Clinical management of catatonic syndromes. Part II: therapeutic algorithms

La gestione clinica delle sindromi catatoniche. Parte II: algoritmi terapeutici

N. Bartolommei, A. Callari, L. Lattanzi, M. Mauri

Dipartimento di Medicina Clinica e Sperimentale, Sezione di Psichiatria, Università di Pisa; Azienda Ospedaliero-Universitaria Pisana


The authors present therapeutic algorithms for clinical management and treatment of the different catatonic clinical pictures based on the main published studies and their own clinical experience.

Materials and methods
A PubMed search was carried out using the key words catatonia treatment, antipsychotics, neuroleptic malignant syndrome, electroconvulsive therapy. The evidence from the literature was integrated with the authors’ clinical experience.

The authors from the School of Pisa offer a therapeutic algorithm for the management and treatment of the main catatonic syndromes in the light of the most recent literature and their clinical experience gained over the years on a large number of cases. Although some recent case reports suggest new therapeutic perspectives, the mainstay of treatment of catatonia, regardless of underlying aetiology, is today based on the administration of high-dose benzodiazepines (BDZ) and electroconvulsive therapy (ECT). ECT, given its good efficacy and safety profile, is the first-line treatment in malignant catatonia/NMS and, more generally, should be used after a trial with BDZ fails.

The timely treatment with BDZ and ECT is fundamental to prevent the risk of onset of serious somatic complications and to reduce the mortality associated with catatonic syndromes, and especially its malignant variant (NMS).

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