UP NHM CHO 7 Sept 2022 (Shift-2)
Mental Health Nursing
Easy
Mutism, negativism, waxy flexibility, bizarre posture are symptoms of:
Appeared in: UP NHM CHO 7 Sept 2022 (Shift-2)
Explanation
- The symptoms listed—mutism, negativism, waxy flexibility, and bizarre posture—are the classic and defining psychomotor disturbances of catatonic schizophrenia.
- Catatonia is defined as a marked decrease in reactivity to the environment, which manifests as these specific motor signs.
- Mutism is a lack of verbal response.
- Negativism is resistance to instructions or external stimuli.
- Waxy flexibility is the maintenance of postures into which the patient is placed.
- Posturing is the spontaneous assumption and maintenance of bizarre or inappropriate postures.
Why Other Options Were Wrong
- Option A: Hebephrenic (or disorganized) schizophrenia is primarily characterized by disorganized speech, disorganized behavior, and flat or inappropriate affect, not the profound motor disturbances seen in catatonia.
- Option B: Paranoid schizophrenia is defined by the presence of prominent delusions (typically persecutory or grandiose) and auditory hallucinations. Motor symptoms are not a core feature.
- Option D: Residual schizophrenia is a diagnosis for a later phase of the illness where prominent positive symptoms (like hallucinations or catatonia) are absent. The patient primarily shows negative symptoms like emotional blunting and social withdrawal.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical features of schizophrenia subtypes as background academic context rather than a clinical decision trigger.
- The immediate nursing priority for a patient with catatonic stupor is ensuring physiological stability. Due to immobility, mutism, and negativism, patients are at high risk for malnutrition, dehydration, pressure ulcers, and deep vein thrombosis. Basic needs must be met by the nursing staff.
- What if? - If the patient's symptoms were persecutory delusions and threatening auditory hallucinations instead of motor disturbances, the diagnosis would shift to Paranoid Schizophrenia. The nursing priority would then be to establish trust, ensure safety related to command hallucinations, and manage anxiety, rather than focusing on physical care for immobility.
How to Approach the Question
- First, identify the key clinical signs presented in the question: Mutism, negativism, waxy flexibility, and bizarre posture.
- Recognize that this cluster of symptoms relates to severe disturbances in motor behavior and reactivity.
- Next, review the options, which are different subtypes of schizophrenia.
- Recall the defining features of each subtype: Paranoid (delusions/hallucinations), Hebephrenic (disorganized thought/affect), Catatonic (motor disturbances), and Residual (negative symptoms after an acute phase).
- Directly match the motor symptoms from the question to the definition of Catatonic schizophrenia.
- Eliminate the other options as their primary features do not align with the profound motor abnormalities described.
Concept Tested & Keywords
- Concept Tested: Clinical features of schizophrenia subtypes
- Stem keywords: Mutism, negativism, waxy flexibility, bizarre posture
- Lead-in keywords: symptoms of
- Negative lead-in flag: false
Question ID
QY_eWczz8ckLcmqoYd_Nnv
Reference Book
E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 1102-1104
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 4738-4740
Practise the full UP NHM CHO 7 Sept 2022 (Shift-2)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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