Descriptive Psychopathology: The Signs and Symptoms of ...

7Disturbances of motor functionIf the proper study of mankind is man, the proper study of mental illness starts with thedescription of how he thinks and feels inside – chaos of thought and passion, all confused. 1Abnormal movements have been recognized as aspects of behavioral illness formillennia, and all severe psychiatric conditions are associated with changes inmotor functioning. Changes can be subtle and non-specific, limited to restlessnessthat suggests anxiety, or dramatic and diagnostic, such as the classic posturesindicating catatonia. Kraepelin and Bleuler both describe choreiform movementsof the face and fingers, tremor, dysdiadochokinesia, and ataxia as features ofschizophrenia, Kraepelin referring to “a cerebellar form” of dementia praecox. 2A modern study of 100 patients with the diagnosis of schizophrenia found98 exhibited motor disturbances before the antipsychotic era. 3Abnormal movements are often associated with problems in executive and othercognitive processes, and frontal lobe structural and metabolic abnormalities. 4Intense emotion adversely affects this brain region, and there also is a strongassociation between motor function and mood. 5 Several investigators considermelancholia a disorder of both mood and motor functioning. 6 The most commonassociations of motor and mood disturbance are listed in Table 7.1.Without movement there is no emotional expression, which is recognized onlywith changes in facial muscle positioning, gestures, body language and vocalinflection. Fear-circuitry and flight/fight processes link fear and anger to motorresponses necessary for species survival. 7 The triggering of avoidance or approachbehaviors requires the correct processing of facial recognition and the emotionalexpressions of others. 8The motor system, linked to emotional expression, also plays a role in motivatedbehavior: most basic are drives to seek food, and eating and drinkingbehaviors. 9 When this system is dysfunctional, as in catatonia and melancholia,patients are avolitional and apathetic, and may starve and become dehydrated.The cerebellum, another component of the motor system, is implicated in the153