Descriptive Psychopathology: The Signs and Symptoms of ...

192 Section 3: Examination domains32 Normal persons will initially increase their blink rate and then habituate to the examiner’stapping the glabellar, the striking finger is not in the patient’s visual field. An abnormalresponse is also seen in Parkinson’s syndrome.33 Ganser and Shorter (1965).34 A young woman who had lived her entire life just outside New York City and who had neverspoken a language other than English when manic had periods of excitement during whichshe spoke with a German accent as if in an old World War II movie. At other times she layon her bed in a stupor, barely mumbled, and could be put into postures. As the stuporousphases of her illness ended, the German accent reappeared.35 Echolalia is also associated with transcortical aphasias, autism, Gilles de la Tourette’ssyndrome, and frontal–temporal dementia.36 In the nineteenth century, stupor associated with mutism and immobility was said to definemelancholia attonita (Taylor and Fink, 2006).A stuporous, mute, and immobile catatonic patient can be temporarily relieved of thecondition with several mg of IV lorazepam. Around the clock lorazepam (8–24mg daily)can maintain the relief without sedation in many patients. Catatonic patients who do notrespond fully to lorazepam will respond fully to bilateral ECT. See Fink and Taylor (2003)for detailed discussions of the treatment of catatonia.37 A similar technique is often helpful in getting the attention of a manic patient. Rather thantrying to outshout the manic patient interrupting his press of speech (an impossible task),the examiner whispers the patient’s name. The whisper stands out from the din and drawsthe patient’s attention.38 Bleuler (1950, p. 215) referred to this as hyperkinetic catatonia or faxen-psychosis.39 Cataplexy is the sudden and usually brief loss of muscle tone and is associated withnarcolepsy (Kobayashi et al., 2002).40 Her catatonia was remitted by a trial of lorazepam, reaching a maximum effect dose of24mg daily.41 Some manic patients will have classic OCD features (Hantouche et al., 2003).42 APA (1994, p. 121).43 Ungvari and Rankin (1990).44 High-stepping gait or “cock walk”, along with other movements, psychosis and cognitiveimpairment is seen in manganese poisoning. Manganese is use in the manufacture ofpaints, disinfectants fertilizers, and varnishes (Clayton and Clayton, 1981).45 Joseph and Saint-Hilaire (1992).46 Adler et al. (1993).47 Carr and Tan (1976); Kon (1994); Pal (1997); Martin (1999).48 Hammond (1883/1973, p. 854).49 Hammond (1883/1973, pp. 507–14).50 Fink and Taylor (2003, vignette 2.5, pp. 24–5).51 Dyspraxia typically reflects parietal lobe disease, but is also seen in disconnection syndromes.A disconnection syndrome is recognized when two associational cortical areas aredisconnected from one another by a structural brain lesion. Lesions of the corpus callosumlead to disconnection syndromes. Some patients with Broca’s aphasia from stroke will have