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Elicited signs of catatonia

Elicited signs of catatonia
Feature Description and examples
Ambitendency The patient appears "stuck" in an indecisive, hesitant movement when the examiner verbally contradicts his or her own nonverbal signal. As an example, the examiner offers his hand as if to shake hands while stating, "Do not shake my hand."
Waxy flexibility The rigid patient's initial resistance to the examiner's manipulations is gradually overcome, allowing re-positioning (as in bending a candle).
Automatic obedience The patient moves with the examiner's light pressure into a new position despite instructions to the contrary. The new position may then be maintained despite instructions to the contrary. Test bilaterally as this sign may result from contralateral brain lesions.
Negativism The patient resists the examiner's manipulations with strength equal to that applied (rigidity); social negativism may include sleeping under the bed, turning away when addressed, refusing to open the eyes, and closing the mouth when offered food or liquids.
Stimulus-bound behavior The patient's behavior is tied to certain stimuli. As an example, the examiner states, "When I touch my nose, you touch your chest," and the patient touches his nose in a mirrored behavior despite understanding the instruction.
Adapted from:
  1. Fink M, Taylor MA. The catatonia syndrome: Forgotten but not gone. Arch Gen Psychiatry 2009; 66:1173.
  2. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.
  3. Bush G, Fink M, Petrides G, et al. Catatonia. I. Rating scale and standardized examination. Acta Psychiatr Scand 1996; 93:129.
  4. Greenhalgh J, Knight C, Hind D, et al. Clinical and cost-effectiveness of electroconvulsive therapy for depressive illness, schizophrenia, catatonia and mania: systematic reviews and economic modelling studies. Health Technol Assess 2005; 9:1.
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