This study aims to describe the clinical response to a zolpidem challenge in a patient with benzodiazepine-refractory catatonia and highlight its potential role as an alternative pharmacologic intervention when standard therapies are ineffective or contraindicated. We report the case of a 25-year-old woman with schizophrenia and severe catatonia admitted to an inpatient psychiatric unit. Catatonic features included psychomotor slowing, mutism, negativism, staring, and stupor. The patient demonstrated no clinical improvement with benzodiazepine therapy and was unable to pursue electroconvulsive therapy (ECT). A zolpidem challenge was initiated at 10 mg to assess symptomatic response. Clinical status was monitored through behavioral observation, functional engagement, and tolerability during dose titration and maintenance. Following zolpidem administration, the patient showed partial improvement in psychomotor slowing, mutism, and alertness, with increased verbal engagement and participation in unit activities after titration to divided daily dosing. This case supports prior literature suggesting that zolpidem may provide short-term symptomatic benefit in benzodiazepine-refractory catatonia. The observed improvements in psychomotor slowing, mutism, and engagement were consistent with previously reported transient responses. However, subsequent sedation and diminishing therapeutic effect underscore limitations related to durability and tolerability with continued use. When benzodiazepines are ineffective and ECT is contraindicated or unavailable, zolpidem may represent a reasonable alternative strategy. Further study is needed to clarify optimal dosing, durability of response, and safety.
Urban et al. (Mon,) studied this question.