Comprehensive exams for Mental Health Q 182
A client is suffering from catatonic behaviors. Which of the following would the nurse use to determine that the medication administered PRN has been most effective?
A. The client responds to verbal directions to eat.
B. The client initiates simple activities without direction.
C. The client walks with the nurse to her room.
D. The client is able to move all extremities occasionally.
Correct Answer: B. The client initiates simple activities without direction
Although all the actions indicate improvement, the ability to initiate simple activities without directions indicates the most improvement in the catatonic behaviors. Catatonia, a neuropsychiatric syndrome characterized by abnormal movements, behaviors, and withdrawal, is a condition that is most often seen in mood disorders but can also be seen in psychotic, medical, neurologic, and other disorders. Most studies on the incidence of catatonia find it to be between 5% – 20% in the acute inpatient psychiatric setting. Most episodes of catatonia can be classified as excited, retarded, or malignant. Symptoms can wax, wane, or change during these episodes, and patients affected can have periods of withdrawal and periods of excitation.
Option A: Catatonia as a syndrome is often secondary to another underlying illness. Psychiatric disorders can present primarily with symptoms of catatonia. Mood disorders such as bipolar disorder and depression are the most common etiologies to progress to catatonia. A psychotic disorder such as schizophrenia can also lead to catatonia, and historically schizophrenia recognition and diagnosis included symptoms of catatonia or was subtyped if catatonic symptoms were present.
Option C: When catatonic symptoms present, the cause is likely psychiatric, but many medical etiologies can lead to catatonia. Neurologic insults such as strokes, neoplasms, or other diseases such as Parkinson’s Disease can lead to catatonia. Autoimmune, paraneoplastic, infectious, metabolic, and certain drug exposures and poisonings can lead to the development of catatonia.
Option D: The initial treatment, once potential catatonia causing agents such as neuroleptics, steroids, stimulants, anticonvulsants, dopamine depleters, and others, are stopped, is to provide a lorazepam “challenge.” By giving a dose such as lorazepam 2 mg IV slowly, 60% – 80% of patients with catatonia will have some or significant improvement in catatonia symptoms within 15 min – 30 min. If the patient responds to this lorazepam challenge, lorazepam can be subsequently scheduled at interval doses, often three times a day (though different patients respond at different rates.)