Descriptive Psychopathology: The Signs and Symptoms of ...

161 Chapter 7: Disturbances of motor functionSatan”. He remained somnolent for several hours, with stable vital signs. Hethen suddenly jumped out of bed and began tap dancing up and down the unithallway. When his efforts brought him to the nurses’ station, he danced inplace and continuously sang, told jokes and commented on anything a staffmember did. After several hours in this excitement, he returned to bed andinto his stuporous state. This cycle continued for several days. When stuporoushe also became cataleptic.Lithium carbonate was prescribed. The periods of agitated despondency,euphoric excitement, and stupor resolved over the next week and the patientwas discharged fully recovered. The patient had never used illicit drugs andrarely ingested alcohol. Other than type II diabetes controlled with diet, hisgeneral medical health was good. Hypertensive on admission, his blood pressurenormalized without medication in parallel with his resolving mania andcatatonia.Other variations of catatonia have been proposed. Karl Leonhard (1979) formulateda unique classification system based on his understanding of the importanceof motor features in delineating psychotic disorders. These states, however, arebest seen as catatonic variants and not different illnesses. Cataphasia was characterizedby alternating phases of excitement and inhibition, the former similar todelirious mania and the latter like the Kahlbaum syndrome. Parakinetic catatoniareferred to excitement with extreme fluctuating mood states and continuousmovements throughout the body, such as shaking, shoulder shrugging, facial ticsand twitching, odd hand and finger movements, and jerky arm and leg movements.It is a form of delirious mania. In children and teenagers, these motorfeatures of catatonia can be difficult to distinguish from tic disorder. 30 Dysmetriaand other cerebellar signs are also described. Kraepelin called this conditionmanneristic dementia.Mutism and other catatonic speech disturbancesVerbal unresponsiveness, or mutism, is not always associated with immobility.The neurologic term is aphemia. Many mute patients are ambulatory, buttypically slowed in their movements (bradykinesia). Mutism is often incomplete,the patient occasionally uttering a few whispered words, or only speaking toselected persons. This may be misunderstood as feigned, but is a form ofnegativism (Gegenhalten of speech). When mutism is complete and the patientrigid and immobile, akinetic mutism is diagnosed. 31 The patient may follow theexaminer about the room with his eyes, but unlike the locked-in syndrome doesnot communicate by responding to questions with eye blinks. The face is masklike,and blinking will not be elicited by glabellar tap. 32