Research criteria for motor psychosis
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[Edit]1 To make a diagnosis
1 - Evolution criteria has to be fullfilled
2 - Criteria for one or both pole have to be met regarding this episode and ALL the former (if many test >= 3 with one of a different pole)
3 - None of the exclusion criteria can be met
Criteria of rank A are requiered for the diagnosis.
Criteria of rank B are not requiered but if prensent give further confidence in the diagnosis.
Clinical symptoms compatible with the diagnosis are just informative and are not part of the criteria.
[Edit]2 Evolution criteria
(A) Acute onset (less then 2 weeks) or subacute (1-3 months).
(A) Single episode, or other episodes of same or opposite polarity.
(A) Complete recovery with full insight
(B) Accentuated personality even when symptom free, which is characterized either by an increase or by a reduction of expressive movements (i.e. "motoric temperament")
(B) Switch common during the episode (but can last only a few minutes)
[Edit]3 Clinical criteria during the episode
Akinetic psychosis
(A) Marked quantitative reduction of reactive and expressive mouvements (eg. No facial expressions)
(A) Less marked slowing of movements on command (part of voluntary movements) when available.
(A) Loss of goal-directed activities (intentional movement, i.e. initiated by the patient himself)
(A) Verbal output markedly reduced or absent (part of intentional movement).
Hyperkinetic psychosis
(A) Quantitative increase in reactive and expressive movements (without distortion), that replace goal-directed activities
(A) Reduced intentional verbal output or mutism, increase of sound, shouts or words of expressive character (Wernicke’s “silent restlessness”).
(B) Purposeless grabing of object (+ agitation = Wernicke’s hypermetamorphosis)
(B) Loosening of associations whenever the patient speaks, the speech is made incomprehensible by the issuance of purposeless expressive words
Various, compatible with the diagnosis but WITHOUT indication for it
- Anxious or ecstatic mood varying often rapidly - Ideas of reference - Hallucinations - Clouding of consciousness up confusion may occur transiently in all bipolar phenotypes (MDP, cycloid psychoses, unsystematized schizophrenias) - Frequent change of global experience: delusional mood or trema, apophany, apocalyptic (Konrad) - Sleep and food intake are often reduced during the episode - Post-psychotic depression frequently occurs
[Edit]4 Exclusion criteria
Not secondary to
(A) Drug intoxication or withdrawal
(A) An organic disease
(A) Not a reactive psychosis (reaction to a severe stressor)
Clinical (symptom that connot be observed)
(A) If an akinetic phase, facial expression of perplexity, ecstasy or fear (suggest another cycloid psychosis).
(A) Mixed symptomes in the restricted meaning (i.e. presence of two poles in the same time and in the same psychic sphere, in this case no hyperkinetic body part with akinetic ones)
(A) Staring in the middle position
(A) True catatonic symptoms according to WKL, i.e. parakinesia, true negativism (i.e. with ambitendance), waxi flexibility (with posture mantenance) ...
(A) Persistence after the episode of a language disorder or illogic reasoning (experimental psychic test)
(A) Organized paranoia, persecutory delusions with designated persecutor passional delusion as erotomania, jealousy
(A) Other mood disorders (mania or melancholia) arising out of the post-episode.