If a patient has secondary mania, it is important to address the causative agent(s) (e.g., steroids, etc) if possible. As with primary mania, the mainstays of treatment would be second-generation antipsychotics and/or benzodiazepines. Mood stabilizers can be used in the treatment of secondary mania, but are generally not necessary. When using any agent in a medically ill patient, one should be cautious of possible adverse effects, such as QTc prolongation, electrolyte imbalances, and P450 interactions.
If a cause for catatonia can be determined, then it should be addressed. Otherwise, the most effective treatments are benzodiazepines and ECT. In some cases, benzodiazepines (such as lorazepam) can provide rapid treatment of motor and speech signs. Because of its safety, ECT can be used the treatment of almost all cases of secondary catatonia.