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Case Report | DOI: https://doi.org/10.31579/2690-8808/275
1GGZ Friesland, Borniastraat 34b, Leeuwarden, 8934 AD, the Netherlands.
2Department of hospital pharmacy, Wilhelmina Ziekenhuis Assen (WZA), Assen, Netherlands.
3Forensic Psychiatric Center (FPC) Dr. S. van Mesdag, Helperlinie 2, 9722, AZ, Groningen, The Netherlasnds.
*Corresponding Author: Harry Jorge Groen, GGZ Friesland, Borniastraat 34b, Leeuwarden, 8934 AD, the Netherlands.
Citation: Harry J. Groen, Nicole M.G. Looman, Jelle R. Lettinga, (2025), Extremely High Dose Lorazepam in The Treatment of Catatonia, J, Clinical Case Reports and Studies, 6(7); DOI:10.31579/2690-8808/275
Copyright: ©, 2025, Harry Jorge Groen. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 10 September 2025 | Accepted: 08 October 2025 | Published: 15 October 2025
Keywords: catatonia; lorazepam; treatment; psychopharmacology
Catatonia is a neuropsychiatric syndrome characterized by symptoms such as stupor, mutism, and autonomic dysfunction. Benzodiazepines, particularly lorazepam, are considered first-line treatment for catatonia, but the optimal dosing strategies, especially at higher doses, remain unclear. This case report presents the treatment of a 27-year-old male with schizophrenia and chronic catatonia, requiring extremely high doses of lorazepam up to 130 mg per day. The significant increase in dosage led to gradual improvement of the catatonic symptoms, without any notable side effects. Especially, the patient showed no signs of sedation or respiratory depression. This case suggests that lorazepam can be safely administered at much higher doses than typically recommended, provided close monitoring for adverse effects. The findings advocate for the consideration of higher doses in patients not fully responding to standard doses and emphasize the need for further research into dosing strategies, safety, and long-term outcomes in the treatment of catatonia with benzodiazepines.
Catatonia is a neuropsychiatric disorder first described by Karl Ludwig Kahlbaum in 1874 [1]. It is a syndrome characterized by a range of symptoms, including stupor, mutism, negativism, staring, autonomic dysfunction [2]and is a potentially life-threatening condition. The prevalence of catatonia is not well established. Within clinical psychiatric populations, prevalence is estimated at approximately 9.0% [3]. When catatonia is suspected, a comprehensive diagnostic evaluation is essential to identify potential underlying causes. This includes a medical screening to assess for somatic conditions that may contribute to the disorder. The most common psychiatric condition associated with catatonia is a mood disorder, particularly bipolar disorder [4].
Benzodiazepines are considered the first-line treatment for catatonia [5]. These medications exert their effects by modulating GABA-A receptors, which are ligand-gated ion channels. Upon GABA binding to the GABA-A receptor, the frequency of chloride channel opening increases, allowing more chloride ions to enter the cell, resulting in an inhibitory effect through hyperpolarization of the cell membrane. The ion flow is also influenced by the ion concentration gradient and the membrane potential of the cell. Benzodiazepines function as positive allosteric modulators by binding to a specific site on the GABA-A receptor, enhancing the effect of GABA. The presence of benzodiazepines increases the frequency of chloride channel openings beyond the effect of GABA alone [6]. Notably, benzodiazepines have no intrinsic activity and require the presence of GABA to exert their therapeutic effects [6]. The efficacy of benzodiazepines in treating catatonia supports the hypothesis that GABA hypoactivity plays a vital role in the pathophysiology of the disorder.
Electroconvulsive therapy (ECT) is another highly effective treatment for catatonia, especially in life-threatening situations or when pharmacological interventions fail [4]. Prognosis is generally favorable if treatment is initiated promptly [5].
Although lorazepam is the primary treatment option in catatonia, little is known about optimal dosing strategies in cases exceeding maximal recommended dosages of lorazepam. This report describes a 27-year-old man of Somali descent with schizophrenia, who presented with catatonia. The primary objective of this case is to raise awareness about the potential for administering extremely high doses of lorazepam in the treatment of catatonia and to encourage further research into optimizing treatment strategies for this condition.
Investigations
We present the case of a 27-year-old male with a history of schizophrenia, intellectual disability (total IQ between 53-58, 95% confidence interval), childhood maltreatment, and cannabis use, who was admitted to the critical care ward at the Dr. S. van Mesdag Centre in Groningen, a high-security forensic psychiatric hospital. The patient had previously been incarcerated in a psychiatric penitentiary facility following a conviction for attempted manslaughter. During his incarceration, he experienced multiple episodes of violent physical aggression, psychosis, and catatonia. The psychosis was primarily characterized by paranoia, disorganized thoughts and behavior, and negative symptoms. The first diagnosis of catatonia was established 2-years prior to his admission to our critical care ward. Symptoms were not well recorded. According the patients’ medical record, his catatonia was successfully treated with clozapine 125mg and lorazepam (unknown dose). The lorazepam was later on tapered off. One year later there was a relapse in psychosis and catatonia. The symptoms of catatonia included: immobility (standing and sitting still) and mutism. The lorazepam was restarted at 7,5mg per day. After, the patient was admitted to our critical care ward.
Diagnosis
Upon admission, the patient, a small-statured man of Somali descent, presented with a frightened and anxious demeanor, as evidenced by his facial expressions and affect. He made brief eye contact but subsequently resisted further engagement. Mental status examination revealed signs of immobility, mutism, catalepsy, mitgehen, gegenhalten, ambivalence, and negativism. The Bush-Francis Catatonia Rating Scale (BFCRS) was scored at 28 points (see table 1). A neurological examination was conducted, but no abnormalities were found, although the assessment was limited by the severity of the catatonia. Vital signs indicated mild tachycardia (108 bpm), other vital signs were within the normal range. The patient was administered lorazepam 2.5 mg orally. Approximately 45 minutes after administration, some improvement in his mental state was observed. He became more responsive to commands and he expressed desires, such as requesting coffee and tobacco.
| Catatonic Sign | Initial Presentation (Steady state 7,5mg) | 50mg during titration | steady state 100mg | steady state 130mg |
| Excitement | 0 | 0 | 0 | 0 |
| Immobility/stupor | 2 | 1 | 1 | 1 |
| Mutism | 2 | 1 | 1 | 1 |
| Staring | 3 | 1 | 0 | 0 |
| Posturing | 2 | 1 | 0 | 0 |
| Grimacing | 1 | 0 | 0 | 0 |
| Echolalia/echopraxia | 1 | 1 | 0 | 0 |
| Stereotype | 1 | 0 | 0 | 0 |
| Mannerism | 0 | 0 | 0 | 0 |
| Verbigerations | 1 | 1 | 1 | 0 |
| Rigidity | 1 | 1 | 0 | 0 |
| Negativism | 3 | 1 | 0 | 0 |
| Waxy flexibility | 0 | 0 | 0 | 0 |
| Withdrawal | 2 | 2 | 2 | 0 |
| Impulsivity | 0 | 0 | 0 | 0 |
| Automatic obedience | 0 | 1 | 0 | 0 |
| Mitgehen | 1 | 0 | 0 | 0 |
| Gegenhalten | 3 | 3 | 0 | 0 |
| Ambitendency | 3 | 3 | 0 | 0 |
| Grasp reflex | 0 | 0 | 0 | 0 |
| Perseveration | 0 | 0 | 0 | 0 |
| Combativeness | 0 | 0 | 0 | 0 |
| Automatic abnormalities | 2 | 2 | 1 | 0 |
| Total score | 28 | 19 | 6 | 2 |
Table 1: BFCRS scores recorded at the time of initial evaluation and at various intervals following the intervention.
Treatment
Given that lorazepam was already being administered regularly in a common dosage, the dose was gradually increased over time. The patient’s clinical condition, vital signs, and BFCRS scores were closely monitored. Due to the slow pace of improvement, the lorazepam dosage was gradually titrated up to 130 mg per day (see Graph 1). This decision was made in consultation with several psychiatrists and a hospital pharmacist. The dosage was increased over 8 days, from 7.5 mg to 100 mg per day, with daily BFCRS assessments (see Graph 1). After three weeks, the dosage was further increased to 130 mg per day. By day twenty-one of admission, the BFCRS score had decreased to 3 points, reflecting stupor, mutism, and withdrawal. According to the Clinical Global Impression Improvement (CGI-I) scale [7], the patient scored a two, indicating a significant reduction in symptoms.
During the titration process, vital signs (heart rate, blood pressure, oxygen saturation, and respiratory rate) were measured three times daily. Common adverse effects [8] associated with high doses of lorazepam (especially sedation and respiratory depression) were closely monitored closely. Over the first two weeks, the patient’s blood pressure fluctuated between 110/90 mmHg and 65/50 mmHg. These hypotensive episodes were brief, and no clinical signs of hypotension were observed. This was attributed to autonomic dysregulation secondary to the catatonia. Although it could also be caused by the clozapine, due to its potent alpha 1 receptor blocking abilities [9]. His heart rate remained stable at 100-110 bpm, which is attributable to the clozapine. Remarkably, respiratory rate and oxygen saturation remained stable within normal values. Lorazepam blood levels were measured multiple times, with values of 701 μg/L and 905 μg/L at 100 mg and 130 mg per day, respectively. Weekly measurements of leucocytes, electrolytes, kidney function, and liver chemistry during the titration phase revealed no significant abnormalities (see Table 2).
| Table 2 | Week 1 | Week 2 | Week 3 | Week 4 | Week 5 | Week 6 | Week 8 | Normal values |
| Leucocytes | 4,9 | 3,5 | 4,2 | 4,8 | 4,3 | 4,3 | 5,0 | 4,0-10 10^9/l |
| ALAT | 30 | 50 | 42 | 29 | 26 | 26 | - | 0-45U/l |
| ASAT | a | 43 | 23 | 20 | 20 | 20 | - | 0-20U/l |
| Amylase | 210 | 116 | 104 | - | - | - | - | 0-107 U/l |
| CRP | 4 | 12 | 6 | 4 | - | - | - | 0-5mg/l |
| Creatinine | - | 73 | 68 | 71 | - | - | - | 50-110umol/l |
| eGFR | - | 120 | 124 | - | 129 | - | - | >60ml/min |
| Clozapineb | - | 587 | 886 | 505 | 664 | - | - | 350-700Ug/l |
| Norclozapineb | - | 163 | 238 | 145 | 190 | - | - | |
| Lorazepam | - | 701c | 815 c | 889d | 905e | 50-250Ug/l |
a Analysis failed
b The administration of clozapine was 400 mg.
c The administration of lorazepam was 100 mg.
d The administration of lorazepam was 120 mg.
e The administration of lorazepam was 130 mg.
- No analysis was performed.
Clozapine was titrated to 400 mg per day, with blood levels measuring 886 μg/L for clozapine and 238 μg/L for norclozapine.
Outcome
During the first three weeks of admission, the patient displayed self-neglect, poor adherence to instructions, and minimal social interaction, spending the majority of his time alone in his room. However, after the lorazepam dose was increased to 100 mg per day, a significant clinical improvement was observed. The patient's withdrawal symptoms decreased, self-care showed some improvement, and he became more compliant with instructions. Despite this progress, persistent negative symptoms such as social withdrawal, blunted affect, and avolition remained, along with disorganized thoughts and residual catatonia. No positive symptoms were noted. As of the time of writing this manuscript, the BFCRS score remained stable at 2 points.
We present a case in which an exceptionally high dose of lorazepam was used in the treatment of catatonia. Lorazepam is generally accepted as a first-line treatment of catatonia. The primary reason lorazepam is the first-choice treatment is the extensive experience in using it to treat catatonia, more so than with other benzodiazepines and due to its rapid onset of action [5]. The onset of effect of lorazepam varies depending on the method of administration: 1 to 3 minutes when given intravenously, 15 to 20 minutes intramuscularly, and up to 2 hours when administered orally [10]. Most studies typically employ doses ranging from 1 to 4 mg per day, with some recommending a maximum dose of up to 30 mg per day [4,11,12]. It is also recommended to increase the lorazepam dose until catatonic signs are relieved sufficiently [13]. It is unclear what the upper limit for safe and effective treatment is. In our case, lorazepam was safely titrated to a dose of 130 mg per day.
When treating aggression, in rare cases, high-dose therapy is required [14]. Since our clinic specializes in aggression there is experience with higher than recommended dosing schedules in a safe and effective manner. Furthermore, it is standard practice to internally consult with fellow psychiatrists and external specialized hospital pharmacists when considering off-label medication use or dosages outside of clinical guidelines. In doing so, we place strong emphasis on the effectiveness, proportionality, and safety for the patient.
In this case, the patient responded positively without any significant side effects. Initially, the dose was increased to 100 mg, and at that point, the BFCRS score was 3. When clinical improvement plateaued and no side effects were observed, the decision was made to increase the dose gradually to 130 mg per day. Subsequently, the BFCRS dropped to 2 points. Although, the clinical picture showed improvement following the dose increase to 120 mg. The increase from 120 mg to 130 mg did not result in any notable clinical changes. Although the clinical picture improved, this was not reflected in the BFCRS. We hypothesize that the BFCRS may not have been able to capture minimal changes at lower scores. The persistence of negative symptoms, such as social withdrawal, blunted affect, and avolition, could also be attributed to the underlying schizophrenia. Additionally, the patient’s cognitive function has declined over time, likely due to recurring psychotic and catatonic episodes, as well as substance abuse. Although this cognitive decline does not fully explain his current mental state.
The reason some patients with catatonia require higher dosages of lorazepam remains unclear. It has been postulated that catatonic patients who tolerate high doses of benzodiazepines may have a disruption in the GABA pathway [12]. We also suggest that the chronic nature of the condition may contribute to such disruption. This idea is supported by a study in which traditional dosages were less effective in chronic cases of catatonia [15,16]. In addition, the relationship between blood levels of lorazepam, receptor occupancy, and clinical outcomes is not well understood. In our patient, lorazepam blood levels were significantly higher than assumed toxic thresholds without the appearance of any toxic clinical effects. Especially sedation and respiratory depression. Further research is needed to explore these mechanisms in more detail.
Guidelines recommend ECT [4] when patients fail to respond or show insufficient response to medication. In this case, the patient continued to respond to lorazepam, and ECT was not available at our institution. While practical considerations should not be the sole basis for treatment decisions, it was more feasible to continue pharmacological therapy in this case. Moreover, the patient is continuing to improve, was able to eat and drink adequately, and his check-ups were not concerning.
To our knowledge, this is the first international published case report detailing the use of extremely high doses of lorazepam in the treatment of catatonia. Our findings suggest that lorazepam can be administered safely at extremely high doses, provided that patients are closely monitored for potential side effects. Particularly central nervous system and respiratory depression, which can lead to hypotension, ataxia, confusion, coma, excessive sedation, muscle weakness, and even death. In patient populations where ECT is not feasible or unavailable, we advocate for considering higher doses of benzodiazepines than currently recommended by guidelines when a patient is not fully responding to typical dosages. We also encourage further research into the mechanisms of action, effectiveness, safety, long-term consequences, and appropriate tapering strategies for benzodiazepine treatment in catatonia. As others have called for [17], we emphasize the need for high-quality studies to refine and improve treatment protocols
Acknowledgments
We would like to acknowledge the patient for their willingness to contribute to medical literature. Furthermore, we would like to thank our colleagues for their input regarding the feasibility, safety, and ethical considerations of the pharmacological treatment plan. We thank Forensic Psychiatric Center Mesdag for the final financial contribution leading to this publication.
Financial Disclosure
None to declare.
Conflict of Interest
None to declare.
Informed Consent
Written informed consent was obtained from the patient.
Author Contributions
-Groen, H.J.: writing original draft, project administration, conceptualization, data curation, visualization
-Looman, N.M.G.: supervision, visualization, writing - review and editing
-Lettinga, J.R: supervision and writing - review and editing
Data Availability
The authors declare that data supporting the findings of this study are available within the article.
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I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
