Echopraxia
Echopraxia is the involuntary imitation of simple actions observed in another person, such as hand-clapping or finger-snapping, without any apparent purpose of the patient's own. The imitation may occur automatically, seemingly without the patient's awareness, or, in some cases, appear to involve some element of choosing which person or action to imitate.
This has traditionally been studied by observing when imitation occurs; while it usually takes place when the patient is actually looking at another person performing the action, some patients have reported echoing the remembered image of another person's action, suggesting the phenomenon is not always a simple, immediate visual reflex.
Recognition features
- Automatic imitation of simple actions performed by another person nearby, such as clapping or snapping fingers
- Usually occurs while the patient is directly observing the other person, though it has occasionally been described in relation to a remembered image of someone else's action
- May appear completely automatic and outside the patient's control, or, less commonly, seem to involve the patient's own choice of whom to imitate
- Distinct from voluntary mimicry or ordinary social imitation by its automatic, seemingly compulsive quality
Eliciting it at interview
- Observe the patient's behaviour around others, including staff and fellow patients, noting any tendency to automatically mirror simple actions
- With appropriate care, a simple gesture can be performed in front of the patient to see whether it is spontaneously imitated
- Consider the surrounding clinical picture, since echopraxia is often seen alongside other catatonic signs such as automatic obedience and echolalia
Distinguishing features
- Differs from ordinary social mimicry or rapport-building imitation, which is a normal, largely voluntary social behaviour, by its automatic and seemingly involuntary quality
- Differs from hyperimitation described in autism spectrum conditions, which has been linked to reduced understanding of others' mental states, whereas echopraxia in catatonia arises in a different clinical context
- Frequently occurs together with echolalia, automatic obedience, and waxy flexibility as part of a broader catatonic presentation
Common misconceptions
- That echopraxia always happens completely without the patient's awareness; some patients have described a degree of choice over which person's action they imitate
- That echopraxia only occurs in schizophrenia; while strongly associated with catatonia, imitation-related phenomena are also described in other clinical contexts, including autism spectrum conditions, for different underlying reasons
Related phenomena
Automatic Obedience · Echolalia
Related syndromes
Diagnostically relevant to
Schizophrenia (catatonic presentations) (links open the DSM-5 Learning Lab)
Practice this
During a ward assessment, a 26-year-old man with catatonia claps his hands and snaps his fingers each time the assessing nurse does so, apparently without noticing he is doing it, continuing until she deliberately stops moving her hands. What is this? · On a ward round, a psychiatry student notices that a patient with schizophrenia touches his own nose every time the consultant touches hers, seemingly without registering that he is doing it. He does not respond when asked directly whether he noticed. Before revealing the answer: what is this finding, and what other catatonic signs would be worth specifically checking for given this observation? · A patient with catatonia seems to be automatically copying the interviewer. Before revealing the answer, decide what would tell you whether this is echopraxia or echolalia. · You want to check a patient with suspected catatonia for echopraxia. Before revealing the answer, decide what you would actually do. · Explain why echopraxia is described as differing from ordinary social mimicry, even though both involve copying another person's actions.
Illustration
During a ward assessment, a 26-year-old man with catatonia claps his hands and snaps his fingers each time the assessing nurse does so, apparently without noticing he is doing it, continuing the pattern for several minutes until the nurse deliberately stops moving her hands altogether.
References
- Casey, P. & Kelly, B. (2019). Fish's Clinical Psychopathology, 4th ed. Ch. 8, 'Motor Disorders'.