The presentation of a patient with<unk>  varies greatly depending on the subtype, underlying cause and it can be acute or subtle. Because most patients with<unk>  have an underlying psychiatric illness, the majority will present with worsening depression, mania, or psychosis followed by<unk>  symptoms.<unk>  presents as a motor disturbance in which patients will display marked reduction in movement, marked agitation, or a mixture of both despite having the physical capacity to move normally. These patients may be unable to start an action or stop one. Movements and mannerisms may be repetitive, or purposeless. The most common signs of<unk>  are immobility, mutism, withdrawal and refusal to eat, staring, negativism, posturing (rigidity), rigidity, waxy flexibility/catalepsy, stereotypy (purposeless, repetitive movements), echolalia or echopraxia, verbigeration (repeat meaningless phrases). It should not be assumed that patients presenting with<unk>  are unaware of their surroundings as some patients can recall in detail their<unk>  state and their actions. There are several subtypes of<unk>  and they are characterized by the specific movement disturbance and associated features. Although<unk>  can be divided into various subtypes, the natural history of<unk>  is often fluctuant and different states can exist within the same individual. Subtypes Retarded/Withdrawn<unk> : This form of<unk>  is characterized by decreased response to external stimuli, immobility or inhibited movement, mutism, staring, posturing, and negativism. Patients may sit or stand in the same position for hours, may hold odd positions, and may resist movement of their extremities. Excited<unk> : Excited<unk>  is characterized by odd mannerisms/gestures, performing purposeless or inappropriate actions, excessive motor activity restlessness, stereotypy, impulsivity, agitation, combativeness. Speech and actions may be repetitive or mimic another person's. People in this state are extremely hyperactive and may have delusions and hallucinations.<unk>  excitement is commonly cited as one of the most dangerous mental states in psychiatry. Malignant<unk> : Malignant<unk>  is a life-threatening condition that may progress rapidly within a few days. It is characterized by fever, abnormalities in blood pressure, heart rate, respiratory rate, diaphoresis (sweating), and delirium. Certain lab findings are common with this presentation; however, they are nonspecific, which means that they are also present in other conditions and do not diagnose<unk> . These lab findings include: leukocytosis, elevated creatine kinase, low serum iron. The signs and symptoms of malignant<unk>  overlap significantly with neuroleptic malignant syndrome (NMS) and so a careful history, review of medications, and physical exam are critical to properly differentiate these conditions. For example, if the patient has waxy flexibility and holds a position against gravity when passively moved into that position, then it is likely<unk> . If the patient has a “lead-pipe rigidity” then NMS should be the prime suspect.
Catatonia
Neuroleptic malignant syndrome
Paratonia
Childhood schizophrenia
Cataplexy
Clonus
Catalepsy
Psychomotor agitation