A 35-year-old woman with bipolar disorder presents mute and immobile in a fixed posture for 3 hours. She resists passive movement, does not respond to commands, but is apparently awake (eyes open). Earlier she was overheard speaking repetitively. Which feature in this presentation specifically points to catatonia rather than psychogenic unresponsiveness?
- A Mutism
- B Eyes open
- C Waxy flexibility (catalepsy) with posturing ✓
- D Unresponsiveness to commands
Correct answer: C. Waxy flexibility (catalepsy) with posturing
Explanation
Waxy flexibility (catalepsy) — the ability to maintain a limb in an externally placed, unusual position for prolonged periods with a 'wax-like' resistance on passive movement — is a pathognomonic feature of catatonia. While mutism, posturing, and unresponsiveness can occur in psychogenic states, waxy flexibility is specifically linked to catatonia (either retarded or excited type). Bush-Francis Catatonia Rating Scale includes catalepsy as a defining item. Lorazepam challenge (improvement within 30 minutes) supports the diagnosis.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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