Descriptive Psychopathology: The Signs and Symptoms of ...

162 Section 3: Examination domainsIn speech-prompt catatonia, the patient briefly speaks only when spoken to.The speech is typically hesitant and slow, and may be limited to “I don’t know”, orwith a “yes” or “no” often as contradictory statements. For example, the question“Do you like ice cream?” is answered “I don’t know”. The question “You do likeice cream, don’t you?” is answered “yes”. The question “You don’t like ice cream,do you?” is answered “no”. This is an example of verbal automatic obedience.Other catatonic patients will respond with non-sequitive answers or seeminglysilly answers (Vorbeireden). The question “How many legs does a three-leggedstool have?” is answered “Four”. The question “What was the color of GeorgeWashington’s white horse?” is answered “Brown”. These responses are forms ofverbal negativism. When occurring in an oneiroid state, the condition is termedGanser’s syndrome. Ganser’s original patients had many other catatonic features. 33These patients often act “silly” or in opposition, and are misunderstood as malingerersor histrionic manipulators. It was originally associated with prisoners orpersons whose illness appeared to provide for some legal or monetary gain.Prosectic speech is whispered, mumbled speech that slowly declines in audibilityand speed until it stops, like a car running out of gas. Stereotypic speech,Verbigeration, is filled with repetitive phrases and sentences. Repeating the lastphrase or word of a sentence with increasing frequency is termed palilalia.Speech mannerisms are also observed. The patient may speak robotically (like acomputer voice), or with an accent inconsistent with the patient’s background. 34Echolalia, a stimulus-bound phenomenon in which the patient constantly repeatssome or all of the examiner’s utterances, 35 and echopraxia, in which the patientspontaneously copies the examiner’s movements or is unable to refrain fromcopying the examiner’s test movements (e.g. raising an arm above the head)despite instruction to the contrary, are seen in manic patients or those withfrontal lobe disease and disinhibition.StuporStupor is extreme unresponsiveness and hypoactivity associated with alteredarousal during which the patient fails to respond to questions. When severe, itis associated with immobility and the patient does not withdraw from painfulstimuli (generalized analgesia). Stupor may last for hours, days, or longer. Thepatient in stupor seems unaware of the happenings around him. 36Negativism and GegenhaltenThe negativistic patient resists stimulation. Resistance to limb manipulation iswith equal and opposite force (Gegenhalten). Attempts to move the patient’shead or open his eyes are met with equal resistance. The eyes look away with onlythe whites showing. Directly facing the patient leads to greater resistance, another