Mutism (speechlessness), negativism (negativism), waxy flexibility, bizarre posture and stupor are symptoms of.?

Appeared in: UP CHO - 2018

Explanation

Catatonic schizophrenia is defined by prominent psychomotor disturbances such as mutism, negativism, waxy flexibility, bizarre posturing, and stupor.
These symptoms are not primary features of other schizophrenia subtypes.
Waxy flexibility is a unique sign where the patient's limbs remain in positions placed by others.
Catatonic symptoms can be either immobility (stupor) or excessive activity, but the listed features are all immobile/stuporous.
The key differentiator is the predominance of motor symptoms over thought disorder or delusions.

Option A: Hebephrenic (disorganized) schizophrenia is characterized by disorganized speech, inappropriate affect, and silly or bizarre behavior, not by catatonic motor symptoms.
Option B: Paranoid schizophrenia is dominated by delusions (often of persecution or grandeur) and auditory hallucinations, not by mutism or waxy flexibility.
Option D: Residual schizophrenia is diagnosed when there is a history of schizophrenia but current symptoms are mild, with negative symptoms like social withdrawal and emotional blunting, not catatonic features.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Recognition of catatonic schizophrenia based on characteristic motor symptoms as background academic context rather than a clinical decision trigger.
Nurses must recognize catatonic symptoms to ensure patient safety, as these patients are at risk for dehydration, malnutrition, and pressure sores due to immobility.
Early identification allows for prompt intervention, including medical management and supportive care.
What if? If the patient instead presented with prominent delusions and auditory hallucinations but normal motor activity, the diagnosis would shift toward paranoid schizophrenia, changing both management and safety priorities.

How to Approach the Question

Identify the key symptoms listed in the stem and match them to known schizophrenia subtypes.
Recall that catatonic features are primarily motor disturbances, not thought or mood disturbances.
Eliminate options that focus on delusions, hallucinations, or disorganized speech if the stem lists only motor symptoms.
Use a process of elimination to differentiate between subtypes based on hallmark features.
For scenario-based questions, always consider the most prominent symptom cluster.

Concept Tested & Keywords

Concept Tested: Recognition of catatonic schizophrenia based on characteristic motor symptoms
Stem keywords: Mutism, Negativism, Waxy flexibility, Bizarre posture, Stupor
Lead-in keywords: are symptoms of
Clinical cues: Presence of multiple motor symptoms points to catatonic subtype

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E6 Parks TextBook of Preventive & Social Medicine part 1 — Subpart C (pp 404-604 of 604) p. 182-184

E6 Parks TextBook of Preventive & Social Medicine part 1 — Subpart A (pp 26-201 of 604) p. 20-22

Practise the full UP CHO - 2018

Attempt every question from this paper in a timed mock, then review the full solution for each one.