. We are now reporting a case of treatment response to risperidone in a patient with chronic catatonia resistant to benzodiazepines.