Commentary

Reduced speech and activity can occur in hypoactive delirium, severe depression and several neurological conditions. Patricia also has sustained posturing: she holds a position against gravity. She repeats other people’s words (echolalia) and resists instructions (negativism). These additional signs require assessment together. Liaison psychiatry and the medical team assess her while considering seizures, medicine effects and other medical causes.

The British Association for Psychopharmacology guideline supports structured assessment of catatonic signs and a monitored lorazepam challenge when clinically appropriate [G04]. Improvement supports the diagnosis but is not completely specific to catatonia. Record signs before treatment and plan safety checks. Assess movement, breathing, alertness and attention separately. The specific catatonic signs justify considering this treatment. Benzodiazepines are not recommended for delirium generally. Reduced speech or activity during delirium does not by itself establish catatonia.

Patricia’s movement symptoms improve while difficulty paying attention continues, as described in the report by Amouri and colleagues [S24]. Later sedation leads to a treatment adjustment. Monitor harms as well as benefits. An inadequate response or a medically dangerous illness would require urgent specialist reassessment and consideration of further treatment options. Repeating the same lorazepam challenge is not the whole treatment plan.

At five weeks, Patricia can take part more readily but still needs help with everyday tasks. Continue to assess her history of depression without using it to dismiss the acute illness. Identify the signs that justified specialist assessment and record how each changed with treatment. Improvement in catatonia does not establish full recovery from delirium.