Waxy flexibility

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Waxy flexibility
File:Flexibilitas cerea (cropped).JPG
Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Catatonia, rigidity, posturing
Complications	Immobility, pressure sores, muscle atrophy
Onset	Can occur at any age
Duration	Variable, depending on underlying condition
Types	N/A
Causes	Often associated with catatonic schizophrenia, mood disorders, neurological disorders
Risks	Psychiatric disorders, neurological conditions
Diagnosis	Clinical observation, psychiatric evaluation
Differential diagnosis	Parkinson's disease, stiff-person syndrome, neuroleptic malignant syndrome
Prevention	N/A
Treatment	Benzodiazepines, electroconvulsive therapy, antipsychotics
Medication	N/A
Prognosis	Depends on underlying cause and treatment response
Frequency	Rare, more common in psychiatric settings
Deaths	N/A

Waxy flexibility is a symptom characterized by a decreased response to stimuli and a tendency to remain in an immobile posture. It is most commonly associated with catatonia, a neuropsychiatric syndrome that can occur in the context of various psychiatric and medical conditions.

Clinical Features

Waxy flexibility is observed when a patient's limbs remain in a position after being moved by someone else. This phenomenon is akin to the flexibility of wax, where the limbs can be molded into different positions and will maintain those positions for extended periods. This symptom is often accompanied by other features of catatonia, such as mutism, stupor, and negativism.

Pathophysiology

The exact pathophysiology of waxy flexibility is not fully understood. It is believed to involve dysfunction in the dopaminergic and GABAergic systems of the brain, particularly affecting the basal ganglia and frontal lobe circuits. These areas are responsible for motor control and the regulation of voluntary movements.

Diagnosis

The diagnosis of waxy flexibility is primarily clinical, based on the observation of the characteristic motor behavior. It is often assessed as part of a broader evaluation for catatonia, which may include the use of standardized rating scales such as the Bush-Francis Catatonia Rating Scale.

Treatment

Treatment of waxy flexibility involves addressing the underlying cause of catatonia. Benzodiazepines, such as lorazepam, are commonly used as first-line treatment. In cases where benzodiazepines are ineffective, electroconvulsive therapy (ECT) may be considered. It is crucial to identify and treat any underlying medical or psychiatric conditions contributing to the catatonic state.

See also

• Catatonia
• Mutism
• Stupor
• Negativism
• Electroconvulsive therapy