Which of the following types of schizophrenia is commonly characterised by mutism, rigidity, negativism, and bizarre posture, echolalia, echopraxia and wax flexibility?

1. A

   Paranoid schizophrenia

2. B

   Hebephrenic schizophrenia

3. C

   Undifferentiated schizophrenia

4. D

   Catatonic schizophrenia

Appeared in: DSSSB 13 August 2024

Explanation

• Catatonic schizophrenia is defined by significant disturbances in motor behavior, which can range from immobility (stupor) to excessive, purposeless motor activity (excitement).
• The symptoms listed in the question—mutism, rigidity, negativism, bizarre posturing, echolalia, echopraxia, and waxy flexibility—are the classic, defining features of catatonia.
• These symptoms represent a distinct cluster of psychomotor abnormalities that are the hallmark of this specific subtype.

Why Other Options Were Wrong

• Option A: This subtype's primary features are prominent delusions (typically persecutory or grandiose) and auditory hallucinations. It does not involve the severe motor disturbances characteristic of catatonia.
• Option B: Also known as disorganized schizophrenia, this type is characterized by disorganized speech, disorganized behavior, and a flat or inappropriate affect. While behavior is disturbed, it lacks the specific structured motor signs of catatonia like waxy flexibility or posturing.
• Option C: This is a diagnostic category for individuals who have symptoms of schizophrenia (like delusions, hallucinations, or disorganized speech) but do not meet the full criteria for the paranoid, catatonic, or hebephrenic types.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Schizophrenia subtypes and their clinical features as background academic context rather than a clinical decision trigger.
• Recognizing catatonic symptoms is a critical nursing responsibility for patient safety. Patients in a catatonic stupor are at high risk for dehydration, malnutrition, and pressure ulcers due to immobility and negativism.
• Catatonia can escalate to a life-threatening medical emergency known as malignant catatonia, characterized by fever, rigidity, and autonomic instability, which requires immediate medical intervention.
• What if? If a patient exhibited waxy flexibility and mutism but also had a major depressive episode, the diagnosis might be Major Depressive Disorder with Catatonic Features, as catatonia can occur in other mood disorders, not just schizophrenia.

How to Approach the Question

• First, carefully read the question stem and identify all the listed symptoms.
• Recognize that all the symptoms provided (mutism, rigidity, posturing, waxy flexibility, echolalia, echopraxia) are related to disturbances in motor function and speech.
• Review the definitions of the schizophrenia subtypes offered as options.
• Paranoid type is associated with delusions/hallucinations.
• Hebephrenic (disorganized) type is associated with disorganized thought and affect.
• Catatonic type is specifically defined by the cluster of motor disturbances listed in the question.

Concept Tested & Keywords

• Concept Tested: Schizophrenia subtypes and their clinical features
• Stem keywords: schizophrenia, mutism, rigidity, negativism, bizarre posture, echolalia, echopraxia, waxy flexibility
• Lead-in keywords: Which of the following types
• Negative lead-in flag: false

Question ID

Qjb2g-CCDpTmwBzEmQZ5GM

Copy ID

Reference Book

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