Descriptive Psychopathology: The Signs and Symptoms of ...

156 Section 3: Examination domainsintense mood. It can be mild, with restlessness and fidgeting, and picking atbed sheets, or it can be severe, such as constant hand wringing, head and facerubbing, pacing, and frenzy. Agitation is observed in depression and mixed moodsyndromes, states of anxiety and excitement, delirium, and drug intoxication.Agitation and hypoactivity may occur simultaneously in melancholic depression,and combined with reduced interactiveness identifies this depressiveillness. 14 Psychomotor disturbance is the most recognized feature in almost allstudies that identify melancholia, 15 and is as fundamental to melancholia as arevegetative signs. 16 In a review of factor and cluster analytic studies of depression,Nelson and Charney (1981) concluded that psychomotor change was the clearestand most consistent feature associated with melancholia. Among nine operationaldefinitions of melancholia, Rush and Weisenberger (1994) reported psychomotorretardation to be the single feature common to all. Five of the nine definitions alsoincluded agitation.AkathesiaAkathesia is a state of motor restlessness, the patient unable to sit or be still.Akathesia can be mistaken for anxiety, but sufferers describe a subjective feelingof jitteriness or terrible restlessness of the muscles, rather than apprehension.They say “I can’t sit still ...I’m jumping out of my skin”. Motor stereotypy is anassociated finding, including purposeless self touching, picking at clothing,rocking, and repeatedly shifting position. Patients may continuously retrace theirsteps, march in place, and sit, then stand, and then sit again. When drug-induced,akathesia occurs early in treatment, and antipsychotic drugs and SSRI arecommon offenders. When it persists after the offending agent is stopped, it istermed tardive akathesia. Akathesia occurring early in treatment presages futuretardive dyskinesia. 17Gait problemsThe patient’s gait reflects general medical health, the presence of musculoskeletaldisease, neurologic impairment, and psychiatric disorder. The ability to walkaffects treatment outcome and disposition. 18Many conditions affect gait. Slowed gait is seen in depressive illness, hypothyroidism,frontal–temporal dementia, and sedative drug intoxication. A jerky,bird-like gait is seen in persons who chronically abuse stimulant drugs. Cerebellarataxia (unsteady trunk, wide-based gait with leg intentional tremor) is seen inintoxications and destructive disease of the cerebellum. A spastic gait (abnormallystiff and awkward) is seen in myelopathies and upper neuron disease. A widebasedgait suggests peripheral nerve disease or proprioception problems, bothoften the results of alcoholism. A hesitant gait, as if hit in the chest by a strong