Psychopharmacology and the Classification of Functional Psychoses 

By Thomas A. Ban and Bertalan Pethö

Four-Dimensional Classification

Affective Psychoses

Schizophrenic Psychoses

Systematic Catatonias

The six subtypes of systematic catatonia represent different stages in the level of deterioration in motor-adaptive structures. It includes patients with a relative excess and a relative deficiency in activities. Relative excess of activity may appear as unnatural-awkward voluntary and jerky involuntary expressive movements with facial grimacing in parakinetic catatonia; obedient answering but talking beside the point (Vorbeireden) with an empty facial expression in speech prompt catatonia; and autonomic obedience with a monotonous mumbling speech in proskinetic catatonia. In contrast, the relative deficiency of activity appears as impoverished speech, such as mutism or delayed and slow replies in speech-inactive catatonia; impoverished involuntary motor activity, such as waxy flexibility or stiff movements and posturing in manneristic catatonia; and an active striving against all attempts at making contact in negativistic catatonia. Thus, among the systematic catatonias negativistic catatonia seems to be the opposite of proskinetic catatonia, manneristic catatonia the opposite of parakinetic catatonia, and speech-inactive catatonia the opposite of speech-prompt catatonia.

In the differentiation among the subtypes of the catatonic category, most revealing are psychopathological symptoms related to speech. Thus, speech-prompt catatonics respond promptly and without delay. However, they do not show spontaneous loquaciousness and their voluble speech in responding to questions lacks meaningful content. While negativistic catatonics may give partial answers, manneristic catatonics frequently do not talk at all.

There is a jerky pattern of speech with short ungrammatical sentences in parakinetic catatonia; murmuring, and verbigeration in proskinetic catatonia; and a continuous whispering to hallucinatory experiences in speech-inactive catatonia. Although opposition (Gegenhalten) is seen in manneristic catatonia, cooperation (Mitmachen) and grasping (Mitgehen) are exclusive for proskinetic catatonia. Abnormal postures, such as generalized rigidity, waxy flexibility (Haltungsverharren), and the so-called "psychological pillow," a manifestation of opposition, are pathognomonic for manneristic catatonia; waxy flexibility may also occur in speech prompt catatonia. Abnormal spontaneous movements are widespread in this category; grimacing is characteristic of parakinetic catatonia; handling and intertwining of proskinetic catatonia; stereotypes of proskinetic and manneristic catatonia and impulsive action of manneristic and negativistic catatonia. While speech prompt and proskinetic catatonics turn toward the examiner in an exaggerated manner (adversion), speech-inactive catatonics turn away (aversion), although true negativism is present only in negativistic catatonia.

Differential characteristics among the systematic catatonias are almost exclusively based on the differential motor and speech patterns of the subtypes. Pathognomonic of the negativistic subtype is the association of blunted affect with negativistic excitement, and of the manneristic subtype the association of hard mannerisms with well retained affectivity and lack of hallucinatory and delusional experiences.