Managing Catatonia: Treatment Guidelines-Challenges-and Case Insights
In this essential follow-up episode, Dr. Mark Oldham—Associate Professor of Psychiatry at the University of Rochester Medical Center, President of the American Delirium Society, and Deputy Editor of the Journal of the Academy of Consultation-Liaison Psychiatry—returns to guide us through the management of catatonia, one of psychiatry’s most urgent and treatable conditions.

Building on the prior episode’s exploration of catatonia’s clinical features, this session focuses on practical management strategies, treatment algorithms, and clinical judgment required to navigate both common and complex presentations. Whether you're a medical student, psychiatry resident, hospitalist, or consultant psychiatrist, this episode delivers valuable insights to help you act swiftly and confidently when faced with catatonia.

🔍 What You’ll Learn in This Episode:
🔹 Why Catatonia Requires Immediate Action
Catatonia is often reversible—but only if recognized and treated early. Dr. Oldham outlines the risks of untreated catatonia, including progression to malignant catatonia, autonomic instability, and even death. Learn why rapid intervention is critical.

🔹 First-Line Management: Lorazepam Trials
Understand how and why lorazepam is used as both a diagnostic and therapeutic agent. Dr. Oldham shares tips on dosage, timing, and what to expect in a “lorazepam challenge,” helping clinicians to act confidently and appropriately at the bedside.

🔹 Electroconvulsive Therapy (ECT) for Catatonia
When benzodiazepines aren’t enough, ECT remains a gold-standard treatment. We discuss when to consider ECT, what to communicate to families and care teams, and how to initiate this life-saving intervention.

🔹 Management of Unique Presentations
Catatonia is not one-size-fits-all. Dr. Oldham presents real-life examples of atypical or complex cases—including catatonia co-occurring with delirium, substance use, and neurodevelopmental disorders—and how management strategies must be adapted accordingly.

🔹 Avoiding Common Pitfalls
We discuss practical challenges such as delayed recognition, diagnostic overshadowing, overuse of antipsychotics, and confusion with similar syndromes like severe depression or psychosis.

🔹 Interdisciplinary Communication
Learn how to work with internal medicine, neurology, and critical care teams when managing hospitalized patients with catatonia. Dr. Oldham offers communication tips that build collaboration and support high-quality care.

📚 Key References for Deeper Learning:
British Association for Psychopharmacology Guidelines
Read the full BAP guidelines on evidence-based catatonia treatment.

Rochester Catatonia Assessment Resources
Access tools and training from Dr. Oldham’s clinical team.

NEJM Review on Catatonia
Comprehensive overview of catatonia by top experts in the field.
Read the article

Nature Review: Catatonia in 2024
Explore cutting-edge research on pathophysiology and treatment.

Schizophrenia Research: Special Issue on Catatonia
Access full volume dedicated to catatonia-related topics.

Oldham 2022 – Describing the Features of Catatonia
Dr. Oldham’s own study on the core clinical signs of catatonia.
PubMed link

💡 Why This Episode Matters:
Catatonia is treatable, but only when recognized and managed early. This episode equips clinicians with:

✅ Rapid-response tools for benzodiazepine initiation
✅ Criteria for escalating to ECT
✅ A deeper understanding of the pathophysiological basis of treatment
✅ Nuanced approaches for medically complex or atypical patients
✅ Strategies to prevent delays in care or harmful misdiagnoses

This is not just theory—this is the real-world practice of life-saving psychiatry.

🔗 Support Our Partners:
🔸 SimplePractice
Get 70% off for 4 months + 7-day free trial. Now with AI documentation support!

🔸 Oasis Psychiatry Conferences
Use code BOOTCAMP for 10% off your next conference registration.

🔸 Beat the Boards
Save 10% on board prep using promo code BOOTCAMP.

🔸 CME to Go
Earn CME credits on your own schedule—extra 10% off with BOOTCAMP.

#Catatonia #PsychiatryBootcamp #ConsultLiaisonPsychiatry #MentalHealthEducation #PsychiatricCare #BushFrancisScale #Lorazepam #PsychiatryPodcast #ECT #Neuropsychiatry #ClinicalPsychiatry #PsychMed #CatatoniaTreatment #PsychiatricEducation #DeliriumDifferential