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This chapter will discuss non-iatrogenic hypokinetic movement disorders. It will first discuss catatonia as an individual entity, then review hypokinetic movement disorders in depression and schizophrenia. The prototype of a hypokinetic or withdrawn catatonia presentation would be a patient manifesting features such as mutism, negativism, posturing, stupor, or obsessional slowness. Benzodiazepines are considered the first-line treatment for catatonia for their rapid onset of action and improvement in symptoms. Psychomotor retardation is recognized as one of the most fundamental features of major depression, involving changes in speech, facial expressions, eye movements, self-touching, posture, and speed and degree of voluntary movements. Parkinsonism in drug naïve schizophrenic patients is most often of the akinetic-rigid type, with bradykinesia and rigidity dominating the picture.

Neurocognitive disorders (NCDs) represent a growing epidemic in the modern world, concomitant with increasing life expectancy. NCDs represent the newer term replacing dementia. A major NCD is the equivalent of dementia, whereas a mild NCD is a new addition to the Diagnostic and Statistical Manual of Mental Disorders , fifth edition ( DSM-5 ). The approach to diagnosing NCDs should include a thorough medical examination targeting potentially reversible causes of impairment, as well as screening for cognitive impairment in the outpatient setting, with focus on memory and functional decline. NCDs tend to have comorbid neuropsychiatric symptoms that include depression, anxiety, psychosis, sleep disturbances, and apathy, which may reduce quality of life and accelerate out-of-home care. The provider needs to be aware of these potential comorbidities, and of the pharmacologic and nonpharmacologic treatment options. [ Psychiatr Ann . 2016;46(2):103–109.]

This study examined the characteristics of caregivers and persons with dementia (PWD) to determine their association with caregiver depression. Participants included 508 PWD (veterans) and 486 caregivers from Boston, Houston, Providence, Beaumont (Texas), and Oklahoma City, identified from diagnoses from medical records and recruited from February 2007 to July 2009, for a larger study evaluating Partners in Dementia Care, a care-coordination intervention. Characteristics evaluated for PWD included activities of daily living, instrumental activities of daily living, cognitive impairment, and disruptive behavior. Caregiver characteristics evaluated included caregiver unmet needs, support-service use, and number of informal helpers. Caregiver depression was measured using the Iowa form 11-item Center for Epidemiologic Studies Depression Scale. Depressed caregivers reported significantly more unmet needs than the nondepressed caregivers. Depressed caregivers also reported a high frequency of disruptive behavior in their PWD. Caregiver perceptions of unmet needs may be an important target for intervention.

Dementia is a clinical syndrome characterized by a gradually progressing cognitive impairment. This impairment is commonly manifested by memory deficits; but the presence of one or more additional cognitive disturbances, including aphasia, agnosia, apraxia or executive dysfunction, is required to make the diagnosis, according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) criteria. Those disturbances should be a change from the previous baseline and should cause significant distress to the patient and caregivers. Medical problems that can cause memory impairment, substance abuse and a psychiatric axis I diagnosis need to be ruled out before making the diagnosis of dementia (The American Journal of Psychiatry 164:5–56, 2007).