Tics and Hyperkinesias in Psychiatry

What symptoms are included in the structure of catatonic syndrome?

The structure of catatonic syndrome includes various motor and behavioral disorders forming contradictory combinations. The main symptoms are:

• Stupor — complete or partial immobility with a bizarre posture.
• Catalepsy (flexibilitas cerea) — waxy flexibility, the ability to maintain a given posture for a long time.
• Negativism — active or passive resistance to commands.
• Mutism (mutus) — complete silence.
• Passive obedience — automatic execution of instructions.
• Echo-symptoms — echolalia, echopraxia, echomimia.
• Catatonic agitation — chaotic, purposeless agitation.

Mannerisms, bizarre facial expressions and gait, impulsive actions, disinhibition of unconditional reflexes (snout reflex), and Pavlov's sign are also distinguished.

How does hebephrenic syndrome manifest in schizophrenia?

Hebephrenic syndrome in schizophrenia manifests as specific changes in behavior and the emotional sphere resembling childishness. The main clinical manifestations include:

• Infantilism — pronounced childishness in behavior.
• Silliness — absurd, situationally inappropriate merriment.
• Grimacing — bizarre, unnatural facial expressions.
• Negativism — unmotivated resistance or refusal to perform actions.

This syndrome is viewed as a variant of catatonic symptomatology and is considered a characteristic manifestation of malignant schizophrenia.

What clinical forms of catatonic agitation are distinguished in psychiatry?

In psychiatry, two main clinical forms of catatonic agitation are distinguished, differing in the presence of speech activity.

• Mute agitation — chaotic motor agitation accompanied by complete silence of the patient.
• Agitation with verbigeration — motor activity accompanied by stereotyped shouting of individual phrases or words.

Both forms are characterized by chaos, senselessness, lack of purpose, and spatial restriction (e.g., the patient stereotypically jumps up and down in bed).

What categories of tics are distinguished in the clinical classification?

In the clinical classification based on manifestations, tics are divided into two main categories, each of which can be simple or complex.

• Motor tics — involuntary muscle contractions. Simple ones manifest as blinking, squinting, head twitching, or shoulder shrugging. Complex motor tics are realized in the form of various gestures.
• Vocal tics — involuntary production of sounds. Simple vocal tics include throat clearing, sniffling, snorting, whistling, and grunting.

What diagnostic signs are pathognomonic for Tourette's syndrome?

Tourette's syndrome is characterized by motor and speech disturbances with onset in childhood: the source indicates onset at 5–6 years of age, predominantly in boys. Clinical manifestations include:

• Motor tics — sudden violent twitches affecting the face, neck, and shoulders.
• Vocal tics.
• Copropraxia.

Movements in this syndrome have the character of sharp tics, which distinguishes them from smooth hyperkinesias in chorea.

What hyperkinesias manifest tardive dyskinesia in antipsychotic therapy?

Tardive dyskinesia from long-term neuroleptic use manifests as persistent involuntary excessive movements. Characteristic manifestations include:

• Facial hyperkinesias — movements of the facial musculature, lips, and head: chewing, lip-smacking, blinking.
• Involuntary neck movements.
• Choreiform and athetoid movements in the limbs.

Sources indicate that upon discontinuation of the neuroleptic, tardive dyskinesia does not disappear and may worsen.

What medicinal products are used to relieve acute neuroleptic dystonia and akathisia?

Specific groups of medicinal products are used to relieve these extrapyramidal complications arising from the use of neuroleptics.