Mutism (speechlessness), negativism (negativism), waxy flexibility, bizarre posture and stupor are symptoms o… - JIPMER Nursing Officer-2024

JIPMER Nursing Officer-2024

Psychiatric Nursing

Easy

Appeared in: JIPMER Nursing Officer-2024

Explanation

The question lists a cluster of symptoms that are primarily psychomotor in nature.
Catatonic Schizophrenia is specifically defined by marked disturbances in motor behavior, which can range from extreme unresponsiveness (stupor) to excessive motor activity (excitement).
The listed symptoms—mutism (no speech), negativism (resistance), waxy flexibility (maintaining posed limbs), bizarre posturing, and stupor (unresponsiveness)—are the hallmark diagnostic criteria for catatonia.

Option A: Hebephrenic (or Disorganized) Schizophrenia is primarily characterized by disorganized thought processes, inappropriate or flat affect, and chaotic behavior, not the structured motor disturbances of catatonia.
Option B: Paranoid Schizophrenia is defined by the presence of prominent delusions (e.g., of persecution or grandeur) and auditory hallucinations, while cognitive and motor functions are relatively preserved.
Option D: Residual Schizophrenia is diagnosed when a person has had a past episode of schizophrenia but now only has lingering negative symptoms (like social withdrawal or blunted affect) without prominent positive symptoms like delusions, hallucinations, or catatonia.

Visual 1: Infographic: A comparative chart showing the key features of Paranoid, Catatonic, Hebephrenic, and Residual Schizophrenia side-by-side.
Visual 2: Illustration: A drawing depicting a patient exhibiting waxy flexibility, where a nurse has positioned their arm in an unnatural way, and it remains there.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical features and subtypes of Schizophrenia as background academic context rather than a clinical decision trigger.
Nurses must prioritize patient safety and physiological needs for individuals with catatonia, as they may be unable to eat, drink, or protect themselves from harm.
Interventions include ensuring adequate nutrition and hydration (possibly via NG tube), performing passive range-of-motion exercises to prevent contractures, and monitoring for skin breakdown due to immobility.
What if? If the patient suddenly switched from stupor to extreme, purposeless motor activity and agitation, this would be 'catatonic excitement.' The nursing priority would shift to ensuring the safety of the patient and others, possibly requiring sedation and physical restraints, as they are at high risk for self-injury or exhaustion.

How to Approach the Question

First, analyze the question stem to identify the core symptoms presented: mutism, negativism, waxy flexibility, posture, and stupor.
Recognize that this cluster of symptoms relates to psychomotor function (movement and responsiveness).
Evaluate each option based on its defining characteristics. Recall or deduce that Hebephrenic involves disorganization, Paranoid involves delusions, and Residual involves negative symptoms post-episode.
Match the psychomotor symptoms from the stem to the definition of Catatonic Schizophrenia, which is primarily a motor disturbance disorder.
This direct match confirms Catatonic Schizophrenia as the correct answer.

Concept Tested & Keywords

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