# 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?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630095  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

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?

## 보기

1. Schizophrenia with the catatonia specifier **✔ 정답**
2. Catatonia due to another medical condition
3. Schizophrenia, catatonic subtype
4. Functional neurological symptom disorder

**정답: 1**

## 해설

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.

## 심화 해설

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].References (research sources)

- [2]Rethinking Catatonia in Neurodevelopmental Conditions: Toward a Refined Typology and Research Framework.Research articleMunir KM. (2025) · DOI: 10.5152/pcp.2025.251286

- [3]Catatonia in ICD-11.Research articleRogers JP, Wilson JE, Oldham MA. (2025) · DOI: 10.1186/s12888-025-06857-6

## 임상 시나리오

Catatonia Specifier in SchizophreniaDSM-5-TR classification update for psychiatric nursing
In DSM-5-TR, the old schizophrenia subtypes were removed. Catatonia is now recorded as a specifier, not a subtype. For a client with established schizophrenia, document the diagnosis as schizophrenia with the catatonia specifier when at least 3 catatonic features are present.

This client shows mutism, posturing, and negativism. A normal medical workup rules out a general medical or substance-related cause, so the catatonia is attributed to the existing schizophrenia.

CautionDo not use schizophrenia, catatonic subtype; that subtype was eliminated. Also avoid catatonia due to another medical condition unless a specific medical cause is confirmed.

## 핵심 개념

- **Catatonia specifier** — A DSM-5-TR specifier applied to disorders such as schizophrenia when at least three catatonic features are present.
- **Mutism** — Absence of speech; one of the catatonic features.
- **Posturing** — Voluntary assumption of an inappropriate or bizarre posture held for long periods.
- **Negativism** — Resistance to instructions or attempts to be moved.
- **DSM-5-TR** — Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision.

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