Preantipsychotic

Motor abnormalities in severe mental disorders have long been observed and commented on, often with excellent descriptions (Berrios 1993; Bleuler 1911/1950; Kahlbaum 1874/1973; Kraepelin 1919; Manschreck 1986; Rogers 1992). These abnormalities fall into various categories, including posture, gait, and voluntary and involuntary motor movements (Table 10-1).

Kahlbaum (1874/1973), for example, described psychotic patients presenting with catatonia as a distinct syndrome categorized as belonging to a severe, deteriorating type of psychotic illness. The latter was referred to as "dementia praecox," by Kraepelin (1919) and renamed "schizophrenia" by Bleuler (1911/1950).

Not only did early reports identify motor abnormalities in schizophrenia, but case records from the early era have enriched understanding of their relationship to schizophrenia. For example, Kraepelin (1919) described features in dementia praecox indistinguishable from contemporary accounts of tardive dyskinesia (TD; Crow et al. 1982, 1983). Turner (1992) examined casebooks from Ticehurst House Asylum from 1845 to 1890. He counted movement abnormalities (e.g., "ugly grimaces, constant fidgeting, extraordinary attitudes, jerking") when they were clearly re-

Table 10-1. Abnormalities of spontaneous motor behavior in schizophrenia

Decreased motor

Increased motor

activity

activity

Postural disturbance

Retardation

Restlessness

Rigidity

Poverty of movement

Excitement

Catalepsy

Stupor

Tremor

Clumsiness

Posturing

Stereotypies/mannerisms

Motor blocking

Perseverative movements

Cooperation

Impulsive movements

Opposition

Mannerisms

Automatic obedience

Negativism

Ambitendency

corded and unambiguously present. Separately he estimated the probable diagnoses of the cohort using standardized criteria and characterized outcome associated with the presence of motor abnormalities. The findings are instructive. Well before the advent of neuroleptic treatment, abnormal movements were recognized as being associated with mental disorder. These movements were particularly concentrated among patients with diagnoses of schizophrenia and, in striking contrast, largely absent among patients with mood and other brain disorders. Far from being incidental findings, these features were associated with a poorer prognosis and limited social recovery.

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