Need to Brace Ourselves for Major Mental Health Is-

Column
sues Post COVID-19 Pandemic
Echopraxia: Very First
*Dr. Ashoka JahnaviDescription
Prasad of the
Symptom Way Back in the 17th
Century
W e are battling a pandemic of unprecedented pro- produce meningitis associated with significant mor-
portions. Healthcare professionals Dr. areAshoka
workingJahnavi
bidityPrasad
and mortality, presenting symptoms including
round the clock to curtail this global menace. It is very headache, nausea, nuchal rigidity, confusion, lethargy,
likely that we would soon be able to slow down the and apathy to be confirmed by the examination of CSF.
alarming rate at which the illness is spreading and from Bacterial meningitis may also result in brain abscess,
the reports in the medical journals that I have been pe- with seizures and various psychiatric symptoms pre-

M
rusing, we would be able to procure a vaccine in due vailing depending on the size and location of the ab-
course. The y first
priceexposure to a patient
that the entire humankind exhibiting
has had echo- toimmune
to scess. conditions,
Successful early with
treatment stages of Alzheimer’s
empirical dis-
antibiotics
pay is huge praxia wasreckoning
by any as a youngand medical
everyonestudent around and
is looking ease,primary
and rare culture-bound
excision of the abscess syndromes
may stilllike latah,
result in
five decades ago. As it was not mentioned in imu, and catatonia.
forward to the day when we would not approach the persistent psychiatric symptoms. In cases of viral en- And in almost always, patients
the then edition
newspapers withofthe Hutchison’s
degree ofClinical
trepidationMethods,that Iwefound with these psychiatric
are cephalitis, symptoms symptoms
are initiallyare dismissed as malin-
very common in
myself completely
doing so today. at sea with absolutely no reference gerers. It, therefore, presents itself with
the acute phase and recovery, especially mood disor- a completely
point. There was a patient, a 32-year-old librarian who ders. different
Majorset disability
of challenges.
can result, including symptoms
But I worry that we are more or less completely un-
was brought over by his brother. The family had no- of depression, amnestic disorders, hypomania, irritabil-
prepared for the psychiatric sequalae of this COVID 19 There was a paucity of medical literature on echo-
ticed that he had suddenly taken to imitating other ity, and disinhibition (sexual, aggressive, and rageful)
which wemovements
would have and to confront praxia in those days. I recall even asking one of my
people’s actionsveryso muchsoon. As so athat
mem- he even months after recovery. Psychosis may also rarely
ber of teachers why was it that no MD research had been at-
had to several
take leaveinternational medical satisfying
off his otherwise relief missions,
job. HeI result. Standard treatments with antidepressants, stim-
have myself noticed the major mental health issues that tempted until then. The symptom itself had kindled
had no insight into his condition and just could not fig- ulants, mood stabilizers, neuroleptics, and electrocon-
emerge in nearly every major epidemic - and it is a fair my curiosity. Thankfully the situation has changed.
ure out why his colleagues at work as well as his fam- vulsive therapy should be applied [1].
bet that this episode would not be any different. The latest edition of Brain’s Neurology has a separate
ily members found him embarrassing.
chapter on echopraxia,
Individuals may sufferand I note with
potentially satisfaction
permanent cog-
Providing psychiatric care to survivors and health-
He would often mimic hand gestures of the other nitive that thedeficits
latest edition of Hutchison’s
secondary to illness Clinical
or its Methods
treatments al-
care workers in the aftermath of a pandemic outbreak
people in the room and occasionally attempt to walk in that so provides valuable
will require insights
cognitive on the differential
rehabilitation. In cases diag-
of
is a complicated, but crucial, imperative in the service
the same manner as they did. The malady progressive- delirium, nosis one ifneeds to entertain
the resultant while encountering
encephalopathy is severethisor
of reducing the burden of human suffering. Challenges
ly worsened to the extent that he started imitating ac- persistent, symptom. pharmacologic interventions with antipsy-
will abound on multiple levels, but there is no substi-
tors he had just witnessed on television. On numerous chotics (such as haloperidol 0.5–20 mg/ day) and mood
tute for preparedness. Knowledge of assessment, differ- For the present lot of medical students who may
occasions, he would violently kick at his family mem- stabilizers (such as valproic acid up to 60 mg/kg/ day)
ential diagnosis, medical complications, and treatment have developed curiosity the way I did, I can certainly
bers after watching a television show which lead to should be considered. Also, psychosocial interventions
will aid the psychiatric care provider in developing a refer them to some very informative articles that have
some very serious injuries. will need to be implemented to maintain safety and
treatment approach for these patients who are most recently appeared.[1-3] But even these do not address
care for someone who may no longer be able to care for
He wasduring
vulnerable forcibly theirbrought
greatestover time to the psychiatric
of need. One must the question that crossed my mind as a medical stu-
themselves.
outpatients
first considerwhich is where I sequelae
the psychiatric encountered him. As the
of surviving the dent: who was the very first person to describe echo-
symptom
illness, its was new to me,and
complications, I did thea lot of reading in
complications of the
its praxia?
In the wake of an infectious disease outbreak, the
library and In
treatments. wastheimmensely
acute phase helped by Dr.
of illness, M.small
even K. Govil,
foci loss of functioning imparted by illness may leave sur-
While working on my doctorate in the history of
of infection
one can produce
of my teachers whopsychiatric
had a special symptoms
interestranging
in neu- vivors feeling demoralized, helpless, and in a state of
medicine, I visited many libraries in several countries
from mood changes
robehavioral disorders. and irritability
It was only then to cognitive
I learned dys-that mourning over the loss of the person, they used to be.
in Europe. And finally, I found the answer to my ques-
function to psychosis. Neuropsychiatric manifestations
this symptom, apart from being found in psychiatric If the patient experiences marked distress or significant
tion, but the name in all probability would be unfamil-
may even present
conditions as the first signs
like schizophrenia, of infection
autism spectrum in an oth- impairment in social or occupational functioning, they
disor-
iar to most medical practitioners including students of
erwiseGilles
ders, well-appearing
de la Tourette’s patient. Hematogenous
syndrome, and general spread
pa- may meet DSM-V criteria for adjustment disorder. Ther-
neurology. And it may amaze many that the symptom
of bacteria
resis or virus
of insane (almost to the central
extinct nervous system
nowadays), was notcan an apeutic interventions in those instances should focus
was first identified in the 17th century.
uncommon feature in patients with epilepsy. Some au- on helping individuals regain a sense of autonomy and
mastery
Here is the through rehabilitation.
Fascinating History It isofhelpful to focus on
Echopraxia
Dr. Ashoka Jahnavi Prasad is identified as the most ed- gaining
George Garden sent this communicationaspects
immediate control over some specific of
to the re-
their lives, as well as helping the persons
ucationally qualified person in the world by The Polymath. cently constituted Royal Society of London in fulfill- identify and
He has a dynamic resume with a PhD in history of med- link with agencies and supports in the community [2] .
ment of his promise to report “all things philosoph-
icine from Cambridge, LLM from Harvard among other Psychotherapy, both individual and group therapy, if
ical” from Aberdeen, Scotland. In it, he described “a
available,
notable qualifications. Dr. Prasad has also worked as Man in this Country”can help survivors come to terms with the
with the surprising “Dotrel-
loss of functioning.
a consultant to the World Health Organization (WHO) quality ... that inclines him to imitate unawares all the
and helped prepare two of their reports. If theand
gestures patient is left
emotions with with
of those significant
whom he depressive
convers-

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The Indian Practitioner d Vol.75 No.10 October 2022 31
 Column

eth.” This was the first published case of echopraxia, a observe that he imitated not only the scratching of the
phenomenon that had been casually noted by Digby in head, but also the wringing of the hands, wiping of the
1644, and which is not uncommon in catatonic states. nose, stretching forth of the palms etc. And we need
The patient’s ‘simple answer’ to the question of ‘how not strain complement to perswade him to be cover’d;
he found himself affected’, namely “That it vexed his for he is still put off and on as he saw us do, and all this
heart and brain” is still about as modern psychiatry or with so much exactness ,and yet with such a natural
neurology can make of it. and unaffected air, that we could not as much suspect
that he did it on design. When we held both his hands,
“Echo phenomenon” as they are called today, was
and caused another to make such motions, he pressed
so named by Moritz Heinrich Romberg (1795-1873),[4]
to get free: But, when we would have known more par-
professor of medicine at the University of Berlin in his
ticularly, how he found himself affected, he could on-
Manual of the nervous diseases of man, 1853 (London,
ly give us this simple answer- That it vexed his heart
Sydenham Society, vol 2, pp 180-181) translated from
and brain.
the second German edition (Berlin 1851) by Sir Edward
H. Sieveking. Romberg had repeatedly observed echo- I shall leave it to your consideration, what peculiar
lalia or imitative movements of articulation in various crises of spirits or distemper of imagination may cause
morbid conditions of the brain. The patient, in a mo- these effects, and what analogy they bear to the in-
notonous way, repeats the words and sentences spo- voluntary motion of yawning after others, and laugh-
ken by somebody in his vicinity, without showing that ing when men are tickled (which some will do if any-
his attention has been attracted, or that he associates body do make that titilating motion with their fingers,
any meaning with what he is articulating. though it be at a distance from them;) and whether, if
his Nurse have accustomed him to the frequent imita-
Echopraxia Described in a Letter [5] tion of little motions and gestures in his infancy, this
“I remember, we had then occasion to speak of a may not have had some influence to mould the texture
Man in this Country very remarkable for somewhat of his Brain and Spirits, and to dispose him to this ri-
peculiar in his temper, that inclines him to imitate diculous apishness?”
unawares all the gestures and emotions of all those
References
with whom he converseth. We then had never seen
1. Odland AP, Mittenberg W. Echopraxia. Encyclopedia of
him our selves. Since our return, we were together at
Child Behavior and Development. 2011;1:557–558.
Scrachbogie where he dwells, and, no withstanding all
2. Larner AJ. A Dictionary of Neurological Signs: Springer,
we had heard of him before, were somewhat surprized
New York. 2016
with the oddness of this Dotrel-quality. This Donald
3. Pridmore S, et al. Echopraxia in Schizophrenia: Possible
Monro (for that is his name) being a little old and very Mechanisms. Australian and New Zealand Journal of Psychiatry.
plain man, of a thin slender body, hath been subject to 2008;42(7):565-71. DOI:10.1080/ 00048670802119747
this infirmity, as he told us, from his very infancy. He 4. Romberg MH. Manual of Nervous Diseases of Man. 1853; 2:180-
is very loath to have it observed, and therefore casts 181.
down his eyes when he walks in the streets, and turns 5. Philosophical Transactions. 1677;12:842-843. Available from:
aside when he is in company. We had made several https://www.jstor.org/stable/pdf/101763.pdf?refreqid=
trials before he perceived our design; and afterwards excelsior%3Afbcdc4536cd0f7c33d102dcdea6eecd4&ab_
had much ado to make him stay. We caressed him as segments=&origin=&acceptTC=1: Accessed on 18th of
much as we could, and had then the opportunity to October 2022. ISSN: 03702316.
+

32 The Indian Practitioner d Vol.75 No.10 October 2022