An Approach to Navigating the Lorazepam Challenge Test for Catatonia in Critical Care Settings

Catatonia often occurs in the setting of psychiatric illness; however, it is also found in other medical conditions, especially within critical care settings. The lorazepam challenge test (LCT) is a key diagnostic and therapeutic intervention for catatonia; however, no specific guidance exists for patients within the intensive care unit (ICU). This review synthesizes psychiatric and critical care literature to propose a structured LCT framework adapted to the ICU. Specific indications and contraindications across gradients of catatonia likelihood and medical complexity are reviewed, along with practical dosing and monitoring recommendations. An interdisciplinary collaborative workflow is also outlined along with post-LCT documentation standards. Our structured approach offers a practical foundation for future standardized protocols, education, and catatonia research in critical care.