The freeze frame: decoding schizophrenia with catatonia in two cases

Abstract The classification of psychiatric disorders evolves continuously, as evidenced by the DSM-5's elimination of schizophrenia subtypes (American Psychiatric Association 2013). Despite the reclassification, a robust body of literature continues to support the clinical relevance of catatonic features within schizophrenia, particularly in guiding treatment decisions and prognostic outlooks. Caroff et al. (Psychiatry (Edgemont), 5(12): 42–50, 2024) advocate for short-term use of electroconvulsive therapy (ECT) in cases of schizophrenia with catatonia, emphasizing its efficacy in resistant presentations. British guidelines (J Psychopharmacol 37(4): 327–369, 2023) recommend lorazepam trials as first-line intervention, followed by clozapine when resistance persists, outlining a tiered approach to treatment. We present two cases of adult male patients with schizophrenia and pronounced catatonic symptoms. Both exhibited prolonged hospital stays and were followed for six months post-discharge. These cases underscore how legal guardianship enabled treatment initiation, demonstrate the utility of structured rating scales in quantifying catatonic symptoms, and provide real-world insight into the challenges of implementing guideline-driven care in schizophrenia with catatonia. Our findings suggest practical, evidence-informed strategies for integrating lorazepam, antipsychotics, and ECT—highlighting the importance of individualized treatment planning, proactive legal intervention, and early identification of treatment resistance.