geropsych pearls


Remember the opening to the Lion King? When he holds up the baby Simba and sings.. "CATATONIAAAAAA". It's there, go listen again.  

That's what catatonia is. So much excitement that you are struck dumb. 

Remember, catatonia is an EXCITATORY brain state. The pt may be mute, but brain activity is in hyperdrive. 

First line tx of catatonia is benzodiazepines

  • For geriatric peeps, we usually start with lorazepam 0.5mg QID - around the clock. Start with IV.
  • Best treatment is ECT. Get it if you can. Harness your inner John Wayne and drawl, "Smoke 'em if you got 'em boys, otherwise this here catatonia is gonna kill you." 
  • There is also a role for NMDA receptor antagonists in catatonia. Memantine. Keep your eyes on the beans*, tho. 
  • Antipsychotics should be used cautiously; and at low doses; pts with catatonia have higher risk of NMS, and they are already rigid.
  • No evidence to support bupropion 
  • No role for anticonvulsants 
  • Hydrate, hydrate, hydrate. 

What's the deal with giving a sleeper during the day? WTF?

  • Here's a fun fact: Zolpidem (Ambien) is also good for catatonia. Paradoxically, it can lift the catatonia enough for folks to feed themselves. We start with zolpidem 10mg po TID, given about 30 minutes prior to meals. [Note to self: You will want to call the pharmacy and explain this, otherwise they will think you are nuckin' futz for ordering Ambien TID].
  • Here's another fun fact: If it's really catatonia, the zolpidem will WAKE THEM UP.  If all they do is fall asleep, then it may not be catatonia after all. 



* Kidney beans, of course.