1. The ratios of the causes of catatonic features: Schizophrenic Mood disorders Neuroleptic-induced disorders GMC 26 9 24 41%

2. After treatments of antipsychotics, benzodiazepam, or electroconvulsive therapy (ECT) 24 patients (70.6%) showed complete remission, seven patients (20.6%) showed partial remission, and three patients (8.8%) showed no response (two died

3. Diagnostic threshold is three or more signs with sensitivity of 100% and specificity of 99%. These signs are: –immobility/stupor –mutism –negativism –oppositionism, (gegenhalten) –posturing –catalepsy ; (waxy flexibility) –automatic obedience (exaggerated co-operation ) –echo phenomena –rigidity –verbigeration –withdrawal/refusal Using this diagnostic tool, prevalence of catatonic syndrome appears to be close to 8% of psychiatric admissions. Other signs are also common but less specific: staring, iterations, stereotypes, mannerism, overactivity/excitement, impulsivity, combativeness.

5. Other authors stress that on average 20 to 40% of catatonias are idiopathic. mesolimbic and mesostriatal dopaminergic imbalance in a frontal lobe- basal ganglia-brainstem system is supposed to be involved.

6. Catatonia in GMC HIV encephalopathy progressive multifocal eukoencephalopathy Encephalitis renal failure elderly and debilitated patients with multiple illnesses Parkinson's disease neuroleptic malignant syndrome aggressive behavioral disorders following brain injury certain forms of epilepsy some forms of delirium due to toxic or metabolic encephalopathies.

7. Treatment 1) Withhold neuroleptic medication. 2) Investigations to exclude treatable physical disorders including standard blood laboratory tests, urinary drug screening, Electroencephalogram, brain computerized tomography)

8. 3) Trial of lorazepam. This therapeutic is safe and 80% effective. We propose to administer an initial oral 2,5 mg challenge; catatonic signs are rated after the first hours If necessary, the patient could receive 3 mg/day with a 6-day full dose treatment and then, treatment would progressively be reduced

9. The most commonly reported treatment for catatonia was with benzodiazepines which were effective in 70 percent of the cases, with lorazepam demonstrating the highest frequency of use and a 79 percent complete response rate

10. Lorazepam appears to offer a safe, effective first-line treatment of catatonia. ECT should be considered when rapid resolution is necessary (e.g., malignant catatonia) or when an initial lorazepam trial fails.

11. If the patient failed to respond to lorazepam, ECT are needed 5) Earlier use of ECT is recommended if autonomic instability or hyperthermia appears and malignant catatonia is suspected. Existing data suggest that ECT is a safe and effective treatment for lethal catatonia

12. Electroconvulsive therapy (ECT) was also efficacious (85%) and was more likely to provide a positive outcome in cases of malignant catatonia.