In this episode of Dr. Brown’s Psych Commute, I break down one of the most commonly missed syndromes in acute psychiatry: catatonia. Although many clinicians think of it as rare, catatonia occurs in roughly 10–20% of psychiatric inpatients, and in my day-to-day practice, that statistic holds up.

I walk through the clinical signs that often get overlooked, how to use the Bush–Francis Catatonia Rating Scale, and why a proper lorazepam (Ativan) challenge remains the fastest and most reliable diagnostic tool. We also cover IV vs IM vs PO dosing, the timelines for reassessment, and why lorazepam’s pharmacokinetics make it the best choice.

I also discuss how to titrate scheduled benzodiazepines, what “high-dose” really means in severe catatonia, and when it’s time to move to ECT. Patients with catatonia often respond dramatically to ECT within one to four treatments, a pattern very different from depressive indications.

Finally, I talk about the differential diagnosis of catatonia. I also highlight excited catatonia, which is frequently mistaken for secondary agitation. Let me know what you think at [email protected].

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