A client with catatonic schizophrenia is mute, can’t perform activities of daily living, and stares out window for hours. What is nurse’s first priority?

Correct Answer: A. Assist the client with feeding

According to Maslow’s hierarchy of needs, the need for food is among the most important. The initial management includes supportive measures such as IV fluids and even nasogastric tubes given that patients with catatonia are susceptible to malnutrition, dehydration, pneumonia, etc. The key is early identification of catatonia in a patient with schizophrenia and initiation of treatment.

• Option B: Catatonia again is a complex combination of psychomotor abnormalities and mood and thought processes. There are at least forty different signs and symptoms that have been associated with catatonia. The Diagnostic and Statistical Manual V has criteria for catatonia with specifiers, including that for schizophrenia.
• Option C: Features of catatonia had been described since the 1800s with prominent physicians such as Kahlbaum and even Kraepelin, who defined catatonia within the larger definition of dementia praecox.[2] There are several theories behind the same as catatonia can be part of a larger psychiatric or neurological illness. Kahlbaum has ultimately been credited with the understanding that symptoms such as stupor and catalepsy were part of a larger syndrome of psychomotor abnormalities, which he termed as “catatonia.” This can be a part of a larger schizophrenic illness or even a bipolar affective illness or medical illness.
• Option D: Other needs, in order of decreasing importance, include hygiene, safety, and a sense of belonging. The epidemiology of catatonic schizophrenia can be multivariate. It is said that about 10% of patients in psychiatric inpatient services have catatonic features.[7] On the one hand, the older school of psychiatry associated schizophrenia with catatonia, while newer epidemiological studies show that 20% of patients with catatonia have schizophrenia, and about 45% have symptoms of mood disorders and medical illness.