Question

A 35-year-old man is brought to the clinic by his wife. His wife says that the patient no longer gives any verbal responses in spite of being very articulate before. He had been experiencing very low moods for the past 3 months and had started shutting himself off from everyone. Recently, he has not been eating routinely and only sleeps a few hours nightly. He remains in his room, barely moving, even to the point of not going to the bathroom to relieve himself. Upon examination, the patient spontaneously raises his arm and keeps it there throughout the examination. He also resists the attempts of the physician to move his arm. What is the most likely diagnosis?

A. Psychosis associated with major depressive disorder
B. Psychosis associated with dysthymia
C. Catatonia disorder associated with major depressive disorder
D. Catatonia disorder associated with schizophrenia
E. Catatonia disorder associated with schizophreniform disorder

Answer 1

The patient's symptoms of mood changes, social withdrawal, and catatonic behavior such as catalepsy and negativism are indicative of a catatonia disorder associated with major depressive disorder. This is the most likely diagnosis given the lack of psychotic symptoms.

Step-by-step explanation:

The clinical presentation described suggests the patient is experiencing catatonic behavior, which is a syndrome characterized by abnormal movements and behaviors. The specific symptoms of not eating, sleeping poorly, social withdrawal, and especially the extended holding of an arm position (known as catalepsy) and resistance to attempts to move the arm (negativism) are consistent with a catatonia disorder associated with major depressive disorder (Option C). While catatonia can also be associated with schizophrenia or schizophreniform disorders, the prolonged low mood, social withdrawal, and absence of psychotic symptoms such as hallucinations or delusions lean towards a depressive etiology. This reinforces the likelihood of catatonia associated with major depressive disorder (C) being the most likely diagnosis. Treatment might include benzodiazepines or electroconvulsive therapy (ECT), depending on the severity and response to initial treatment.