Hyperkinetic-akinetic motor psychosis

Motor psychosis are part of the cycloid psychoses family. It predominantly involves psychomotricity , ie d. decision making, planning and motor execution. There are two symptomatic poles alternating in times during the same episode or from one episode to the other. There is no accumulation of residual symptoms between episodes, whatever the number of relapses.

Proposed criteria

These proposed criteria are probably not definitive. We work hard to make them operative and validated. They are inspired from those put forward by the team of Würzburg, those of Sigmund (1998, 1999) and DRC Budapest-Nashville (Pethö 1988). They were not complemented inputs seminars Gerald Stöber and may be updated from day to day by a wiki page.

Click here to see the present state of the wiki page. Only members are allowed to directly modify the criteria but we encourage any contribution (send a mail).


To make a diagnosis:

  • Evolution criteria has to be fullfilled
  • 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)
  • 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 (shifted to the right).
Clinical symptoms compatible with the diagnosis are just informative and are not part of the criteria.

Evolution criteria

  • Acute onset (<2 weeks) or subacute (1-3 months)
  • Single episode, or other episodes of same or oposite polarity
  • Complete symptomatic recovery with full insight
    • Accentuated personality even when symptom free
    • Switch common during the episode (but can last only a few minutes)

Clinical criteria during the episode

Akinetic psychosis

  • Marked quantitative reduction of reactive and expressive mouvements (eg. No facial expressions)
  • Less marked slowing of mouvements on command (part of voluntary movements) when available.
  • Loss of goal-directed activities (intentional mouvement, i.e. initiated by the patient himself)
  • Verbal output markly reduced or absent (part of intentional mouvement).

Hyperkinetic psychosis

  • Quantitative increase in reactive and expressive mouvement (without distortion), that replace goal-directed activities
  • Reduced intentional verbal output or mutism, increase of sound, shouts or words of expressive character (Wernicke's "silent reslessness").
    • Purposeless grabing of object (+ agitation = Wernicke's hypermetamorphosis)
    • 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 being indicative 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

Exclusion criteria

Not secondary to

  • Drug intoxication or withdrawal
  • An organic disease
  • A reactive psychosis (reaction to a severe stressor)

Clinical (symptom that can not be observed)

  • If an akinetic phase, facial expression of perplexity, ecstasy or fear (suggest another cycloid psychosis).
  • 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)
  • Staring in the middle position
  • True catatonic symptoms according to WKL, i.e. parakinesia, true negativism (i.e. with ambitendance), waxy flexibility (with posture mantenance) ...
  • Persistence after the episode of a language disorder or illogic reasoning (experimental psychic test)
  • Organized paranoia, persecutory delusions with designated persecutor passional delusion as erotomania, jealousy
  • Other mood disorders (mania or melancholia) arising out of the post-episode.

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