Results of a review of studies of benzodiazepine treatment for catatonia in schizophrenia suggest that there is an urgent need to assess treatment options for catatonia, according to the results of a review published in the Cochrane Database of Systematic Reviews. The researchers of the study noted that anecdotally, “. . .these drugs would appear to be a promising pharmacological approach.”

Researchers with the Cochrane Schizophrenia Group provided updates to a previous review comparing the effects of benzodiazepines with other drugs as well as with placebo or electroconvulsive therapy for catatonia in people with schizophrenia and other serious mental illnesses. The original review, conducted in 2007, included 130 citations, from which 30 full-text articles for 22 studies were obtained. Of these studies, 17 were excluded. In the updated review, no new records were found. However, investigators extracted data from 1 study awaiting assessment that has been included in this review.

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According to Cochrane researchers, the study included 21 participants (mean age 50.8 years) and was conducted over 3 days. Participant diagnoses included severe major depressive episode, major depressive episode with psychotic features, bipolar disorder with concurrent depression, schizoaffective disorder with concurrent depression, and schizophrenic disorder. The final analysis included 13 women and 4 men.

This trial directly compared lorazepam and oxazepam. Seven participants received lorazepam 2 mg, followed by oxazepam 60 mg. Ten patients received 60 mg oxazepam, followed by lorazepam 2 mg. The study outcome was an evaluation of the degree of catatonic like symptoms using the Visual Analogue Scale (VAS) at baseline and days 1, 2, and 3. No clear difference was noted between treatment groups in terms of a clinically important change in symptoms (risk ratio 0.95; 95% CI, 0.42-2.16). 

The new review also excluded 20 studies: 6 were not randomized, 2 did not use benzodiazepines, 1 did not collect precrossover data, 2 trials had no useable data, and 8 included participants with schizophrenia or other severe mental illnesses although it was unclear whether these patients also had catatonia. Many of the randomized and nonrandomized studies did not focus specifically on treatment outcomes of catatonia.

Currently, no studies are awaiting assessment, and investigators did not identify any ongoing studies.

“We found some small relevant trials, but we were only able to extract data for analysis from one study,” the researchers noted. “This study was a direct comparison between two benzodiazepines and the results showed no clear difference between the two treatments. The quality of the evidence is very low due to the number of participants involved and risk of bias within this trial. Currently…there is no high-quality evidence available regarding the effects of benzodiazepines for catatonia in people with schizophrenia or similar [serious] mental illnesses.”

Reference

Zaman H, Gibson RC, Walcott G. Benzodiazepines for catatonia in people with schizophrenia or other serious mental illnesses. Cochrane Database Syst Rev. 2019;8:CD006570.