Psychosis lorazepam

Cocaine or stimulant intoxication may require administration of a small dose of a short-acting benzodiazepine (e.g., lorazepam 1 to 2 mg) for agitation or severe anxiety. Antipsychotics (e.g., haloperidol 2 to 5 mg) should be used only if psychosis is present. If hyperthermia is present, initiate cooling measures. 

First, two or three drug combinations lithiumP or valproate0 plus a benzodiazepine (lorazepam or clonazepam) for short-term adjunctive treatment of agitation or insomnia lorazepam is recommended for catatonia. If psychosis is present, initiate atypical antipsychotic in combination with above. 

It usually takes several days to a few weeks before the symptoms of psychosis noticeably improve. During that period, benzodiazepines (usually lorazepam or clonazepam) can also be used to cahn the agitated patient. 

Anxiety. Like psychosis, choosing a medication to treat anxiety in demented patients depends in large part on whether the anxiety is acute or longstanding. Acute severe anxiety requires rapid relief. For this, we recommend a benzodiazepine. Our first choice is lorazepam (Ativan) that is given as needed at 0.25-0.5 mg per dose. We prefer lorazepam because elderly patients tolerate it well (i.e., they metabolize it easily), and it is available in both oral and injectable forms. Oxazepam (Serax) is another benzodiazepine that older patients metabolize easily, but it is only available in oral form. When using benzodiazepines, be careful that your patients do not become overly sedated or delirious. 

After first trimester carbamazepine, lamotrigine, oxcarbazepine, or valproate Second choice benzodiazepine (lorazepam) Third choice calcium channel blocker With psychosis first choice adjunctive high-potency typical antipsychotic (haloperidol, perphenazine, thiothixene, or trifluoperazine)... 

Wang BZ, Gupta A, BastiampiUai T, Sani F. Recurrent clozapine and lorazepam withdrawal psychosis with catatonia. Aust N Z J Psychiatry 2012 46(8) 795-6. 

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