Descriptive Psychopathology: The Signs and Symptoms of ...

154 Section 3: Examination domainsTable 7.1. Diseases commonly associated with motor and mood disorderParkinson’s diseaseHuntington’s diseaseWilson’s diseaseAlzheimer’s diseaseEpilepsyMigraineTraumatic brain injurySchizophreniaAutistic spectrum disorderEncephalitisDemyelinating diseaseStrokeAutoimmune diseaseToxic encephalopathyEndocrinopathiesMelancholiaManiapathogenesis of autistic spectrum disorders and schizophrenia. 10 Both conditionsare characterized by abnormal emotional expression, including the movements ofemotions (e.g. facial expression, hand gestures), and in the recognition of theemotional valence expressed by others. 11 The examinations of motor and emotionsystems are conjoined. Understanding their related psychopathology isessential to diagnosing behavioral syndromes.Disturbances in activityAbnormal activity level is common among patients with behavioral illness.Determining what the patient does during a typical day or observing the patientin the waiting area, examining room, or in the common areas of the inpatientunit reveals many of these disturbances.HyperactivityHyperactive patients exhibit many actions simultaneously or in a short period oftime. They rush from one undertaking to the next. Severe hyperactivity appears asfrenzy, the patient failing to complete even simple household or personal hygienetasks. The lack of an apparent goal in the plethora of activity, however, does notdelineate syndromes. It is a sign of severity, not of specific pathophysiology.Hyperactivity is the motor equivalent of distractibility and flight-of-ideas(thought associations that jump from topic to topic). It is a classic feature ofmania and stimulant drug intoxication.When severe, hyperactivity is associated with excitement (extreme hyperarousaland intense emotional expression), a state termed manic delirium.Almost all such patients will have catatonic features. 12 A hyperkinetic state is alsoseen in children with complex partial seizures. This state can be intense, involvingfrenetic movements of the extremities and trunk. Flailing, kicking, screaming,