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Psychiatry · Catatonia: lorazepam challenge
Sample itemA mute, immobile patient shows posturing and negativism. A 2 mg IV lorazepam test produces marked improvement within minutes. This response
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
D. Supports catatonia and indicates benzodiazepines as the first-line treatment
A dramatic response to a lorazepam challenge supports the diagnosis of catatonia of any cause, since it can complicate mood disorders, schizophrenia and medical illness. Benzodiazepines are first-line, with ECT for non-response or malignant forms. Response does not identify the underlying disorder.
Option by option
A. Rules out catatonia
A positive response supports rather than excludes catatonia.
B. Proves schizophrenia as the cause
Catatonia occurs in several conditions, so response does not prove schizophrenia.
C. Contraindicates ECT forever
ECT remains an effective option if benzodiazepines fail.
D. Supports catatonia and indicates benzodiazepines as the first-line treatment (correct)
Correct. Rapid improvement supports catatonia and guides first-line treatment.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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