Descriptive Psychopathology: The Signs and Symptoms of ...

167 Chapter 7: Disturbances of motor functionperformed without the patient self-guiding his movements by first speaking eachstep. The patient is asked to silently demonstrate how to use an imagined key,comb, and hammer. “Hand as object” is an example of ideo-motor dyspraxia, thepatient mimicking the object rather than how to hold and use it (e.g. extendingthe index finger as the key, making a fist to represent the hammer head).The inability to open one’s eyelids on command while retaining the ability tospontaneously do so is termed eyelid apraxia, and is associated with Parkinson’sdisease, 52 frontal lobe lesions, right hemisphere disease, and catatonia. 53Kinesthetic dyspraxiaKinesthetic dyspraxia is the inability to repeat the examiner’s simple movements.The patient is asked to mimic hand postures (left and right) such as making a fist,pointing with the index finger, and the “OK” and “stop” signs. The examiner nextplaces one of the patient’s hands in a posture out of the patient’s view, and asksthe patient to make the same posture with the other hand. To accomplish this, thepatient’s corpus callosum must be functional.Dressing dyspraxiaDressing dyspraxia is the inability to dress oneself. It may be observed in thepatient’s failure to properly dress, or tested by asking the patient to put on ahospital gown.Construction dyspraxiaConstruction dyspraxia is the inability to copy simple geometric shapes(e.g. intersecting pentagons, diamond, square, and mushroom), or to draw theface of a clock from memory, the hands at 2:45. 54Abnormal eye movementsAbnormal eye movements are seen in patients with behavioral syndromes.Schizophrenic patients with classic emotional blunting, formal thought disorderand childhood neurodevelopmental and behavioral abnormalities have difficultieswith smooth eye pursuit. Jerky movements lagging behind the target arecharacteristic, and are demonstrated by asking the patient not to move his headwhile following the examiner’s finger. 55 Such movements are also seen inHuntington’s and other basal ganglia disease, and in patients with frontal lobedisease. 56 Asking the patient to move his head from side to side while focusing ona stationary target may also reveal subtle ophthalmoplegia. 57Abnormal saccades are also reported in patients with manic-depression, schizotypaldisorder, 58 and in the first-degree relatives of these patients and those