Many catatonic features lack standardized definitions and are often incorrectly used by clinicians. The following is an attempt to standardize the vocabulary in concordance with DSM-5 terminology.
Waxy flexibility (flexibilitas cerea): a physical examination finding in catatonia, in which despite instructions to maintain a flaccid muscle tone, there is present a light and even resistance (as opposed to cogwheeling) to the examiner’s movement of the patient’s extremity, with a quality similar to bending a piece of wax or plastic. Some clinicians differ from this explanation, and define waxy flexibility as the ability to reposition a patient, as if they were made of wax (catalepsy).
Mitmachen (German for “working together” as in “participate”): a physical examination finding in catatonia, in which despite instructions to the patient to resist any movement, the examiner is able to place the patient’s body in any position. If the patient maintains this forced position as a posture, it is called catalepsy. Mitmachen is not frequently used as a descriptive term in North America.
Catalepsy: a physical examination finding in catatonia, in which despite instructions to the patient to maintain a flaccid muscle tone, the examiner is able to position the patient into postures that are subsequently maintained by the patient for an abnormally long period of time.
Mitgehen (German for “going along”): a physical examination finding in catatonia, in which despite instructions to the patient to resist any movement, the examiner is able to move the patient in any direction using very slight pressure. Mitgehen may be viewed as an extreme form of mitmachen and is also called the “anglepoise lamp” sign.
Negativism: an observable sign as well as a physical examination finding, usually in catatonia but also in other conditions, including autism spectrum disorder, intellectual disability, and traumatic brain injury. It is a phenomenon in which the patient refuses or does the opposite of what is asked or physically attempted by the examiner, in a manner that appears detached from a clearly identifiable motive. Motoric negativism can progress to rigidity. Refusal to eat or drink may also be viewed as a form of negativism. Negativism is often misinterpreted as volitional uncooperativeness.
Gegenhalten (German for “holding against”) (paratonia in neurology): a physical examination finding, in which the patient opposes movements with the same degree of force as applied by the examiner. The patient with gegenhalten needs not to display negativism.
Posturing: an observable sign in catatonia, in which the patient spontaneously develops and maintains a rigid, immobile posture, and maintains the posture for an abnormally long period of time. The posture may appear exaggerated, grotesque, bizarre, and contorting, or it may appear superficially ordinary and underwhelming, such as sitting in a chair or bed abnormally still and with a tense appearance. Psychological pillow is a form of posturing in which a supine patient spontaneously develops and maintains a head posture above the plane of the bed without apparent effort or strain.
Grimacing (German Schnauzkrampf or “snout cramp”): an observable sign in catatonia, in which the patient spontaneously contorts the facial muscles and maintains a grimacing facial posture for an abnormally long period of time. Grimacing may also be viewed as a form of facial posturing.
Catatonic stupor: an observable sign in catatonia, in which a patient retains alert consciousness but has minimal interaction with the external environment. Patients with catatonic stupor may display increased response latency in speech or action, hypoactivity or immobility, minimal or no visual scanning of the environment, or dead pan staring.
