Commentary

Patricia's reduced speech and activity could occur in hypoactive delirium, severe depression or several neurological conditions. The additional signs change the assessment: sustained posturing, echolalia and negativism form a specific cluster. Liaison psychiatry and the medical team assess these findings together, while considering seizures, medication effects and other medical causes.

The BAP guideline supports structured examination of catatonic signs and a monitored lorazepam challenge when clinically appropriate [G04]. A response is supportive rather than completely specific. The comic therefore includes a baseline assessment, a safety plan and separate observation of motor signs, breathing, arousal and attention. The indication is the specific cluster of catatonic signs. Benzodiazepines are not recommended for delirium generally, and reduced speech or activity during delirium does not by itself establish catatonia.

The motor syndrome improves while inattention continues, consistent with the separation reported by Amouri and colleagues [S24]. Later sedation prompts treatment adjustment, consistent with the need to observe harms as well as benefit. If the response were inadequate or the syndrome became medically dangerous, urgent specialist reassessment and further treatment options would be required; the clinical plan is not limited to repeating the same challenge.

By week five, Patricia can engage more but still needs help with everyday tasks. Her depressive history remains part of follow-up without being used to explain away the acute illness. Discussion can focus on which observed signs justified the specialist assessment, how response was measured, and why resolution of catatonia did not establish full recovery from delirium.

An anonymised composite case that does not describe one identifiable person and is not research evidence.