Mrs. Gowri, on assessment, shows the following behaviour?
a. Maintaining rigid posture
b. Being mute
c. Hears "God's voice"
d. Repeating the phrases

These are the characteristics of:-

1. A

   Paranoid Schizophrenia

2. B

   Undifferentiated schizophrenia

3. C

   Catatonic schizophrenia

4. D

   Residual Schizophrenia

Appeared in: AIIMS Raipur - 2017 (shift-2)

Explanation

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• The correct option is Catatonic Schizophrenia because the patient's symptoms are a classic presentation of catatonia.
• Maintaining a rigid posture is a form of posturing or catalepsy, a hallmark sign of catatonia.
• Being mute (mutism) is another core feature of catatonic stupor.
• Repeating phrases is known as echolalia, a specific type of disorganized speech commonly seen in catatonia.
• While auditory hallucinations ('God's voice') can occur in various schizophrenia subtypes, the presence of multiple, prominent psychomotor disturbances is the key differentiator for the catatonic type.

Why Other Options Were Wrong

• Option A: Paranoid Schizophrenia is primarily defined by prominent delusions and auditory hallucinations, without the significant motor disturbances (like posturing and mutism) seen in this case.
• Option B: Undifferentiated Schizophrenia is a diagnosis used when a patient's symptoms are mixed and do not clearly fit into the paranoid, catatonic, or disorganized categories. Here, the symptoms clearly point to catatonia.
• Option D: Residual Schizophrenia is characterized by the absence of prominent positive symptoms (like active hallucinations, delusions, or catatonia). The patient's symptoms are active and positive.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Identification of schizophrenia subtypes based on clinical features to guide bedside assessment, documentation, and the next nursing action.
• Nurses must be able to quickly identify signs of catatonia as it is a medical emergency requiring immediate intervention to ensure patient safety and physiological stability.
• Priorities for a patient in a catatonic state include maintaining a patent airway, ensuring adequate nutrition and hydration, preventing skin breakdown and deep vein thrombosis from immobility, and protecting them from injury.
• What if? If the patient displayed purposeless, excessive motor activity, agitation, and echopraxia (mimicking movements) instead of immobility, the diagnosis would still be Catatonic Schizophrenia, but of the 'excited' type rather than the 'stuporous' type. Nursing care would then focus on ensuring safety, reducing stimuli, and managing agitation.

How to Approach the Question

• First, analyze the clinical vignette and list the specific symptoms presented by the patient: 1) rigid posture, 2) mutism, 3) auditory hallucinations, 4) repeating phrases.
• Next, translate these lay-term descriptions into clinical terminology: rigid posture = posturing/catalepsy; mutism = lack of speech; repeating phrases = echolalia.
• Recall the defining characteristics of each schizophrenia subtype provided in the options.
• Systematically compare the patient's cluster of symptoms to the criteria for each subtype.
• Note that while hallucinations are present, the most striking and specific symptoms are the psychomotor disturbances (posturing, mutism) and disorganized speech (echolalia).
• Conclude that this specific combination of symptoms is the hallmark of Catatonic Schizophrenia, making it the best fit among the choices.

Concept Tested & Keywords

• Concept Tested: Identification of schizophrenia subtypes based on clinical features.
• Stem keywords: rigid posture, mute, Hears "God's voice", Repeating the phrases, schizophrenia
• Lead-in keywords: characteristics of

Question ID

Q3ZLRptGKZBNHwx5HcSYtd

Copy ID

Reference Book

E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) pp. 1102-1104, 1104-1106, 1101-1103