Descriptive Psychopathology: The Signs and Symptoms of ...

222 Section 3: Examination domains38 Although empathy generally refers to responses to another person’s distress, it may alsoinvolve positive emotions. Excessive empathy that elicits maladaptive behavior is associatedwith an inability to regulate emotional responses to the discomfort of others (Lazarus,1991).39 Ghika-Scmid and Bogousslavsky (2000).40 The failure of patients with schizophrenia to activate the right fusiform gyrus when askedto identify facial emotional expressions suggests a deficit in early facial identification(Johnston et al., 2005).41 Kraepelin (1976), pp. 54–60.42 Young et al. (1983).43 Taylor and Abrams (1973, 1975a); Abrams et al. (1979); Winokur et al. (1969); Goodwinand Jamison (1990, chapter 2).44 Yan et al. (1982).45 Taylor and Abrams (1973).46 In addition to mixed states, many manic episodes are preceded by a longer period ofdepression and end with a period of depression. These depressive periods can be severe,suicide risk is high, and treatment for the depression often needed.47 Not seen in chronically ill, poor patients who do not have the minimal resources for overspending.48 In some samples the prevalence of catatonia is as high as 70%. It is a critical misconceptionthat a catatonic patient must be mute and immobile (Fink and Taylor, 2003).49 Kraepelin (1976), pp. 61–2.50 Haslam (1809/1976).51 Carlson and Goodwin (1973).52 Abrams et al. (1974); Taylor et al. (1974).53 Mania A Potu was the term for pathological intoxication, an idiosyncratic excitementresponse to small amounts of alcohol that is no longer considered a valid syndrome. Suchpatients may have experienced a delirium or delirious mania (Bell, 1849).54 Kraepelin (1976), pp. 70–4.55 Fink (1999); Fink and Taylor (2003).56 Perugi and Akiskal (2005).57 Akiskal et al. (1977).58 Stanton et al. (2007).59 Carlson et al. (2000).60 Taylor and Fink (2006).61 Psychomotor change is essential to melancholia in the studies by Parker and Hadzi-Pavlovic(1996), Rush and Weissenberger (1994), and Taylor and Fink (2006).62 The description of benign stupor by August Hoch (1921) is excellent. He described patientswith stupor who were severely depressed, delusional, and often with signs of catatonia.The overlap of catatonia and melancholia is not limited to patients in stupor, and carefulexamination of patients with melancholia often finds multiple signs of catatonia; amongpatients with retarded catatonia, other signs of melancholia are often described (Fink andTaylor, 2003).