Exclude or treat underlying physical illness

Lorazepam up to 4 mg/day^*
Start with 2 mg and give a further 2 mg if no effects after three hours
Use IM route from then on

End

^* Lorazepam is absorbed sublingually and is tasteless. This route may be preferred in non-cooperative patients or those who cannot swallow.

^** Intravenous diazepam may be considered here.

^*** Do not wait to give ECT if there is significant danger to life.

Stupor in the context of affective/conversion disorder