High dose Ativan for negative symptoms of schizophrenia

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Specializes in Forensic Psychiatry.

Hello All!

I recently had a psychiatric resident prescribe Ativan 2mg four times daily to a young 18 year old male with schizophrenia to help with some of the negative symptoms specifically catatonia. This particular patient spends most of his day staring out a window or sleeping and at times will be observed responding to internal stimuli. He's a fairly new patient to the unit and has never been on any psych meds up till now.

The doctor won't give me any parameters regarding when to hold and stated I should, "use my best judgment," and assessment skills. I am not exactly comfortable administering this. We don't really know how this patient is going to react especially at such a high dose and I worry about excessively sedating him even more. Has anyone had any success with this?

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Specializes in Psych (25 years), Medical (15 years).

Ativan is a benzodiazepine antianxiety commonly used in conjunction with an antipsychotic to control the overt symptoms of psychosis. It is unusual for Ativan to be solely administered for psychosis. Antipsychotics can be solely utilized in treating the symptoms of psychosis when those symptoms may or may not include anxiety or agitation.

Your concerns have foundation, MMC.RN. If the Doctor has advised you to use your best (nursing) judgment, hold the Ativan if unsteadiness, lethargy, respiratory depression or any other untoward signs or symptoms of the prescribed dose are present. Document the rationale for your actions along with a status report to the Doctor.

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Specializes in Psych.

Yes, I have seen this done in the past for catatonia. It was pretty effective the times I have seen it used. Mind you, this was for severe cataonia where the patient was unresponsive and just laying in bed starinv at the ceiling. I would assess respiratory status, sedation, and vital signs before giving though. The patients I have done this for however have been so sick we had to gibe IM because they were again, essentially unresponsivs. ECT also works brilliantly in these cases, I dont know if your facility performs it.

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Although I realize that sounds v. counterintuitive (give a sedating medication to someone whose problem is he appears too sedated?), Ativan is the first-line treatment for catatonia. I've seen it work wonders for people. Once the catatonia is improved, the dosage can be reduced to a maintenance level (or maybe discontinued entirely).

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Specializes in psych, addictions, hospice, education.

I learn something new every day!

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Although I realize that sounds v. counterintuitive (give a sedating medication to someone whose problem is he appears too sedated?), Ativan is the first-line treatment for catatonia. I've seen it work wonders for people. Once the catatonia is improved, the dosage can be reduced to a maintenance level (or maybe discontinued entirely).

Yes. OP, true catatonia will be treated with ativan. I have seen it used as both one time doses that were frequently re-ordered as well as routine (TID/QID) orders. Its very effective. Always be mindful that when a patient comes to they can remember everything that is said from others around them during their catatonic state, so I always remind the other staff to keep that in mind and explain things to them in detail just as if they were responding. Even though it should go without saying to be professional at all times, well you know how that goes.

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I concur with posts above. We use it for catatonia and do not give anti-psychotics.

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Specializes in Forensic Psychiatry.

Thank you for all of the responses! I have heard of this therapy briefly for catatonia, but never saw it in practice. I think my main concern administering this is because I'm not so sure it's true catatonia and the rest of the nurses tend to agree with me. Ultimately the patient took it for two weeks and it was discontinued due to massive drowsiness and lethargy. He sat in his room and was found drooling and slept all day, even more than before. He didn't even take the full dose most days it was held more often than not. It was a resident who originally prescribed it and when our regular psychiatrist came back from vacation he immediately discontinued it because it wasn't in fact true catatonia.

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