Catatonia — MRCPsych Paper B MCQ

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EasySchizophrenia & PsychosisCatatoniaMRCPsych Paper B

A 30-year-old man with schizophrenia becomes mute and minimally responsive. He spontaneously adopts uncomfortable postures and maintains them for prolonged periods. When his arm is repositioned, he initially offers slight resistance and then holds the new position. His temperature, pulse and blood pressure are normal. Which syndrome is most likely?

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Correct answer: B — Catatonia

The correct answer is B, catatonia. Mutism, stupor, sustained spontaneous posturing and slight initial resistance to passive repositioning followed by maintenance of the imposed position—waxy flexibility—are characteristic catatonic signs. Catatonia can occur with schizophrenia, mood disorders and medical or neurological conditions. Neuroleptic malignant syndrome is less likely without hyperthermia, prominent generalised rigidity or autonomic instability. Serotonin syndrome typically produces hyperreflexia, clonus and autonomic disturbance. Acute dystonia causes focal or generalised sustained muscle contractions, often after dopamine-blocking medication, but does not explain this combination of stupor, mutism and posturing. Delirium primarily involves disturbed attention and awareness with a fluctuating course. Catatonia requires assessment for underlying causes and complications; lorazepam is commonly first-line, with ECT considered when severe or insufficiently responsive.

Reference: Royal College of Psychiatrists. Catatonia: What are the symptoms of catatonia? and How do we treat catatonia? 2022. https://www.rcpsych.ac.uk/mental-health/mental-illnesses-and-mental-health-problems/catatonia