Tofisopam as an alternative intervention in organic catatonia: An open label study

BACKGROUND: The treatment in organic catatonia includes benzodiazepines, ECT and treatment of underlying condition. In a pilot study(1), Lorazepam produced sedation, hypotension and respiratory depression. Tofisopam, (FDA approved for IBS2) was safe and effective which can be a treatment alternative. This study was designed to study the efficacy and adverse effects of Tofisopam in organic catatonia. MATERIALS AND METHODS: This study included 60 patients irrespective of age and gender with diagnosis of Organic Catatonia (F061, ICD-10). Patients with Delirium, Psychiatric illness and SUD were excluded. Busch Francis Catatonia Rating Scale (BFCRS) was used to assess the features of catatonia at baseline and at 48 to 72 hours. Tofisopam 50-100mg/day was administered. Changes in BP, RR, spO(2) and GCS was noted. Paired T test, Chi square test, Pearson’s correlation and SPSS 17 was used. RESULTS AND DISCUSSION: The mean age was 54.27 ± 16.5 years with 46 males and 14 females. The mean baseline score in BFCRS was 11.73+-1.31. Out of 60 patients, 44 (71%) had response. Response was defined as reduction of catatonic signs to 1 or none on 14 item BFCRS(3). Response occurred in CKD, Parkinsonism, Hypertensive encephalopathy, post-CABG and post-GI surgery patients. No response occurred in Septicemia, CKD with Multi-organ Failure. The domains with significant response were Stupor, Mutism, Staring, Posturing, Rigidity, Negativism and Withdrawal without significant side-effects. Tofisopam (mixed dopamine agonist- antagonist)(4) modulates the hypo-dopaminergic state in catatonia. Its non-sedative, non-hypotensive5 property can explain the added advantage over lorazepam. CONCLUSION: Tofisopam can be a safe and effective alternative treatment in Organic Catatonia.