Descriptive Psychopathology: The Signs and Symptoms of ...

172 Section 3: Examination domainsNarcolepsy is a non-REM sleep disorder characterized by periods of semiwakefulnessat night with associated hypnogogic and hypnopompic hallucinations(see Chapter 10) and sleep paralysis. Daytime episodes of cataplexy(a sudden loss of tone and collapse that can elicit injury) and overwhelmingsleepiness also occur.REM-related parasomnias occur in the second half of the night and rarely afterdaytime naps. They include episodes of violent and dramatic motor activitysuch as talking, yelling, swearing, kicking, punching, and jumping out of bedand running. Bed partners can be hurt. Acute onset conditions are associatedwith the use of antidepressant medications and cholinergic agents, barbiturates,alcohol, or excessive caffeine. Chronic conditions are idiopathic or associatedwith Parkinson’s disease, Lewy body dementia, and olivo-ponto-cerebellar andmultiple system atrophy.Movements associated with other parasomniasSleep bruxism is the forcible grinding, clenching, or tapping of the teeth byrhythmic contractions of the jaw muscles during sleep, sometimes producingaudible sounds. It can lead to complaints of jaw and facial pain mistaken forsomatization disorder, and the grinding may lead to dental damage. It is commonand its cause unknown. Benign neonatal sleep myoclonus occurs during the firstfew months after birth and is characterized by intervals of repetitive jerks of thedistal limbs lasting up to 20s. No associated pathology has been demonstrated.Dystonias can occur during periods of non-REM sleep, particularly during thefirst third of the night. 76Cataplexy and sleep paralysisCataplexy and sleep paralysis (transient weakness or inability to move) arefeatures of narcolepsy. Cataplexy occurs during wakefulness and can be triggeredby sudden emotion and excitement, the patient suddenly collapsing without lossof consciousness. Sleep paralysis occurs on sleep onset as the patient immediatelyenters a REM period. It may be associated with hypnogogic and hypnopompichallucinations. Excessive daytime sleepiness is a typical feature of narcolepsy. 77Basal ganglia motor signs“Extrapyramidal” motor signs are described in never medicated patients withpsychosis. In a recent study of never medicated schizophrenics, 35% exhibiteddyskinesia, and 15% Parkinsonism. These features are considered part of thedisease process and are associated with cognitive impairments. 78