Are benzodiazepines effective in treating catatonia?

SUMMARYEstablishing an evidence base for the clinical management of catatonia is made difficult by the heterogeneous nature of the condition and the limited understanding of its pathophysiology. Benzodiazepines are a mainstay of treatment. The Cochrane review discussed identified only one eligible study (17 participants with catatonia who received either lorazepam or oxazepam), which found no difference on the single outcome measure (a 50% improvement on a visual analogue scale). This commentary discusses the findings in more detail, and considers what constitutes high-quality evidence for the acute treatment of catatonia, why there is such a paucity of randomised controlled trials (RCTs) on the topic and whether RCTs are both feasible and appropriate for the condition.

Problems in the Evaluation of Treatment Programs for Drunk Drivers: Goals and Outcomes

Measures used in evaluating drunk driving treatment programs over the last 15 years are reviewed and critiqued in terms of construct validity. The concept of triangulation with increased use of self-report and collateral measures is recommended over the current reliance on the single outcome measure of rearrest. Greater attention to collecting data on processes and intermediate outcomes is also recommended to provide information for program improvement, dissemination, and identification of effective treatment models. Ambiguity concerning program goals and directions is cited as another related problem area which has led to unintended differences in program philosophies and methods.