Descriptive Psychopathology: The Signs and Symptoms of ...

163 Chapter 7: Disturbances of motor functionform of Gegenhalten. Questioning the patient from the side in a whispered voicereduces negativistic responses. 37Some patients do the exact opposite of the instruction. When asked to stand,they sit. When asked to walk, they stop. When asked to face the examiner, theyturn away. The same question is answered with opposite responses. An action isstopped at an obviously inappropriate moment (e.g. going to the bathroom whenasked but then urinating on the floor or without removing the necessaryclothing). The patient uses the back end of a key to open a lock, tries to writewith the wrong end of a pen, pours water onto the floor instead of into a cup, andwhen going to bed, sleeps at the edge of the mattress or with feet on the pillow. 38Catalepsy and posturingMaintaining positions for prolonged periods of time defines catalepsy. 39 Thisimmobility was termed obstruction, and is a variant of pathological inertia. Inaddition to posturing, the patient may freeze in the middle of a movement, oris unable to start a movement when asked but later performs it. For example, theydo not answer the examiner’s questions until the examiner is about to leave theroom (“The reaction at the last moment”).Catatonic postures can be mundane or strange. A catatonic teenage girl satimmobile for hours in a chair with a writing tablet on her lap, pen in hand andpoint in contact with the paper and head bent as if deep in thought. 40 Otherpatients sit with their heads tilted and arms raised as if resting on an imaginarydesk. Others stand for hours at attention, saluting, or lying in bed, upper bodyraised as if on an imaginary pillow (psychological pillow). Some precariously lieon the edge of the bed, squat for hours on the bed or in a hallway, twist theirupper body into an almost right angle to their lower body, or sit with arms andlegs extended as if falling. Postures may involve only the hands (e.g. the fingersheld like a fan in front of the mouth, the hands held as if they were pistols) or theface (e.g. grimacing, puckering the lips, wrinkling of the nose with an exaggeratedpouting of the lips, Schnauzkrampf).Waxy flexibility (Cera flexibilitas)Cataleptic patients can be moved into different positions, but with difficulty.They offer initial resistance before gradually allowing themselves to be repositionedas if made of softened wax, thus the term waxy flexibility. Waxy flexibilityis not observed, it is demonstrated by manipulating the patient’s limbs.StereotypyStereotypy is the automatic repetition of mundane movements such as tapping,gesturing and grooming. Constant head and face rubbing is a common example.