You are assessing a patient who is immobile and largely unresponsive. Before revealing the answer, decide how you would explore whether this is stupor.

Assess the completeness of the loss of activity and reaction to external stimuli, and note whether any brief, muttered, monosyllabic replies can be obtained, since sub-stuporose patients may still produce these even in a full presentation. Use whatever clinical evidence is available — eye movements, resistance to passive movement, autonomic signs, and collateral history — to judge the underlying level of consciousness, since psychiatric stupor typically occurs with clear consciousness while akinetic mutism involves a genuine lowering of consciousness from an organic cause. Consider where on the spectrum from mild psychomotor slowing through obstruction to complete stupor the presentation sits, and seek collateral history for the wide range of conditions, from psychological shock and dissociative states to depression, catatonia, organic brain disease, and epilepsy, across which stupor can occur.