Descriptive Psychopathology: The Signs and Symptoms of ...

191 Chapter 7: Disturbances of motor function4 Executive function refers to prefrontal cortex oversight of cognition. Recognizing problemsand opportunities, and developing, carrying out, monitoring, self-correcting, judging theresults, and stopping when appropriate are examples of executive function.5 Saint-Cyr et al. (1995).6 Taylor and Fink (2006).7 Bracha et al. (2005).8 Volchan et al. (2003); Leslie et al. (2004).9 Ono et al. (2000).10 Schutter and van Honk (2005).11 Williams et al. (2006a).12 Fink and Taylor (2003).13 Weinstock et al. (2003).14 Parker et al. (1993).15 The extensive studies by Parker and Hadzi-Pavolvic summarized in their monographMelancholia: A Disorder of Movement and Mood (1996) emphasize psychomotor disturbanceas the classic sign of the syndrome.16 Lewis (1934).17 Braude and Barnes (1983).18 Rubino (2002).19 Kaufman (1995).20 Venna and Sabin (1992).21 Smith et al. (1999).22 Koroshetz et al. (1992).23 For a detailed presentation of the catatonia literature, see Fink and Taylor (2003).24 Fink and Taylor ( 2003, chapter 8); Caroff et al. (2004, chapters 16 and 17).25 A rating scale of catatonic features developed at the State University of New York at StonyBrook can be used to systematically assess patients for both clinical and research purposes(Fink et al., 1993).26 Fink (1996a,b); Carroll et al. (2001); Fink and Taylor (2003).27 Diesing and Wijdicks (2006). Patient 7.2 illustrates that NMS and malignant catatonia aresimilar and that NMS need not be associated with exposure to antipsychotics. The appropriatetreatment is an initial trial with lorazepam (often in daily doses of 8–20mg) followed bybilateral ECT if needed. This approach typically producing relief from the life-threateningfeatures within a few days and full remission with 12–15 treatments (Fink and Taylor, 2003).28 See discussion in Chapter 6.29 Gjessing (1938, 1974).30 Catatonia in a young patient is associated with the same conditions that are seen in adultpatients, with the exception that epilepsy and developmental disorders are more frequent.When the catatonia is the result of a mood disorder, there will likely be a family history ofdepressive illness (Fink and Taylor, 2003).31 In addition to catatonia, akinetic mutism is seen in bilateral lesions involving the anteriorcingulate gyri and supplemental motor areas. Lorazepam challenge may relieve the syndromewhen it is an aspect of catatonia (Fink and Taylor, 2003).