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 patient's symptoms directly align with the core features of catatonia, a specifier for schizophrenia.
• Maintaining a rigid posture is a form of 'posturing,' a key sign of catatonia.
• Being mute, or 'mutism,' is another classic psychomotor symptom in catatonia.
• Repeating phrases is known as 'echolalia,' which involves mimicking another's speech.
• The presence of three distinct psychomotor disturbances (posturing, mutism, echolalia) confirms a catatonic presentation.

Why Other Options Were Wrong

• Option A: Paranoid Schizophrenia is primarily defined by prominent delusions and auditory hallucinations, without the severe motor disturbances like posturing and mutism seen in this patient.
• Option B: Undifferentiated Schizophrenia is a diagnosis used when a patient's symptoms are mixed and do not clearly fit into the catatonic, paranoid, or disorganized types. Here, the symptoms clearly fit the catatonic subtype.
• Option D: Residual Schizophrenia is characterized by the predominance of negative symptoms (e.g., flat affect, lack of motivation, poverty of speech) after an acute psychotic episode has passed. This patient is exhibiting active, positive psychomotor symptoms.

Related Visual

• Visual 1: Table: Summarizing the key features and diagnostic criteria for different schizophrenia subtypes (Paranoid, Catatonic, Disorganized, Residual).
• Visual 2: Infographic: Illustrating the signs of catatonia, such as waxy flexibility, posturing, mutism, and echopraxia.

Clinical Relevance

• Nursing practice connection: Use the key finding related to Identification of schizophrenia subtypes based on clinical presentation to guide bedside assessment, documentation, and the next nursing action.
• Recognizing catatonia is critical for nurses as it is a medical emergency. The immobility can lead to life-threatening complications like dehydration, malnutrition, pressure ulcers, and deep vein thrombosis (DVT).
• The priority for a nurse managing a patient with catatonia is to ensure physiological stability and safety. This includes monitoring vital signs, hydration, nutrition, and protecting the patient from self-injury.
• What if the patient was instead agitated, pacing, and exhibiting purposeless motor activity? This would be classified as 'catatonic excitement,' which is still a form of catatonia. The nursing priority would shift to managing agitation and preventing exhaustion and self-harm, often requiring sedation.

How to Approach the Question

• First, break down the clinical information provided in the stem. List the patient's specific behaviors: 1. Rigid posture, 2. Mute, 3. Auditory hallucination ('God's voice'), 4. Repeating phrases.
• Next, analyze these behaviors and translate them into clinical signs. 'Rigid posture' is posturing, 'mute' is mutism, and 'repeating phrases' is echolalia.
• Systematically evaluate each option against this cluster of signs.
• Recall or look up the defining features of each schizophrenia subtype.
• Note that while hallucinations are present, the most striking and defining features are the severe psychomotor disturbances.
• Conclude that the triad of posturing, mutism, and echolalia strongly indicates the Catatonic subtype, making it the best fit.

Concept Tested & Keywords

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

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