Autism spectrum disorder diagnostic criteria US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Autism spectrum disorder diagnostic criteria. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Autism spectrum disorder diagnostic criteria US Medical PG Question 1: A 5-year-old girl is brought to the physician because her mother has found her to be inattentive at home and has received multiple complaints from her teachers at school. She does not complete her assignments and does not listen to her teachers' instructions. She refuses to talk to her parents or peers. Her mother says, “She ignores everything I say to her!” She prefers playing alone, and her mother reports that she likes playing with 5 red toy cars, repeatedly arranging them in a straight line. She avoids eye contact with her mother and the physician throughout the visit. Physical and neurological examination shows no abnormalities. Which of the following is the most likely diagnosis?
- A. Rett syndrome
- B. Conduct disorder
- C. Oppositional defiant disorder
- D. Attention deficit hyperactivity disorder
- E. Autism spectrum disorder (Correct Answer)
Autism spectrum disorder diagnostic criteria Explanation: ***Autism spectrum disorder***
- The child exhibits core features of **autism spectrum disorder (ASD)**, including **social communication deficits** (refuses to talk, ignores parents, avoids eye contact) and **restricted, repetitive patterns of behavior** (playing with 5 red toy cars, repeatedly arranging them in a straight line).
- Her inattention and difficulty following instructions are also common in ASD, often related to focus on their specific interests rather than external demands, and **sensory processing differences** or **executive dysfunction**.
*Rett syndrome*
- This is a neurodevelopmental disorder almost exclusively affecting **females** and typically presents with a period of normal development followed by **regression of acquired skills**, especially **language and motor skills**.
- Key features include **stereotypic hand movements** (hand-wringing, squeezing), **gait abnormalities**, and **deceleration of head growth**, none of which are described in the patient.
*Conduct disorder*
- Characterized by a **persistent pattern of behavior** in which the basic rights of others or major age-appropriate societal norms or rules are violated, such as **aggression to people and animals**, **destruction of property**, deceitfulness or theft, and serious rule violations.
- The presented symptoms of social communication deficits and repetitive behaviors are not indicative of conduct disorder.
*Oppositional defiant disorder*
- Involves a pattern of **angry/irritable mood, argumentative/defiant behavior**, or **vindictiveness** lasting at least 6 months, often directed at authority figures.
- While the child may appear defiant by not listening, the broader constellation of **social communication deficits** and **repetitive behaviors** points away from ODD as the primary diagnosis.
*Attention deficit hyperactivity disorder*
- Presents with a persistent pattern of **inattention and/or hyperactivity-impulsivity** that interferes with functioning or development.
- Although the child is inattentive, the presence of **social communication difficulties** and **restricted, repetitive behaviors** are not characteristic of ADHD and are better explained by ASD.
Autism spectrum disorder diagnostic criteria US Medical PG Question 2: A mother brings her 3-year-old son to the doctor because she is worried that he might be harming himself by constantly banging his head on the wall. He has been exhibiting this behavior for a few months. She is also worried because he has started to speak less than he used to and does not respond when his name is called. He seems aloof during playtime with other children and seems to have lost interest in most of his toys. What is the most likely diagnosis?
- A. Autism spectrum disorder (Correct Answer)
- B. Attention deficit hyperactivity disorder
- C. Generalized anxiety disorder
- D. Bipolar disorder
- E. Obsessive-compulsive disorder
Autism spectrum disorder diagnostic criteria Explanation: ***Autism spectrum disorder***
- The child's symptoms of **head banging** (a repetitive, self-stimulatory behavior), **decreased speech**, **lack of response to his name**, **social aloofness**, and **loss of interest in toys** are classic indicators of **Autism Spectrum Disorder (ASD)**.
- ASD involves persistent deficits in **social communication and interaction** across multiple contexts, as well as **restricted, repetitive patterns of behavior, interests, or activities**.
*Attention deficit hyperactivity disorder*
- **ADHD** is characterized primarily by **inattention, hyperactivity, and impulsivity**, which are not the prominent or primary concerns described in this case.
- While children with ADHD may have social difficulties, their core symptoms do not typically include severe **social aloofness, communication regression**, or **self-injurious repetitive behaviors** like head banging.
*Generalized anxiety disorder*
- **Generalized anxiety disorder (GAD)** in children typically presents with excessive worry about multiple events or activities, often accompanied by **physical symptoms of anxiety** such as restlessness, fatigue, and difficulty concentrating.
- It does not explain the **communication regression, social deficits**, or **stereotypical behaviors** like head banging observed in this child.
*Bipolar disorder*
- **Bipolar disorder** in children often manifests with severe mood dysregulation, including distinct periods of **elevated or irritable mood (mania/hypomania)** and depression.
- The symptoms described, such as social withdrawal and communication difficulties, are not characteristic of the primary presentations of bipolar disorder.
*Obsessive-compulsive disorder*
- **OCD** is characterized by the presence of **obsessions (recurrent, persistent thoughts, urges, or images)** and/or **compulsions (repetitive behaviors or mental acts)**.
- While head banging can be a repetitive behavior, the broader constellation of symptoms, including social and communication deficits, is not typical of primary OCD in young children.
Autism spectrum disorder diagnostic criteria US Medical PG Question 3: A 10-year-old boy is brought to the physician by his parents because they are concerned about his “strange behavior”. The parents state that he has always been a lonely kid without many friends, but recently he has been having behavioral problems that seem to be unprovoked and are occurring more frequently. The child throws tantrums for no reason and does not respond to punishment or reward. He also has a “strange obsession” with collecting rocks that he finds on his way to and from school to the point where his room is filled with rocks. He plays alone in his room, lining the rocks up, organizing them by size, shape, or color, and he will randomly bark or make high-pitched noises without provocation. His teachers say he daydreams a lot and is very good at art, being able to recreate his favorite cartoon characters in great detail. On physical assessment, the patient does not make eye contact with the physician but talks incessantly about his rock collection. The child’s grammar and vocabulary seem normal but his speech is slightly labored, and he can’t seem to tell that the physician is not really interested in hearing about his rock collection. Which of the following is the most likely diagnosis?
- A. Autism spectrum disorder (Correct Answer)
- B. Obsessive-compulsive disorder
- C. Tourette’s syndrome
- D. Pick disease
- E. Attention deficit hyperactivity disorder
Autism spectrum disorder diagnostic criteria Explanation: ***Autism spectrum disorder***
- This case presents classic features of **autism spectrum disorder (ASD)**, including **social deficits** (lonely, no friends, no eye contact, lack of awareness of others' interest), **repetitive behaviors and fixated interests** (rock collection, lining them up, organizing), and **stereotyped movements/vocalizations** (random barking, high-pitched noises).
- The child's excellent artistic skills and normal grammar/vocabulary despite other communication difficulties are also consistent with the varying presentations within the **autism spectrum**, which can include areas of exceptional talent alongside core deficits.
*Obsessive-compulsive disorder*
- While the rock collection and organizing might resemble an **obsession/compulsion**, OCD typically involves **intrusive thoughts (obsessions)** causing distress and **repetitive behaviors (compulsions)** performed to alleviate that distress.
- The presented social deficits, communication difficulties, and stereotyped movements are not characteristic of OCD alone.
*Tourette’s syndrome*
- **Tourette's syndrome** is characterized by **multiple motor tics** and **one or more vocal tics**. The barking and high-pitched noises could be tics, but Tourette's does not explain the profound social impairments, repetitive behaviors/interests, and communication difficulties described.
- The global pattern of symptoms points beyond Tourette's.
*Pick disease*
- **Pick disease** is a rare form of **frontotemporal dementia** that primarily affects adults, typically presenting with **personality changes**, **behavioral disinhibition**, and **language difficulties**.
- It is an adult-onset neurodegenerative disorder and would not be diagnosed in a 10-year-old child presenting with developmental differences.
*Attention deficit hyperactivity disorder*
- **ADHD** is characterized by **persistent patterns of inattention** and/or **hyperactivity-impulsivity**. While "daydreaming" could suggest inattention, the core features of social impairment, repetitive behaviors, and specific vocalizations are not typical of ADHD.
- The child's "strange obsession" and social isolation point away from a primary diagnosis of ADHD.
Autism spectrum disorder diagnostic criteria US Medical PG Question 4: A 4-year-old girl is brought to the pediatrician by her parents after her mother recently noticed that other girls of similar age talk much more than her daughter. Her mother reports that her language development has been abnormal and she was able to use only 5–6 words at the age of 2 years. Detailed history reveals that she has never used her index finger to indicate her interest in something. She does not enjoy going to birthday parties and does not play with other children in her neighborhood. The mother reports that her favorite “game” is to repetitively flex and extend the neck of a doll, which she always keeps with her. She is sensitive to loud sounds and starts screaming excessively when exposed to them. There is no history of delayed motor development, seizures, or any other major illness; perinatal history is normal. When she enters the doctor’s office, the doctor observes that she does not look at him. When he gently calls her by her name, she does not respond to him and continues to look at her doll. When the doctor asks her to look at a toy on his table by pointing a finger at the toy, she looks at neither his finger nor the toy. The doctor also notes that she keeps rocking her body while in the office. Which of the following is an epidemiological characteristic of the condition the girl is suffering from?
- A. There has been a steady decline in prevalence in the United States over the last decade.
- B. There is an increased risk if the mother smoked during pregnancy.
- C. There is an increased risk with low prenatal maternal serum vitamin D level.
- D. There is an increased incidence if the mother gives birth before 25 years of age.
- E. This condition is 4 times more common in boys than girls. (Correct Answer)
Autism spectrum disorder diagnostic criteria Explanation: **_This condition is 4 times more common in boys than girls._**
- The clinical presentation, including **impaired social interaction** (not looking at the doctor, not responding to her name, not playing with other children, not enjoying parties), **communication deficits** (delayed language, lack of pointing), **repetitive behaviors** (flexing doll's neck, body rocking) and **sensory sensitivities** (screaming at loud sounds), is highly suggestive of **Autism Spectrum Disorder (ASD)**.
- **ASD** is indeed diagnosed approximately four times more often in boys than in girls, making this a characteristic epidemiological feature.
*There has been a steady decline in prevalence in the United States over the last decade.*
- The **prevalence of ASD** has actually been **steadily increasing** in the United States and globally over the last few decades, partly due to increased awareness, improved diagnostic criteria, and better screening.
- This statement is contrary to current epidemiological trends for **ASD**.
*There is an increased risk if the mother smoked during pregnancy.*
- While maternal smoking during pregnancy is linked to other developmental issues like **ADHD** and **premature birth**, a definitive, strong, and consistent causal link to a significantly increased risk of **ASD** has not been established.
- Research on environmental risk factors for **ASD** is ongoing, but maternal smoking is not a primary, well-established epidemiological characteristic.
*There is an increased risk with low prenatal maternal serum vitamin D level.*
- Some studies suggest a potential association between low prenatal maternal vitamin D levels and an increased risk of **ASD**, but this link is **not yet definitively established** and requires further research to confirm causation.
- It is considered a potential risk factor, but not a widely accepted or strong epidemiological characteristic for the condition.
*There is an increased incidence if the mother gives birth before 25 years of age.*
- The risk of **ASD** has been more consistently associated with **advanced parental age** (both maternal and paternal), not with younger maternal age.
- Studies generally indicate a **higher risk for children born to older parents**, making this statement inaccurate.
Autism spectrum disorder diagnostic criteria US Medical PG Question 5: A 28-year-old male presents to his primary care physician with complaints of intermittent abdominal pain and alternating bouts of constipation and diarrhea. His medical chart is not significant for any past medical problems or prior surgeries. He is not prescribed any current medications. Which of the following questions would be the most useful next question in eliciting further history from this patient?
- A. "Does the diarrhea typically precede the constipation, or vice-versa?"
- B. "Is the diarrhea foul-smelling?"
- C. "Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life"
- D. "Are the symptoms worse in the morning or at night?"
- E. "Can you tell me more about the symptoms you have been experiencing?" (Correct Answer)
Autism spectrum disorder diagnostic criteria Explanation: ***Can you tell me more about the symptoms you have been experiencing?***
- This **open-ended question** encourages the patient to provide a **comprehensive narrative** of their symptoms, including details about onset, frequency, duration, alleviating/aggravating factors, and associated symptoms, which is crucial for diagnosis.
- In a patient presenting with vague, intermittent symptoms like alternating constipation and diarrhea, allowing them to elaborate freely can reveal important clues that might not be captured by more targeted questions.
*Does the diarrhea typically precede the constipation, or vice-versa?*
- While knowing the sequence of symptoms can be helpful in understanding the **pattern of bowel dysfunction**, it is a very specific question that might overlook other important aspects of the patient's experience.
- It prematurely narrows the focus without first obtaining a broad understanding of the patient's overall symptomatic picture.
*Is the diarrhea foul-smelling?*
- Foul-smelling diarrhea can indicate **malabsorption** or **bacterial overgrowth**, which are important to consider in some gastrointestinal conditions.
- However, this is a **specific symptom inquiry** that should follow a more general exploration of the patient's symptoms, as it may not be relevant if other crucial details are missed.
*Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life*
- Quantifying pain intensity is useful for assessing the **severity of discomfort** and monitoring changes over time.
- However, for a patient with intermittent rather than acute, severe pain, understanding the **character, location, and triggers** of the pain is often more diagnostically valuable than just a numerical rating initially.
*Are the symptoms worse in the morning or at night?*
- Diurnal variation can be relevant in certain conditions, such as inflammatory bowel diseases where nocturnal symptoms might be more concerning, or functional disorders whose symptoms might be stress-related.
- This is another **specific question** that should come after gathering a more complete initial picture of the patient's symptoms to ensure no key information is overlooked.
Autism spectrum disorder diagnostic criteria US Medical PG Question 6: A 7-year-old girl is brought to the physician by her mother because she has been increasingly reluctant to speak at school over the past 4 months. Her teachers complain that she does not answer their questions and it is affecting her academic performance. She was born at 35 weeks' gestation and pregnancy was complicated by preeclampsia. Previous well-child examinations have been normal. Her older brother was diagnosed with a learning disability 4 years ago. She is at 65th percentile for height and weight. Physical examination shows no abnormalities. She follows commands. She avoids answering questions directly and whispers her answers to her mother instead who then mediates between the doctor and her daughter. Which of the following is the most likely diagnosis?
- A. Selective mutism (Correct Answer)
- B. Social anxiety disorder
- C. Rett syndrome
- D. Autism spectrum disorder
- E. Reactive attachment disorder
Autism spectrum disorder diagnostic criteria Explanation: ***Selective mutism***
- The child's reluctance to speak in specific social situations (school) despite being able to speak in others (whispering to her mother), and the impact on academic performance, are classic signs of **selective mutism**
- **Selective mutism** typically involves anxiety and a consistent failure to speak in situations where speaking is expected, despite speaking in other situations
- This diagnosis fits the **DSM-5 criteria**: consistent failure to speak in specific social situations for >1 month, interfering with educational achievement
*Social anxiety disorder*
- While social anxiety can be **comorbid** with selective mutism, the hallmark of this presentation is the **specific refusal to speak** in certain settings, rather than generalized anxiety about social interactions
- A child with generalized social anxiety might interact nervously but would likely attempt to speak, which is not described here
*Rett syndrome*
- **Rett syndrome** is a neurodevelopmental disorder almost exclusively affecting girls, characterized by **normal early development followed by regression** of acquired skills, loss of purposeful hand use, and deceleration of head growth
- The presented symptoms of reluctance to speak in specific settings, without other regressive signs or developmental abnormalities, do not fit the diagnosis of Rett syndrome
*Autism spectrum disorder*
- **Autism spectrum disorder** is characterized by persistent deficits in **social communication and social interaction** across multiple contexts, and **restricted, repetitive patterns of behavior**
- This child's ability to speak to her mother and follow commands suggests intact communication skills in some contexts, making autism less likely than selective mutism for the primary presentation
*Reactive attachment disorder*
- **Reactive attachment disorder** typically arises from patterns of **extremely insufficient care** in early childhood, leading to emotionally withdrawn behavior toward caregivers and limited positive affect
- The child's selective non-speaking in school in this scenario, with normal previous well-child examinations and interaction with her mother, is inconsistent with the characteristic features of reactive attachment disorder
Autism spectrum disorder diagnostic criteria US Medical PG Question 7: A 4-year-old boy is brought to the physician by his parents because of concerns about his behavior during the past year. His parents report that he often fails to answer when they call him and has regular unprovoked episodes of crying and screaming. At kindergarten, he can follow and participate in group activities, but does not follow his teacher's instructions when these are given to him directly. He is otherwise cheerful and maintains eye contact when spoken to but does not respond when engaged in play. He gets along well with friends and family. He started walking at the age of 11 months and can speak in two-to-three-word phrases. He often mispronounces words. Which of the following is the most likely diagnosis?
- A. Selective mutism
- B. Hearing impairment (Correct Answer)
- C. Conduct disorder
- D. Specific-learning disorder
- E. Autistic spectrum disorder
Autism spectrum disorder diagnostic criteria Explanation: ***Hearing impairment***
- The child's inconsistent response to being called, failure to follow direct instructions, and unprovoked crying and screaming, despite maintaining eye contact and having normal social interactions, are all suggestive of a **hearing impairment**.
- His delayed and unusual speech patterns (two-to-three-word phrases, mispronouncing words) for his age further points to **auditory processing difficulties** due to hearing loss.
*Selective mutism*
- This condition involves a consistent failure to speak in specific social situations where speaking is expected, despite speaking in other situations. The child's issue is with comprehending and responding to speech, not with speaking itself.
- The behavior observed (not responding to calls or direct instructions) is more indicative of an inability to hear rather than a choice not to speak.
*Conduct disorder*
- Conduct disorder is characterized by a persistent pattern of behavior that violates the rights of others and major societal norms appropriate for the individual's age.
- The child's symptoms do not include aggression, destruction of property, deceitfulness, or serious rule violations and he gets along well with friends and family.
*Specific-learning disorder*
- A specific learning disorder involves difficulties with academic skills, despite normal intelligence. While he has speech difficulties, he can participate in group activities, and there is no information about his academic performance.
- The primary concern here is his inability to respond to auditory input, which precedes and likely causes any potential learning difficulties rather than being a learning disorder itself.
*Autistic spectrum disorder*
- Autism spectrum disorder is characterized by persistent deficits in social communication and social interaction across multiple contexts, and restricted, repetitive patterns of behavior, interests, or activities.
- This child maintains eye contact, is cheerful, gets along well with friends and family, and can participate in group activities, which argues against significant **social communication deficits** typical of autism.
Autism spectrum disorder diagnostic criteria US Medical PG Question 8: A 5-year-old non-verbal child with a history of autism is brought into the emergency department by his grandmother. The patient’s grandmother is concerned her grandchild is being abused at home. The patient lives in an apartment with his mother, step-father, and two older brothers in low-income housing. The department of social services has an open case regarding this patient and his family. The patient is afebrile. His vital signs include: blood pressure 97/62 mm Hg, pulse 175/min, respiratory rate 62/min. Physical examination reveals a malnourished and dehydrated child in dirty and foul-smelling clothes. Which one of the following people is most likely abusing this patient?
- A. Mother (Correct Answer)
- B. Neighbor
- C. Brother
- D. Stranger
- E. Step-father
Autism spectrum disorder diagnostic criteria Explanation: ***Mother***
- **Child abuse** is complex, but the **mother (or primary caregiver)** is often the abuser, especially in cases where the child is non-verbal and has a disability.
- The child's **malnutrition and poor hygiene** point to neglect, which is a form of abuse, and the primary caregiver is responsible for the child's basic needs.
*Neighbor*
- While abuse can occur outside the home, a **neighbor is highly unlikely** to be responsible for the child's chronic neglect, malnutrition, and dehydration, given the living circumstances described.
- **Neighbors typically do not have consistent, unsupervised access** to a child in a manner that would lead to such severe and ongoing neglect.
*Brother*
- Although **siblings can be perpetrators of abuse**, particularly physical or sexual abuse, it is **uncommon for siblings to be responsible for severe neglect** leading to malnutrition and chronic poor hygiene in a younger child.
- This kind of chronic neglect usually points to a **primary caregiver's failure** to provide basic needs.
*Stranger*
- Abuse by a **stranger is relatively rare** compared to abuse by a family member or acquaintance.
- The consistent pattern of **neglect, malnutrition, and poor hygiene** suggests ongoing failure of care within the home environment, not a single or intermittent encounter with a stranger.
*Step-father*
- A **step-father is a recognized risk factor for child abuse**, and he could certainly be involved, especially given the child's vulnerability.
- However, in cases of **chronic neglect and failure to provide basic care**, the primary responsibility often lies with the **biological parent** who is also a co-resident caregiver.
Autism spectrum disorder diagnostic criteria US Medical PG Question 9: An 11-year-old boy’s parents brought him to a psychologist upon referral from the boy’s school teacher. The boy frequently bullies his younger classmates despite having been punished several times for this. His mother also reported that a year prior, she received complaints that the boy shoplifted from local shops in his neighborhood. The boy frequently stays out at night despite strict instructions by his parents to return home by 10 PM. Detailed history reveals that apart from such behavior, he is usually not angry or irritable. Although his abnormal behavior continues despite warnings and punishments, he neither argues with his parents nor teachers and does not display verbal or physical aggression. Which of the following is the most likely diagnosis?
- A. Attention-deficit/hyperactivity disorder, hyperactivity-impulsivity type
- B. Disruptive mood dysregulation disorder
- C. Intermittent explosive disorder
- D. Conduct disorder (Correct Answer)
- E. Oppositional defiant disorder
Autism spectrum disorder diagnostic criteria Explanation: ***Conduct disorder***
- The boy's behaviors, including **bullying**, **shoplifting**, and **violating rules** (staying out past curfew), represent a persistent pattern of behavior that violates the basic rights of others or major age-appropriate societal norms, which are core features of **conduct disorder**.
- The history indicates these behaviors have been ongoing for at least a year and are not just isolated incidents, fulfilling the diagnostic criteria for **duration and pervasiveness**.
*Attention-deficit/hyperactivity disorder, hyperactivity-impulsivity type*
- While ADHD involves **hyperactivity** and **impulsivity**, it does not typically manifest with deliberate violations of others' rights or societal norms like **bullying** and **shoplifting**.
- There is no mention of symptoms such as **difficulty sustaining attention**, **fidgeting**, or **excessive talking** which are characteristic of ADHD.
*Disruptive mood dysregulation disorder*
- This disorder is characterized by **severe recurrent temper outbursts** and persistent **irritable or angry mood** between outbursts.
- The case explicitly states the boy is "not angry or irritable" and "neither argues with his parents nor teachers," ruling out this diagnosis.
*Intermittent explosive disorder*
- This disorder involves recurrent behavioral outbursts representing a failure to control aggressive impulses, often with verbal aggression or physical aggression toward property, animals, or other individuals.
- The boy does not display verbal or physical aggression and is not noted to have anger or irritability, which are central to this diagnosis.
*Oppositional defiant disorder*
- ODD involves a pattern of **angry/irritable mood**, **argumentative/defiant behavior**, or **vindictiveness**.
- While violating rules is present, **bullying** and **shoplifting** (which violate the basic rights of others) are more severe behaviors that go beyond the scope of ODD and are characteristic of conduct disorder.
Autism spectrum disorder diagnostic criteria US Medical PG Question 10: A 23-year-old woman is admitted to the inpatient psychiatry unit after her boyfriend reported she was “acting funny and refusing to talk.” The patient’s boyfriend states that he came home from work and found the patient sitting up in bed staring at the wall. When he said her name or waved his hand in front of her, she did not respond. When he tried to move her, she would remain in whatever position she was placed. The patient’s temperature is 99°F (37.2°C), blood pressure is 122/79 mmHg, pulse is 68/min, and respirations are 12/min with an oxygen saturation of 98% O2 on room air. During the physical exam, the patient is lying on the bed with her left arm raised and pointing at the ceiling. She resists any attempt to change her position. The patient remains mute and ignores any external stimuli. The patient’s medical history is significant for depression. She was recently switched from phenelzine to fluoxetine. Which of the following is the best initial therapy?
- A. Electroconvulsive therapy
- B. Lorazepam (Correct Answer)
- C. Haloperidol
- D. Cyproheptadine
- E. Benztropine
Autism spectrum disorder diagnostic criteria Explanation: **Lorazepam**
- The patient presents with classic symptoms of **catatonia**, including **mutism**, **waxy flexibility**, and **posturing**, following a medication change from phenelzine (MAOI) to fluoxetine (SSRI), which could potentially precipitate catatonia or serotonin syndrome.
- **Benzodiazepines**, particularly lorazepam, are the **first-line treatment** for catatonia, often showing a rapid and dramatic response.
*Electroconvulsive therapy*
- While **ECT** is a highly effective treatment for severe catatonia, especially when unresponsive to benzodiazepines, it is typically considered a **second-line intervention** or for cases involving medical instability.
- Given the strong initial efficacy and safety profile of benzodiazepines, they are preferred as the first step before proceeding to ECT.
*Haloperidol*
- **Antipsychotics** like haloperidol are generally **contraindicated** in catatonia, as they can sometimes worsen the symptoms or even induce **neuroleptic malignant syndrome (NMS)**, which shares some features with severe catatonia.
- NMS is a serious condition with high mortality, and introducing an antipsychotic in a catatonic patient could be dangerous.
*Cyproheptadine*
- **Cyproheptadine** is a **serotonin antagonist** used primarily in the treatment of **serotonin syndrome**, which involves symptoms like hyperthermia, agitation, and hyperreflexia.
- While the medication change could raise suspicion for serotonin syndrome, the clinical picture of **waxy flexibility, mutism, and posturing** is much more indicative of catatonia, for which cyproheptadine is not an effective treatment.
*Benztropine*
- **Benztropine** is an **anticholinergic medication** primarily used to treat **extrapyramidal symptoms (EPS)** caused by antipsychotics, such as **dystonia** or **parkinsonism**.
- The patient's symptoms are not indicative of EPS, and benztropine has no role in the treatment of catatonia.
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