Catatonia: malignant catatonia: practice question

A Psychiatry question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Psychiatry · Catatonia: malignant catatonia

Sample item

A patient with schizophrenia and catatonic stupor develops fever, rigidity, autonomic instability and altered sensorium, but has never received an antipsychotic. What is the most likely diagnosis and treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Malignant catatonia; give benzodiazepines and ECT

Malignant catatonia is catatonia with fever, autonomic instability and rigidity, and it resembles NMS but occurs without antipsychotic exposure. Antipsychotics can worsen it. Lorazepam and ECT are the treatments and early ECT is lifesaving.

Option by option

  • A. Malignant catatonia; give benzodiazepines and ECT (correct)

    Correct. Catatonia with autonomic instability and no antipsychotic exposure is malignant catatonia, treated with benzodiazepines and ECT.

  • B. Neuroleptic malignant syndrome; give an antipsychotic

    NMS follows dopamine antagonist exposure, and an antipsychotic would worsen both conditions.

  • C. Serotonin syndrome; give an SSRI

    Serotonin syndrome follows serotonergic drugs and shows clonus and hyperreflexia, and an SSRI would worsen it.

  • D. Heat stroke; give lithium

    Heat stroke is not treated with lithium, which is itself toxic in dehydration.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is A, Malignant catatonia; give benzodiazepines and ECT. Malignant catatonia is catatonia with fever, autonomic instability and rigidity, and it resembles NMS but occurs without antipsychotic exposure.

Why is "Neuroleptic malignant syndrome; give an antipsychotic" not the answer?

NMS follows dopamine antagonist exposure, and an antipsychotic would worsen both conditions.

Why is "Serotonin syndrome; give an SSRI" not the answer?

Serotonin syndrome follows serotonergic drugs and shows clonus and hyperreflexia, and an SSRI would worsen it.

Why is "Heat stroke; give lithium" not the answer?

Heat stroke is not treated with lithium, which is itself toxic in dehydration.

What concept does this question test?

It tests Catatonia: malignant catatonia in Psychiatry. Antipsychotics can worsen it. Lorazepam and ECT are the treatments and early ECT is lifesaving.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Catatonia: malignant catatonia?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.