![]() ![]() See “Diagnostics” in “ Approach to psychosis” for details.Facilitate admission to a psychiatric facility with limited resources.Identify comorbidities (e.g., diabetes mellitus) or other conditions (e.g., pregnancy) that influence management.Establish a baseline before initiating pharmacological treatment.Rule out an organic cause (e.g., using diagnostic studies for secondary psychosis).Diagnostic studies may be indicated to:.Schizophrenia is a clinical diagnosis based on the DSM-5 criteria.Adequate hydration and specialized nutritive support.Treat the underlying psychiatric condition with appropriate pharmacotherapy. ![]() Discontinue dopamine blocking drugs (e.g., antipsychotics ) only reinitiate after catatonia resolves.Second-line in case of inadequate response to benzodiazepine therapy.First-line for malignant catatonia and nonmalignant catatonia due to a mood disorder with psychotic features.Benzodiazepines (Intravenous or sublingual lorazepam ): first-line for all forms of catatonia.Malignant catatonia : fever, autonomic instability (e.g., tachycardia, tachypnea, abnormal BP, and sweating), rigidity, and delirium (resembles neuroleptic malignant syndrome ).Excited catatonia : excessive, purposeless movement in both the upper and lower limbs, restlessness, and impulsivity.Retarded catatonia : immobility, posturing, negativism (resisting external commands), staring, mutism.Drug adverse effects (e.g., antipsychotics).Catatonia associated with medical disorders.Catatonia associated with mental disorders. ![]() Definition: a behavioral syndrome characterized by abnormal movements and reactivity to the environment.Hallucinations are more common than delusions at younger ages, but must be clearly differentiated from age-appropriate imaginative activity. Prognosis: typically more severe than adult-onset schizophrenia with worse outcomes the earlier the onset of symptoms.Catatonia is less common than in adult-onset schizophrenia.In young children, hallucinations should be differentiated from age-appropriate imaginative activity (e.g., engaging with imaginary friends or roleplay). ![]()
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