Psychotic disorders: ECT in lorazepam-resistant catatonia: practice question

A Psychiatry question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Psychiatry · Psychotic disorders: ECT in lorazepam-resistant catatonia

Sample item

A 25-year-old woman with schizophrenia is mute, immobile and refusing food for six days, with negativism and posturing. Three days of lorazepam at adequate doses have brought no improvement, and she is now losing weight. What is the most appropriate next step?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Electroconvulsive therapy

When catatonia does not respond to benzodiazepines, ECT is the next treatment and works rapidly, even more so when food refusal makes the situation urgent. High-potency antipsychotics can worsen catatonia or precipitate malignant catatonia.

Option by option

  • A. Start propranolol

    Propranolol treats akathisia and tremor, and does nothing for catatonic stupor.

  • B. Electroconvulsive therapy (correct)

    Correct. ECT is the effective treatment after benzodiazepine failure in catatonia.

  • C. Add lithium

    Lithium has no established role in treating catatonia and would be risky with poor intake.

  • D. Switch to intramuscular haloperidol

    High-potency D2 blockade can aggravate catatonia and trigger malignant features.

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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Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is B, Electroconvulsive therapy. When catatonia does not respond to benzodiazepines, ECT is the next treatment and works rapidly, even more so when food refusal makes the situation urgent.

Why is "Start propranolol" not the answer?

Propranolol treats akathisia and tremor, and does nothing for catatonic stupor.

Why is "Add lithium" not the answer?

Lithium has no established role in treating catatonia and would be risky with poor intake.

Why is "Switch to intramuscular haloperidol" not the answer?

High-potency D2 blockade can aggravate catatonia and trigger malignant features.

What concept does this question test?

It tests Psychotic disorders: ECT in lorazepam-resistant catatonia in Psychiatry. High-potency antipsychotics can worsen catatonia or precipitate malignant catatonia.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Psychotic disorders: ECT in lorazepam-resistant catatonia?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.