Descriptive Psychopathology: The Signs and Symptoms of ...

177 Chapter 7: Disturbances of motor functionRepetitive ritualistic behaviors like compulsions can be inhibited only briefly.Sufferers are compelled to perform these behaviors, often in a formulaic manner.Repetitive self-mutilating behavior includes cutting, burning, hitting, headbanging, and eye gouging. Speech compulsions include automatically repeatingwords or phrases. Stock words is another speech compulsion. Echolalia andechopraxia occur. Echolalia is also associated with receptive transcortical aphasia,autism, abnormal startle reactions (seen post-encephalitic states), Gilles de laTourette’s syndrome, and catatonia. 97Utilization behavior in which the patient compulsively manipulates, takes, oruses objects not his own is reminiscent of the unwanted release of proceduralmemories. It is associated with echopraxia. The patient sees a pen, takes it andwrites with it. The patient sees a bed and lies on it. The patient sees an object in astore and takes it (kleptomania). The patient sees an attractive person and inappropriatelytouches the person. This exaggerated dependency on environmental cuesis associated with a deficit in self-monitoring.A rare variant of compulsion is abulomania. It was originally described as aparalysis of will without accompanying obsessions in which the sufferer was unableto perform certain actions despite the strong desire to do so and adequate motorand sensory capacity. There was no associated psychosis or acute mood disorder,and no other features suggestive of catatonia or a focal neurologic disruption.Examples are: a notary who could no longer write his signature, despite great effortto do so, raising his hand, making writing movements but unable to put pen topaper; a woman who could carry out all needed minor activities but was immobilizedwhen faced with making a decision that she thought important; and a manwho could not make decisions about dressing or undressing and so remained in thesame clothes for days unless assisted. 98Cerebellar motor signsThe classic motor features of cerebellar disease are ataxia, poor coordination ofmovements, unstable gait, impaired speech articulation, and difficulties with eyemovements and swallowing.Speech and language problems associated with cerebellar disease, discussed inChapter 9, include scanning dysarthria with slowing of utterances, irregular rhythmand volume, slurring, intention tremor in the voice, and ataxic respirations.Many pharmaceuticals affect cerebellar function. Cerebellar dysfunction is alsoassociated with schizophrenia, autism, dyslexia, alcoholism, and multiple sclerosis.99 Kraepelin recognized a “cerebellar form” of dementia praecox. 100