DISORDERS OF GENERAL BEHAVIOUR

Closely related to affective, cognitive and perceptual mental function.

Over-activity

Agitation is a state of restless motor activity that is a manifestation of emotional tension.

Hyperkinesis in children may be related to organic or emotional disturbance.

General increase in activity may be related to euphoric mood states.

Focussed on compulsions and rituals in obsessive compulsive states.

Under-activity

Depressive retardation may lead to slowing of response and

ultimate stupor.

Psychaethenic states due to anxiety may limit activities because of feelings of fatigue and exhaustion.

Catatonic stupor in schizophrenic patients may lead to prolonged periods of inactivity.

Self-neglect

May be related to:

- retardation and ideas of futility in depressive psychosis.

- preoccupation with fantasies and delusions in schizophrenia.

- excitement and lack of judgement in hypomania.

- intellectual impairment in dementia.

Abnormal movements
Stereotypies: the frequent repetition of any speech or action. Common in chronic schizophrenia.

Mannerisms: idiosyncratic elaboration of normal movements,

common in chronic schizophrenia.

Compulsions

Occur as part of an obsessional state. Repetitive, stereotyped motor acts, usually secondary to obsessional ideas: e.g. hand washing follows idea of contamination. Only transient reduction of anxiety achieved.

Echolalia

Pathological repetition by imitation of speech of another person.

Called echopraxia when this involves imilation of movement

Flexibilitas cerea

Maintenance of imposed posture as in hypnosis or catatonic schizophrenia.

Negativism

Resistance to suggestion, tending to do the opposite, as seen in catatonic schizophrenia.

MOTOR SIGNS

Motor disorder in schizophrenia

- Mannerisms - odd, stilted, voluntary patterns of behaviour

- Stereotypies - seemingly involuntary movements (grimacing, schnauzkrampf)

- Negativism

- automatic obedience

- obstruction (motor equivalent of thought biocking)

- mitgehen

- waxy flexibility

- psychological pillow

- echopraxia

- advertence (bizarre, exaggerated turning head towards examiner when addressed)

- posturing

- Catatonic stupor ( akinesis, mutism apparently preserved consciousness)

- may be interrupted by catatonic excitement

OBSESSIONAL AND COMPULSIVE SYMPTOMS

Obsessions

Recurrent, persistent thoughts, impulses, or images that enter the patients mind despite his effor'ts to exclude them.

The patient recognizes the thoughts as his own. There is a struggle to resist them. They are usually thought to be

senseless and untrue. They generally cause much distress.

- Thoughts

- Ruminations

- Doubts

- Impulses

- images

- "obsessional phobias" (obsessiona thoughts with fearful content)

Compulsions

Repetitive, seemingly purposeful behaviours carried out in a stereotyped fashion. Usually resisted, recognized as senseless. Usually associated with obsessions.

Obsessional slowness

May occur as a primary phenomenon but slowness in patients with OCD is of course more usually due to the time taken to perform and repeat rituals.

PHOBIAS

A fear which is out of proportion to any real threat and which results in avoidance. Anticipatory anxiety describes the fear experienced merely by thinking about the phobic situation. The following simple classification was suggested by Marks (1969):

Phobias with external cues:

Agoraphobia: Heterogeneous symptoms - crowds, spaces, etc.

Social phobia: Being with people "performing" in presence of others etc.

Animal phobias

- other specific phobias Phobias with Internal cues:

- Illness phobias:

- "Obsessional phobias" ("obsessional Fears")

DEPERSONALIZATION AND DEREALIZATION

DepersonalizatIon:

Altered self awareness: the subject feels changed and unreal, sometimes complaining of feeling "detached" or "unable to feel emotion".

Derealizatlon:

The subject feels as thought the world around him, objects and people, have become unreal and in some way lifeless.

PANIC ATTACKS

Characteristic features:

- sudden onset

- impending doom, catastrophy

- associated fears: of choking, of collapsing, of embarrassing event.

- profound anxiety

- somatic symptoms of anxiety.