Descriptive Psychopathology: The Signs and Symptoms of ...

178 Section 3: Examination domainsIntention tremorIntention tremor is coarse and is observed by asking the patient to reach forobjects. There is no tremor when the limb is at rest. It is seen in cerebellar disease,essential tremor, and exposure to many pharmaceuticals (e.g. caffeine and otherstimulants, alcohol, lithium).Past-pointing (dysmetria)Past-pointing is difficulty in accurately directly one’s hand to grasp an object,missing and going past the object. It can be observed, or tested by asking thepatient to touch the examiner’s index finger with his index finger, the examiner’sfinger moving into high, low, left and right positions. The patient touching theexaminer’s finger and then his own nose is a variation of the test. The heel to shintest is another example.DysdiadochokinesiaThe inability to perform rapid, alternating movements such as pronation andsupernation of one palm against the other (10 trials) defines dysdiadochokinesia.Another test is asking the patient to rapidly touch the tip of his thumb with thetip of each of his fingers in sequence, while his arms are extended, palms up.Mistakes in placement, breaks in movement, jerky irregular movement can occur.Other errors in movement regulation can be observed during this testing.AsynergyAsynergy is the inability to smoothly perform simple movement. Jerky, roboticmovements occur. Any of the hand tests of movement can be used to observe forasynergy.Coordination problemsPoor coordination is observed while the patient performs other motor tasks.Movements are awkward and jerky. When severe, ataxia, weaving movements ofthe head, trunk, and gait is seen. The gait becomes wide-based, turning is difficultand can result in falls, and high-stepping, staggering, and side-to-side lurchingoccurs. Ataxia is tested by asking the patient to heel-to-toe walk across theexamination room with eyes open (tandum gait). Dystaxia is elicited while thepatient is standing erect, feet together and eyes open, a slight push to his backcausing swaying or staggering.Procedural memory problemsDeclarative memory is memory for facts and events. Memory for skills is termedprocedural memory and is a form of implicit memory. The demonstration of