EpistemisNegativism
Specialty: Psychiatry.
Why it occurs
- Catatonic schizophrenia (the patient does the opposite of what is asked or rigidly resists passive movements)
- Oppositional defiant disorder (in children and adolescents)
- Advanced dementia with symptoms of agitation/opposition
- Antisocial or borderline personality disorder
- Hypoactive delirium (passive resistance due to mental confusion)
Initial workup
Assessment of muscle strength and endurance (stiffness versus spasticity); Bush-Francis catatonia scale; complete ionogram, renal function and plasma osmolarity; urine test.
red flags
Absolute and prolonged refusal to ingest food, water or vital medication, which can induce hypernatremic dehydration, acute prerenal renal failure or decompensation of serious chronic diseases (diabetes, heart failure).
Standard management
- Lorazepam — highly effective in catatonic-based negativism, administered via IM or IV
- Risperidone — for oppositional defiant disorder with severe aggression or in the context of dementia
- Olanzapine — in schizophrenia with active negativism
- Enteral or parenteral hydration solutions in critical cases of prolonged food refusal.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Psychiatry
- Listed causes
- 5
- Treatment options
- 4