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Background: Catatonia develops in children, adolescents, and adults with autism spectrum disorders., Aim: To review catatonia in autism spectrum disorders., Method: A case-report is presented and discussed., Results: Catatonia is a comorbid syndrome occurring in 12-17% of selected groups of adolescents and young adults with autism spectrum disorders who have been referred for specialised care or admitted to hospital. Clinical experience and case-reports indicate that benzodiazepines and electroconvulsive therapy can be used safely and effectively in both the treatment in acute cases and maintenance treatments for catatonia patients with autism spectrum disorders., Conclusion: Catatonia is a recognisable and treatable syndrome in children and adolescents with autism spectrum disorders.

Background: In The Netherlands, no guidelines exist for rapid tranquillisation in the context of acute agitation, excitement or aggression secondary to a psychiatric disorder., Aim: To generate an overview of medication regimes suitable for rapid tranquillisation., Method: A literature search was conducted focussing on the effect of medical interventions in acute excitement, agitation or aggression. Primary outcome measurements were tranquillity, being calm, sedation, or asleep within two hours. Secondary outcome measures were frequency of re-administration and adverse side effects., Results: Haloperidol appears as effective as lorazepam; haloperidol in combination with lorazepam does not have added value to lorazepam or haloperidol alone. Dehydrobenzperidol, risperidone, olanzapine and aripiprazole are comparable in effectiveness to lorazepam or haloperidol. Haloperidol in combination with promethazine is associated with a more rapid onset of effect than lorazepam, haloperidol or olanzapine. Midazolam is faster than the combination of haloperidol and promethazine, but requires more frequent re-administration of medication and increases the risk for respiratory depression. The literature on quetiapine was insufficient. The level of evidence, however, is modest., Conclusion: Haloperidol in combination with promethazine, and olanzapine, are effective in psychotic agitation, although haloperidol plus promethazine has a more rapid onset of effect faster; lorazepam is effective in non-psychotic agitation, aggression or excitement as well as in acute agitation of unknown origin.

Catatonia is a neuropsychiatric syndrome characterized by dysregulation of the motor system. It is associated with affective disorders, psychosis, and a number of somatic conditions. The condition tends to be undertreated due to under-recognition. This is unfortunate, because various cheap and effective treatment methods are widely available. In this clinical lesson, we present case studies of three patients with schizophrenia and severe catatonic symptoms. They were all treated with lorazepam, in dosages ranging from 2 to 60 mg a day, following which they achieved full remission of their catatonic symptoms. We recommend being alert for catatonia in patients with or without a psychiatric disorder. Early recognition and treatment is vital for the quality of life of these patients, and may in some cases be life-saving. In addition, we recommend a thorough analysis of possible underlying somatic disorders.

A 24-year-old man who was mentally retarded and had an autistic disorder, developed mutism and motor symptoms. He was diagnosed with catatonia and was treated successfully with lorazepam. Additionally, we review the literature about the diagnosis and treatment of catatonia in patients with autism; in such cases accurate diagnosis is vital but is complicated by overlapping symptoms.

Two patients with the neuroleptic malignant syndrome (NMS), a man aged 31 years and a woman aged 83 years, were referred for electroconvulsive therapy after 70 and 7 days, respectively. Both patients benefited from the treatment, but the patient who had had the syndrome longer had persistent contractures. NMS is potentially lethal. Diagnosis and treatment should be done as soon as possible to prevent mortality and complications. Admission to a general hospital and early consultation of NMS-experienced colleagues is strongly advised. Electroconvulsive therapy is indicated ifa trial course of lorazepam yields insufficient improvement.

A patient who developed acute catatonia during benzodiazepine withdrawal is discussed. The case prompted us to review the literature on the role of benzodiazepines in the treatment of acute catatonia. Only retrospective and open studies were found which indicate that benzodiazepines do have a beneficial effect. Lorazepam is the most widely studied benzodiazepine and at present is the best treatment option. In the specific case of acute catatonia brought on by benzodiazepine withdrawal the recommended dosage is the same as for acute catatonia caused by something other than benzodiazepine withdrawal.