A severely depressed patient has become profoundly withdrawn and largely unresponsive. Before revealing the answer, decide how you would assess whether this is depressive stupor.

Look carefully at the facial expression, since depressive stupor retains a recognisably depressed quality, sometimes with an admixture of anxiety or bewilderment, and note whether it worsens specifically when affect-laden topics, such as family affairs, are raised, in contrast to the deadpan quality typically seen in catatonic stupor. Assess muscle tone, since it remains normal here rather than showing the altered tone typical of catatonic stupor, and check specifically for the absence of catalepsy, obstruction, stereotypies, and incontinence, all of which are typical of catatonic stupor but not of this form. Given the profound severity and urgency of the presentation, ensure the same careful exclusion of an organic or neurological cause is carried out as for any other rapidly developing stupor.