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PubMed1999

A case of agitated catatonia.

Agitation is one of the diagnostic features of catatonia in the DSM IV classification, but permanent forms of agitated catatonia have occasionally been described. We report the case of a 43-year-old man who had already suffered from undifferentiated schizophrenia for 7 years, and in whom we diagnosed agitated catatonia. While our patient was being treated with a neuroleptic during a second episode of paranoia, a state of agitation was observed which persisted for a further 8 months. During this period, he was treated with several different neuroleptics and benzodiazepines, either alone or in association, without any improvement. No organic cause was found. He was then transferred to our electroconvulsive therapy (ECT) unit, with a diagnosis of schizophrenic agitation resistant to drug therapy. ECT was begun, and he was only given droperidol in case of agitation and alimemazine for insomnia, neither of which had any effect. In view of his persistent agitation without any purpose, echolalia and echopraxia, stereotyped movements with mannerisms and marked mimicking and grimacing, we diagnosed him as having agitated catatonia. After the fourth session of ECT, we decided to stop all treatment and gave him lorazepam at a dose of 12.5 mg daily. Twenty-four hours later, all symptoms of agitation had disappeared. In our opinion, permanent catatonic agitation is not rare. In our case, the neuroleptic treatment maintained and may even have worsened the symptomatology. Lorazepam can be used as a therapeutic test for this type of agitation, especially if it does not respond to neuroleptics. This also allows the patient to be sedated rapidly and effectively, thus preventing him from injuring himself further.

Adult↗
PubMed1999

A perplexing document in the early history of Gilles de la Tourette Syndrome: Melotti's rendition of a "Lecture of Charcot" (including a complete translation from the Italian with commentary).

In 1885, Dr. Guilio Melotti published an Italian translation of a lecture on "Convulsive Tics with Coprolalia and Echolalia" given by Jean-Martin Charcot. Although this lecture often has been cited as an authoritative statement of Charcot's view, until now it has not been translated into English. The lecture presents a number of statements that appear nowhere else in Charcot's published corpus, including some that seem to contradict Charcot's other pronouncements on maladie des tics. Although the Melotti-Charcot lecture may portray Charcot's position accurately in many passages, the article most likely is a compilation from a variety of sources.

France↗
PubMed1988

Acute transcortical mixed aphasia. A carotid occlusion syndrome with pial and watershed infarcts.

Four of 1,200 consecutive patients with their first stroke showed acute transcortical mixed aphasia (TMA) characterized by nonfluent speech with impaired naming, semantic paraphasias, echolalia, impaired comprehension, good repetition, reading, and writing on dictation. All 4 had left internal carotid artery (ICA) occlusion with ipsilateral anterior pial territory infarction (precentral-central sulcus artery territory) and watershed infarction between the middle and posterior cerebral artery territories, which spared and 'isolated' the perisylvian speech areas. Although rare, acute TMA is highly suggestive of infarction due to ICA occlusion, in that it is probably related to simultaneous embolism (anterior pial infarction) and haemodynamic insufficiency (posterior watershed infarction).

Acute Disease↗
PubMed2000

A prospective cohort study of childhood behavioral deviance and language abnormalities as predictors of adult schizophrenia.

Language and behavioral deviance in early childhood in preschizophrenia individuals suggests that the pathologic processes predisposing to schizophrenia are present from early in life. However, the etiologic antecedents of such impairments, and the degree to which they predict adult schizophrenia, have not been conclusively demonstrated. To address this, we examined language and behavioral predictors of adult psychiatric outcome in a population cohort (72 individuals with schizophrenia or schizoaffective disorder, 63 of their unaffected siblings, and 7,941 with no diagnosis) evaluated prospectively with behavioral examinations and a speech and language evaluation at 8 months, 4 years, and 7 years of age. Psychiatric outcome was ascertained via adult treatment contacts, and diagnoses were made by chart review according to DSM-IV criteria. Social maladjustment at age 7 was found to predict adult schizophrenia, and focal deviant behaviors (e.g., echolalia, meaningless laughter) at ages 4 and 7 were significantly associated with both schizophrenia and sibling status. Unintelligible speech at age 7 was a highly significant predictor of adult schizophrenia (odds ratio = 12.7), and poor expressive language ability predicted both schizophrenia and unaffected sibling outcome. Early behavioral and language dysfunction did not differentially characterize preschizophrenia subjects with a history of fetal hypoxia or an early age of first treatment contact. Given that unaffected siblings show similar signs of deviance, such problems may indicate genotypic susceptibility to the disorder, or shared environmental influences, or both.

Adult↗
PubMed1995

Case study: corticosteroid treatment of language regression in pervasive developmental disorder.

The authors describe a child whose language and behavior regressed at 22 months and in whom pervasive developmental disorder was later diagnosed. At 6 years, he displayed a profound receptive-expressive aphasia accompanied by behavioral disturbances characterized by hyperactivity, impaired social interactions, tantrums, gestural stereotypies, and echolalia. A single-photon emission computed tomography scan and steady-state auditory evoked potentials suggested bitemporal and left frontal pathophysiology. The overall profile resembled Landau-Kleffner syndrome, but no electroencephalographic disturbance was evident. Corticosteroid treatment resulted in amelioration of language abilities and behavior. These findings suggest that the factors underlying language regression in pervasive developmental disorder can, in special circumstances, be amenable to pharmacological treatment.

Adrenal Cortex Hormones↗
PubMed1999

Naltrexone and communication skills in young children with autism.

OBJECTIVE: To evaluate the effect of naltrexone on communication skills of young children with autism. METHOD: Twenty-four children with autism, 3.0 to 8.3 years old (mean 5.1) who were living at home and attending appropriate school programs, participated in a randomized, double-blind, placebo-controlled, crossover trial. Naltrexone, 1.0 mg/kg, or placebo was administered daily for 2 weeks. Communication was evaluated from videotaped samples of seminaturalistic parent-child interaction. Child and parent language were assessed using similar measures. RESULTS: In this heterogeneous sample, the median number of words the child produced on placebo was 9.5 (range 0-124). The median proportion of utterances with echolalia was 0.16. No differences were found between the naltrexone and placebo conditions in any of the measures of children or parents' communication. Significant correlations were found between the child's number of words and developmental quotient (Spearman rho = 0.58, p = .003) and between the child's and parent's number of words (rho = 0.55, p = .005). CONCLUSIONS: Previous studies showed that naltrexone was associated with modest reduction in hyperactivity and restlessness in this group of children with autism. In this short-term study, the medication did not lead to improvement in communication, a core deficit of autism.

Autistic Disorder↗
PubMed1982

Movement disorders in children: Tourette syndrome.

Movement disorders in childhood are rare, but their occurrence is dramatic and frightening. Differential diagnosis depends primarily on a detailed evaluation of the history and an analysis of the characteristics of the movements. Tics are the most common movement disorder in childhood, ranging in severity for simple transient tics to the complex Tourette syndrome, which may be associated with many bizarre behaviors. Minimal defining characteristics of Tourette syndrome are the presence of multiple motor and vocal tics. Associated features may include echolalia, coprolalia, complex stereotyped movements, and compulsive behavior. There is a prominent familial occurrence of Tourette syndrome. Stimulant drugs may cause exacerbation of symptoms. The only consistency useful medication is haloperidol, but its use is associated with side effects in approximately 50% of the patients treated.

Athetosis↗
PubMed1997

Differences in clinical characteristics between Tourette syndrome patients with and without 'generalized tics' or coprolalia.

The purpose of this study is to examine whether there are differences in clinical characteristics between Tourette syndrome (TS) patients with and without 'generalized tics' (GT) which involve the entire body, and/or coprolalia. Subjects were 64 patients (55 males and 9 females, mean age, 17.4 +/- 7.2 years) who visited Tokyo University's outpatient clinic of neuropsychiatry from 1974 to 1993 and who met criteria for Tourette's disorder of DSM-III-R. Data on clinical characteristics, including tic symptoms and courses of their development, complications and developmental histories, treatment and severity, were collected by systematic chart review of all subjects. Tourette syndrome patients with 'generalized tics' tended to show multiple complex vocal tics more frequently than TS patients without GT. Tourette syndrome patients with coprolalia tended to show significantly higher rates of copropraxia, echolalia, and 'cleaning/washing' compulsion than did the TS patients without coprolalia. Tourette syndrome patients with both GT and coprolalia were classified as the severest group in terms of tic symptoms and social impairment. Tourette syndrome patients who had neither of these morbidities were classified into the mildest group in all aspects. Generalized tics and coprolalia seemed to indicate the severest end of the TS spectrum and seemed to be related with a need of intensive treatment.

Adolescent↗
PubMed1989

Asperger's syndrome and autism: comparison of early history and outcome.

The authors compared children with Asperger syndrome (AS) with high-functioning autistic children and psychiatric outpatient controls on measures of early history and outcome. In terms of their early history, the autistic probands showed more social impairment, a higher frequency of echolalia and pronoun reversal, and a more restricted range of activities than the AS group. Cluster analysis suggested refinements to the diagnostic criteria, which resulted in larger differences between the groups on these early history measures. In terms of their outcome, the autistic probands spent more time in special education classes but developed fewer accessory psychiatric symptoms than the AS children. It was clear, however, that there were no substantive, qualitative differences between the AS and autistic groups, indicating that AS should be considered a mild form of high-functioning autism. The inclusion of AS among the autistic spectrum of disorders has implications both for aetiological studies and for prevalence estimates of the pervasive developmental disorders.

Autistic Disorder↗
PubMed1979

Gilles de la Tourette syndrome. Interactions with other neuropsychiatric disorders.

Gilles de la Tourette syndrome is a neuropsychiatric disease with a childhood onset below age 16, characterized by chronic involuntary movements, obsessions, compulsions, utterances, echolalia, coprolalia and aggressive behavior symptoms. Two unique case histories are described in this report, one with an intercurrent history of primary anorexia nervosa and the other with rheumatic encephalitis. They were successfully treated; the former with chlorimipramine, and the latter with combination of L-tryptophan, nicotinic acid, and pyridoxine HCl. These two cases illustrate the possibility that one neuropsychiatric syndrome may induce another during its evolution when the same anatomo-biochemical loci of the brain are involved.

Adolescent↗
PubMed1982

Differential diagnosis of presenile dementia on clinical grounds.

Fifty-seven patients were studied for differential diagnosis between dementias. Three rating-scales were used for identification of Alzheimer's disease (AD), Pick's disease (PD) and multi-infarct dementia (MID). Their validity was tested against verified diagnoses in 28 patients. The rating-scale of ischemic score consisting of 13 items such as abrupt onset, stepwise progression, fluctuating course, history of strokes and neurological symptoms and signs, identifies patients with MID. This can also be achieved by the two rating-scales for diagnosis of AD (12 items) and PD (9 items), which, however, can also be used for the differentiation between these two dementias. The rating-scale for diagnosis of AD contains clinical features such as early spatial disorientation, apraxia, aphasia, agnosia, logoclonia and increased muscular tension. The rating-scale for PD contains i.a. early loss of insight, early signs of disinhibition, echolalia, mutism and amimia. The results show that the differentiation between the major types of presenile dementia can be achieved by a systematic rating of the clinical features.

Adult↗
PubMed2006

Frontal lobe syndrome or adolescent-onset schizophrenia? A case report.

OBJECTIVE: To highlight the difficulties that abound in making a clinical distinction between early-onset schizophrenia (EOS) and juvenile frontal dementia early in the course of illness. METHOD: Clinical information and data from investigations in single case was collated and reviewed. RESULTS: A 15-year-old girl was admitted to our psychiatric unit because of cognitive decline and formal thought disorder with echopraxia, echolalia and palilalia, and a lack of flexibility in the use of cognitive and motor strategies that culminated in psychosis. A single photon emission computerized tomography scan showed marked frontal lobe hypoperfusion; however, on proton spectroscopy there was no differential in N-acetyl aspartate levels. CONCLUSION: Hypofrontality in EOS is well established and the association of frontal functional alterations, neuropsychological impairment and psychotic symptomatology is suggestive of frontal lobe prodrome that precedes the onset of psychosis.

Adolescent↗
PubMed1984

A clinical study of Gilles de la Tourette syndrome in the United Kingdom.

The clinical features of 53 British-born patients with Gilles de la Tourette syndrome are described. The mean age at onset of body tics was seven years and for vocalisations 11 years. Coprolalia was present in 39%, copropraxia in 21%, echolalia in 46% and echopraxia in 21%. Complicated antics and mannerisms were also common, often involving the compulsive touching of objects or self-injurious behaviour. Forty-six per cent of cases had a family history of tics in a single close relative and in two individuals a further member of the family had Gilles de la Tourette syndrome. Focal dystonia was present in four patients who had never received neuroleptics drugs and chorea was seen in two other untreated patients. In three patients acoustic startle consistently induced brief eye blink followed by a whole body jerk or jump. Rapid repetitive movements of the hands increased the frequency and severity of tics in 13 patients, but the performance of mental arithmetic under time pressure had a much more unpredictable effect. Electroencephalographic abnormalities occurred in eight (13%) but no definite CT brain scan abnormalities were detected. The incidence of left handedness did not differ from that in the general population and no evidence to suggest organic impairment was found on neuropsychological testing. This study provides no support for the notion that Gilles de la Tourette syndrome is a degenerative disorder of the central nervous system but provides some evidence for heterogeneity.

Adolescent↗
PubMed1996

A Brazilian cohort of patients with Tourette's syndrome.

The clinical features of 32 patients (24 males) with Tourette's syndrome in Brazil were studied. The mean age at onset was 7.1 years, tics being the first symptom in 71% and hyperactivity in 29%. Blinking, grimacing, and shoulder elevation were the most common motor tics and sniffing, throat clearing, and grunting noises, the most frequent vocal tics. Coprolalia was present in 28%, echolalia in 16%, palilalia in 9%, and copropraxia in 25% of patients. Attention deficit and hyperactivity disorder was diagnosed in 63%, and obsessive compulsive behaviour in 44% of patients. In 84% of patients there was a family history of tics whereas attention deficit and hyperactivity disorder and obsessive compulsive behaviour were respectively present in relatives of 19% and 53% of the patients studied. These data suggest that Tourette's syndrome in Brazil is not clinically different from other countries, supporting the notion that genetic factors play the most important part in its aetiology.

Adolescent↗
PubMed1985

Long-term study of schizophasic patients.

The hypothesis that some symptoms of schizophrenia only manifest in the early stages whereas others only appear later is tested with 33 inpatients in 'terminal states'. It is found that while the onset shows no specificity, the outcome is very typical. The initial symptoms are polymorphous; thought disorders can be found in less than one third of the patients and frank incoherence approaching the severity of schizophasia not at all. Many years later appear symptoms registered as paralogism, echolalia, verbigeration, stilted speech, neologism, hypotonic thinking, retardation, derailment, and incongruous answers. Only then, sometimes 25 years after the onset of the illness, the peculiar and highly specific picture of the schizophasic disorder becomes established.

Arousal↗
PubMed1990

Studies of the course of schizophasia.

The course of psychoses of schizophrenic type follows rules which are still not adequately understood. It is, however, clear that certain symptoms appear mostly early, others only late. With this hypothesis in mind, we studied 44 final phase patients whose main symptom was disordered thinking of the schizophasic type and whose illness was of at least 10 years' standing. The most important finding of this study is that the varied and unspecific initial phase progresses into a highly specific syndrome. The symptoms initially registered include various disorders of thinking in less than one third of patients. In no case did these involve schizophasia. In a second phase symptoms were observed such as paralogism, echolalia, verbigeration, circumstantiality, neologism, hypotonic thinking, perseveration, blocking. The symptoms of schizophasia are only recognizable in a third phase and are highly specific. This enables us to confute the claim that psychiatric syndromes are not clinically specific. The three phases described above also provide evidence for the biological nature of this endogenous psychosis.

Follow-Up Studies↗
PubMed1979

Tourette's syndrome symptom onset at age thirty-five.

It is apparent to the authors that the primary factors influencing this particular case of Tourette's Syndrome are psychological. The condition appeared to result from threatening environmental conditions causing repression. The repressed material manifested itself in multiple tics, echolalia and coprolalia. Because of this patients's extreme resistance to accept the true conditions of his situation, individual and group psychotherapy have been difficult modes of treatment.

Adult↗
PubMed1996

Association of a Tourette-like syndrome with ofloxacin.

OBJECTIVE: To describe the association between the use of the fluoroquinolone ofloxacin in an elderly man and an unusual acute encephalopathy with characteristics suggestive of Tourette's syndrome. CASE SUMMARY: An unusual syndrome was observed in a 71-year-old man temporally related to the initiation of ofloxacin therapy that resolved completely after discontinuation of the drug. The most remarkable phenomena were spitting and profuse swearing; other features were echolalia, echopraxia, orofacial and limb automatisms, hypersalivation, and amnesia for the episode on recovery. The clinical syndrome had several features in common with Tourette's syndrome and possibly with frontal lobe onset complex partial seizures. The electroencephalographic, neuroradiologic, and cerebrospinal fluid examinations were normal. DISCUSSION: The reported neurotoxic effects of the fluoroquinolones include insomnia, seizures, delirium, and psychosis, best explained by the gamma-aminobutyric acid-antagonistic properties of this class of drugs. This is the first reported case of a Tourette-like syndrome associated with the use of any quinolone, suggesting a possible interaction with central dopaminergic neurotransmitter systems. CONCLUSIONS: Use of drugs such as ofloxacin that have improved central nervous system penetration, disease- or age-related reductions in renal function, concomitant use of drugs such as theophylline and nonsteroidal antiinflammatory drugs, and possibly increased pharmacodynamic sensitivity place the elderly at special risk for quinolone neurotoxicity. Dosing modifications and an awareness of possible central nervous system adverse effects are warranted.

Aged↗