A psychiatric patient who is not responding (rigid) to stimulus, not speaking (mutism), holding the body in an unusual position, is described as which type of schizophrenia?

1. A

   Paranoid schizophrenia

2. B

   Hebephrenic schizophrenia

3. C

   Differential schizophrenia

4. D

   Catatonic schizophrenia

Appeared in: NORCET-7 Mains-2024

Explanation

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• The patient's presentation includes a triad of classic catatonic symptoms: rigidity (resistance to movement), mutism (lack of speech), and posturing (holding an unusual body position).
• Catatonic schizophrenia is specifically defined by these marked psychomotor disturbances.
• These symptoms represent a state of catatonic stupor, which is a primary feature of this subtype.

Why Other Options Were Wrong

• Option A: Paranoid schizophrenia's core features are positive symptoms like delusions of persecution or grandeur and auditory hallucinations, not the profound motor disturbances seen in the patient.
• Option B: Hebephrenic (or disorganized) schizophrenia is characterized by disorganized speech (e.g., word salad), disorganized behavior, and flat or inappropriate affect. The patient's symptoms are structured (rigid, posturing), not disorganized.
• Option C: 'Differential schizophrenia' is not a recognized diagnostic category in major classification systems like the DSM-5 or ICD-10.

Related Visual

• Visual 1: Infographic: A chart comparing the primary symptoms of different schizophrenia subtypes (Paranoid, Disorganized, Catatonic, Undifferentiated) to highlight their key differences.
• Visual 2: Illustration: A drawing depicting a patient exhibiting classic catatonic postures, such as waxy flexibility or posturing, to provide a clear visual example of the condition.

Clinical Relevance

• Nursing practice connection: Use the key finding related to Clinical features and subtypes of schizophrenia to guide bedside assessment, documentation, and the next nursing action.
• Recognizing catatonia is critical for nurses as it is a medical emergency. These patients are at high risk for malnutrition, dehydration, deep vein thrombosis (DVT), and pressure ulcers due to immobility.
• Nurses must provide total care, including nutritional support, passive range-of-motion exercises, and regular repositioning to prevent complications.
• What if? If a patient with these catatonic features also developed a high fever, muscle rigidity, and autonomic instability (e.g., high blood pressure, tachycardia), the nurse must immediately consider Neuroleptic Malignant Syndrome (NMS), a life-threatening reaction to antipsychotic medication, and escalate care.

How to Approach the Question

• First, identify the key symptoms presented in the question stem: rigidity (not responding), mutism (not speaking), and holding an unusual position (posturing).
• Recognize that these are all related to motor function and behavior.
• Next, review the options provided. Recall the defining characteristics of each subtype of schizophrenia.
• Paranoid type involves delusions/hallucinations. Hebephrenic type involves disorganization. 'Differential' is not a valid type.
• Match the cluster of motor symptoms (rigidity, mutism, posturing) to the correct diagnosis, which is Catatonic schizophrenia.

Concept Tested & Keywords

• Concept Tested: Clinical features and subtypes of schizophrenia.
• Stem keywords: psychiatric patient, not responding, rigid, mutism, unusual position, schizophrenia
• Lead-in keywords: described as which type
• Clinical cues: The combination of rigidity, mutism, and posturing points directly to a catatonic state.

Question ID

Q12tmJs5dwscRvTiRNQuwV

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