Which benzodiazepine is specifically recommended for catatonia?

• A. Diazepam
• B. Lorazepam
• C. Alprazolam
• D. Clonazepam

Answer: (B)

Catatonia often improves with benzodiazepines, and lorazepam is the one most consistently recommended because it acts quickly and can be given by injection when the patient can’t take oral meds. Lorazepam is potent at the GABA-A receptor and can be given intramuscularly or intravenously, so you can expect a rapid change in catatonic signs within minutes to an hour. Its lack of active metabolites makes the response more predictable and safer in acute care or in patients with liver concerns, reducing the risk of delayed or variable effects. Clinically, a lorazepam challenge—administering a small dose and observing marked improvement—is both diagnostic and therapeutic for catatonia. Other benzodiazepines can be used in some contexts, but they’re less reliable for catatonia due to slower onset, longer or unpredictable metabolism, or less robust evidence for reversing the fixed features of catatonia.