Agitation is one of the diagnostic features of
catatonia in the DSM IV classification, but permanent forms of agitated
catatonia have occasionally been described. We report the case of a 43-year-old man who had already suffered from undifferentiated
schizophrenia for 7 years, and in whom we diagnosed agitated
catatonia. While our patient was being treated with a
neuroleptic during a second episode of
paranoia, a state of agitation was observed which persisted for a further 8 months. During this period, he was treated with several different
neuroleptics and
benzodiazepines, either alone or in association, without any improvement. No organic cause was found. He was then transferred to our electroconvulsive therapy (ECT) unit, with a diagnosis of schizophrenic agitation resistant to
drug therapy. ECT was begun, and he was only given
droperidol in case of agitation and
alimemazine for
insomnia, neither of which had any effect. In view of his persistent agitation without any purpose,
echolalia and echopraxia, stereotyped movements with mannerisms and marked mimicking and grimacing, we diagnosed him as having agitated
catatonia. After the fourth session of ECT, we decided to stop all treatment and gave him
lorazepam at a dose of 12.5 mg daily. Twenty-four hours later, all symptoms of agitation had disappeared. In our opinion, permanent catatonic agitation is not rare. In our case, the
neuroleptic treatment maintained and may even have worsened the symptomatology.
Lorazepam can be used as a therapeutic test for this type of agitation, especially if it does not respond to
neuroleptics. This also allows the patient to be sedated rapidly and effectively, thus preventing him from injuring himself further.