A patient presents with classic symptoms of catatonic schizophrenia, including immobility, muteness, and waxy flexibility. Which of the following is NOT listed among the DSM-5 diagnostic criteria for catatonia?

1. A

   Echolalia

2. B

   Negativism

3. C

   Stupor

4. D

   Stereotypy

Appeared in: NORCET 9 Mains - 2025

Explanation

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• The question asks to identify the option that is NOT a DSM-5 diagnostic criterion for catatonia.
• A careful review of the DSM-5 criteria reveals that all four options (Echolalia, Negativism, Stupor, Stereotypy) are, in fact, listed as potential symptoms.
• However, in 'best-fit' or 'exception' questions, one must identify the option that is the 'odd one out'.
• Stereotypy, which is repetitive, non-goal-directed movement, is a less specific symptom and a core feature of other conditions like Autism Spectrum Disorder.
• In contrast, Stupor, Negativism, and Echolalia are considered more classic and hallmark features of the catatonic syndrome itself, making Stereotypy the intended correct answer.

Why Other Options Were Wrong

• Option A: Echolalia, the mimicking of another person's speech, is explicitly listed as one of the 12 diagnostic criteria for catatonia in DSM-5.
• Option B: Negativism, defined as opposition or no response to instructions or external stimuli, is a core diagnostic criterion for catatonia in DSM-5.
• Option C: Stupor, a state of no psychomotor activity and not actively relating to the environment, is a primary and defining criterion for catatonia in DSM-5.

Related Visual

• Visual 1: Infographic: A visual chart listing the 12 DSM-5 diagnostic criteria for catatonia, with brief descriptions for each. This helps in memorizing the full list of symptoms.
• Visual 2: Flowchart: A decision tree for diagnosing catatonia, starting with observing psychomotor disturbance and checking for at least 3 of the 12 criteria.

Clinical Relevance

• Nursing practice connection: Use the key finding related to DSM-5 Diagnostic Criteria for Catatonia to guide bedside assessment, documentation, and the next nursing action.
• Recognizing the full spectrum of catatonia symptoms is crucial for nurses, as it is a treatable but potentially life-threatening condition if missed. It can lead to complications like malnutrition, dehydration, deep vein thrombosis (DVT), and pressure ulcers.
• Catatonia is a medical emergency. A nurse's prompt identification and reporting can lead to life-saving interventions, such as the lorazepam challenge test or electroconvulsive therapy (ECT).
• What if? If a patient with known schizophrenia suddenly becomes mute and rigid after starting a new high-potency antipsychotic, the nurse must consider Neuroleptic Malignant Syndrome (NMS) as a differential diagnosis, which presents similarly to catatonia but also includes hyperthermia and autonomic instability.

How to Approach the Question

• First, identify the question type. This is a negatively framed question ('NOT'), which requires you to identify the exception among the options.
• Next, recall the core concept being tested: the diagnostic criteria for catatonia as per DSM-5.
• Systematically evaluate each option against your knowledge of the criteria. The DSM-5 lists 12 symptoms for catatonia.
• You may recognize that Stupor, Negativism, Echolalia, and Stereotypy are all on the official list. This indicates a nuanced or potentially flawed question.
• In such cases, look for the 'best' answer by considering which symptom is least specific or could be considered an outlier. Think about which symptom is also a hallmark of another major disorder.
• Stereotypy is a prominent feature of Autism Spectrum Disorder, making it less specific to catatonia than the other, more classic signs like stupor and negativism. This makes it the most likely intended answer.

Concept Tested & Keywords

• Concept Tested: DSM-5 Diagnostic Criteria for Catatonia
• Stem keywords: catatonic schizophrenia, immobility, muteness, waxy flexibility, DSM-5, diagnostic criteria
• Lead-in keywords: NOT
• Clinical cues: The patient presents with classic symptoms of catatonia, guiding the focus to this specific syndrome.
• Negative lead-in flag: Question asks for the exception (NOT a criterion).

Question ID

Q04-txQtu1n8_CzPv57u20

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