Initial Treatment for Severe Catatonia

Second-Line Treatment: Electroconvulsive Therapy (ECT)

The American Academy of Child and Adolescent Psychiatry recommends ECT when benzodiazepines fail or in life-threatening situations, such as severe malnutrition from food refusal, extreme suicidality, or florid psychosis with catatonia 1
ECT is particularly indicated for catatonia associated with mood disorders, schizophrenia with prominent affective symptoms, and neuroleptic malignant syndrome, with a recommendation from the American Academy of Child and Adolescent Psychiatry 1, 2
For critically ill patients with catatonia, bilateral electrode placement may be used initially, as suggested by the American Academy of Child and Adolescent Psychiatry 3
Treatment typically begins at a frequency of two to three times weekly, with anesthesia administered by qualified personnel, using methohexital as the anesthetic agent and succinylcholine for muscle relaxation, as recommended by the American Academy of Child and Adolescent Psychiatry 3
Monitoring during ECT should include observation of seizure duration, airway patency, vital signs, and adverse effects, according to the American Academy of Child and Adolescent Psychiatry 3
Patients should be monitored for at least 24 hours after ECT for potential complications such as tardive seizures, as advised by the American Academy of Child and Adolescent Psychiatry 3

The American Academy of Child and Adolescent Psychiatry recommends that anesthesia for Electroconvulsive Therapy (ECT) should be administered by qualified personnel experienced with adolescents/adults, with methohexital commonly used as the anesthetic agent, and muscle relaxation achieved with succinylcholine, with treatment beginning at either two or three times weekly 4
The American Academy of Child and Adolescent Psychiatry suggests monitoring vital signs, airway patency, and level of consciousness during and after benzodiazepine administration 4