Abstract
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 undiffer-entiated 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.
