Situation: The nurse on a psychiatric unit reviews admission records. Each record lists the client's diagnosis under the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), and nursing diagnoses written with NANDA International (NANDA-I) 2024–2026 labels. A 30-year-old client with established schizophrenia has been mute for 2 days, holds one arm raised for long periods, and resists every attempt to move him. His medical workup, including laboratory tests and neurologic examination, is normal. How should this presentation be classified under the current psychiatric manual?

The old subtypes of schizophrenia, including the catatonic subtype, were removed in DSM-5, and catatonia is now recorded as a specifier. Mutism, posturing, and negativism are at least three catatonic features, and a normal medical workup makes the specifier on his existing schizophrenia the correct classification.

Classification in DSM-5-TR The presentation is classified as schizophrenia with the catatonia specifier. In DSM-5-TR, catatonia is not a stand-alone diagnosis and the older schizophrenia subtypes, including the catatonic subtype, were removed. Instead, catatonia is recorded as a specifier that can accompany schizophrenia and several other disorders ^[2][3].

Why the catatonia specifier applies The client already has an established diagnosis of schizophrenia. The current symptoms include mutism (absence of speech), posturing (holding one arm raised against gravity for long periods), and negativism (resisting attempts to be moved). These are three distinct catatonic features. A normal medical workup, including laboratory tests and a neurologic examination, rules out a general medical or substance-related cause, so the catatonia is attributed to the existing schizophrenia.

Distinguishing the other options

Option	Why it is incorrect
Catatonia due to another medical condition	Requires evidence that catatonia is the direct pathophysiologic consequence of a medical condition. Here the medical and neurologic workup is normal, so no such cause is identified.
Schizophrenia, catatonic subtype	The catatonic subtype of schizophrenia was eliminated in DSM-5 and is not used in DSM-5-TR. Catatonia is now coded as a specifier, not a subtype.
Functional neurological symptom disorder	This diagnosis is not appropriate when symptoms are better explained by schizophrenia. The catatonic features are part of the schizophrenia presentation, not a separate functional neurologic disorder.

Clinical reasoning for nursing care Catatonia is a transdiagnostic syndrome, meaning it can appear across psychiatric, medical, and developmental conditions ^[2]. In a client with known schizophrenia, the appearance of motor and behavioral changes such as mutism, posturing, and negativism should prompt assessment for the catatonia specifier. The priority is to first exclude medical or substance-induced causes through physical examination, laboratory studies, and neurologic evaluation. When those are unremarkable, the catatonia is classified as a specifier of the underlying schizophrenia .

Watch out! Do not use the term catatonic subtype in DSM-5-TR. The correct documentation is schizophrenia with catatonia or schizophrenia with the catatonia specifier. Key point! Mutism, posturing, and negativism are three separate catatonic signs, and the presence of three or more catatonic features supports the specifier when the medical workup is normal ^[3].