Recurrent Benzodiazepine Withdrawal Catatonia in an Older Adult

A 79-year-old woman presented to the emergency department with 2 days of altered mental status characterized by staring, mutism, and motor resistance to commands. Six days prior to presentation, clonazepam was discontinued (daily dose of 0.5 mg prescribed for 10 years). Her history included mild cognitive impairment, unspecified anxiety, and past major depression without catatonia. Purposeless agitation, including stereotypies and combativeness, occurred when staff obtained intravenous access. After receiving 2 mg of lorazepam intravenously, the patient began speaking and became more cooperative. She received another 1 mg of lorazepam intravenously to facilitate incremental improvement in mental status. Metabolic laboratory and head imaging test results were unremarkable. Her vital signs were unchanged from baseline, and tremor was absent. Catatonia signs and symptoms remained absent 12 hours later during psychiatric evaluation. There was no recent history or examination findings of depression, mania, psychosis, or delirium. The most likely explanation for catatonia was benzodiazepine discontinuation. Chart review revealed the patient developed catatonia, with similar symptoms to the current episode, 5 years prior due to clonazepam discontinuation. Given the patient’s history of recurrent catatonia after benzodiazepine discontinuation, the patient was advised to continue 0.5 mg of clonazepam daily.