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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 The rigid patient's initial resistance to the examiner's manipulations is

flexibility gradually overcome, allowing re-positioning (as in bending a candle).

Automatic The patient moves with the examiner's light pressure into a new position
obedience 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- The patient's behavior is tied to certain stimuli. As an example, the examiner
bound states, "When I touch my nose, you touch your chest," and the patient
behavior 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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