The phenomena of schizophrenia

Negative symptoms

Another line of development followed the ideas of Kahlbaum (1874/1973), who had been the first to describe both hebephrenia and catatonia, and of Kraepelin, who included catatonia as a form of dementia praecox. Bleuler gave a detailed description of catatonic signs but regarded them as ‘accessory’ phenomena and tended to interpret them in psychoanalytical terms.

Fisher (1983) noted that, ‘prior to 1900, when neurological and psychiatric syndromes were being delineated, the symptoms of psychomotor retardation, slowness, apathy and lack of spontaneity were universally regarded as manifestations of abulia’.

Much of the literature was concerned with the most severe state, akinetic mutism. Kleist (1960) and Leonhard (1957; Fish 1958) delineated narrow clinical syndromes intended to serve as indicators of equally specific brain abnormalities, but were unable to convince sceptics who pointed to the lack of evidence of specific pathology.

More recently, there has been a recrudescence of interest in motor disorders associated with psychological abnormalities.

Rogers (1992) has reviewed the history of the concept of catatonia and its long-standing separation from extrapyramidal neurological disorders (dyskinesias and parkinsonism).  He pointed to the occurrence of both kinds of symptom in schizophrenia, affective disorders, obsessive–compulsive disorder and mental handicap.

The motor phenomena observed in schizophrenia before the advent of psychotropic medication included reduced and increased speech and behaviours, abnormalities of non-verbal means of communication, symptoms such as negativism, ambitendence,  forced grasping,  echopraxia and echolalia,  opposition,  automatic   obedience,  mannerisms,  posturing   and stereotypies.  This list is taken from the tenth edition of the Present State Examination (PSE) (WHO 1999). Some of these phenomena, such as automatic obedience, forced grasping and negativism, can be interpreted as disturbances of volition.

Extrapyramidal and catatonic signs were highly correlated in a sample of patients with schizophrenia examined by McKenna et al. (1991). More specifically, there were ‘independent associations between tardive dyskinesia and “positive” catatonic phenomena (i.e.  those distinguished by the presence of an abnormality), and between parkinsonism and “negative” catatonic phenomena (i.e. those featuring the absence or diminution of a normal function)’.

J.K. Wing and N. Agrawal

Edited by
Steven R. Hirsch
MD FRCP FRCPsych
Professor of Psychiatry Emeritus, Division of Neuroscience and Psychological Medicine Imperial College Faculty of Medicine and Director of Teaching Governance, West London Mental Health NHS Trust London, UK


Daniel R. Weinberger MD
Chief, Clinical Brain Disorders Branch Intramural Research Program National Institute of Mental Health Bethesda MD 20982, USA

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