330:. He reported that the attacks would last for up to several hours and seemed to be outside of the patient's control. He characterized the shouting as extremely loud, noting that it could be in the form of syllables, vowels or even animal noises. In addition, he observed that while the nature of the shouting could suggest that the patient was in pain, the sounds themselves were unrelated to any physical discomfort. He stated that the patient appeared to have the ability to anticipate an incident and could even prevent it through deep and rapid breathing. However, he noted that the effort required to suppress klazomania could be even more tiring than enduring it. He said that though anxiety could increase the frequency of klazomania, it did not affect the overall presentation.
135:. After 15 minutes, further motor symptoms arose, with the patient making small jerky motions with his arms that developed into larger, circular movements. At 20 minutes, the attack reached its peak, with the patient becoming bright red and making large compulsive movements with his arms and kicking his legs. He began swearing, shouting, screaming, grunting and barking loudly, with intermittent bouts of heavy panting. He remarked upon the people present, with his comments being related to the situation in question. He attempted at times to excuse his behavior. Afterwards the patient was able to provide an account of what had happened. Wohlfart
106:. It is defined as compulsive shouting, which can be in the form of swearing, grunting or barking. The subject may appear flushed, and klazomania can occur with increasing frequency if the person is agitated. The duration of the incident depends on the individual, but it can be characterized by a peak period, followed by intermittent remissions of less intensity. Although the individual may sound like they are in pain, there does not appear to be any actual physical discomfort. The shouting can be accompanied by other symptoms, such as
354:
reported to appear angry during the incidents. At the end of the outbursts he would appear surprised, though he was able to continue a conversation. The patient remained fully oriented between attacks. The episodes themselves occurred at a frequency of one or two a month, generally taking place in the evening and they got progressively worse from the time of their first presentation.
144:. The peak of the attack lasted 30 minutes; the intensity then started to subside, though the patient still exhibited bouts of shouting and movement after several minutes of remission. The remission periods between the shouting episodes became longer, until the entire attack was over in about an hour and a half.
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concluded that the patient was aware of his surroundings during the attack, with the patient even expressing concern over missing a scheduled appointment; the patient demonstrated some ability to control his behavior when spoken to in a sharp tone, but he would inevitably return to his shouting and
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Two of
Benedek’s colleagues, E. Von Thurzó and T. Katona, recorded two further instances of klazomania in 1927. They expanded upon Benedek’s earlier observations, describing the angry flushed face of one patient, as well as extreme restlessness and agitation. They noted that afterwards the patient
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of the mouth and tongue. At the age of 44, the patient experienced his first bout of klazomania. He remained conscious for the entire incident, while he shouted for about half an hour and appeared "crazy" for hours after the shouting ended. The next day, he felt better, though he did report being
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reported on a 63-year-old who was admitted to a psychiatric hospital with a two-year history of sudden episodes of shouting. The man claimed to have no memory of the attacks, which he could anticipate by a few seconds. The episodes were characterized by shouting of "aagh" or "help" and he was
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One of the first instances in which an infectious disease was associated with klazomania was the notable pandemic of the encephalitis lethargica from 1916 to 1927. This pandemic also gave rise to observations of other tics that came to be associated with encephalitis lethargica such as complex
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hypothesized that klazomania originates in the periaqueductal gray matter in the mesencephalon. The vocalizing center in animals is located in the periaqueductal gray matter and a klazomania-like episode involving grunts and animal sounds can be evoked by electrical stimulation of this region.
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at the age of 12. While he reported no significant ill effects from the disease, he was irritable and complained of fatigue for years after recovering. At 22, the patient received a head injury, though he did not sustain a concussion or cranial fracture from the incident. Six months later, he
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According to
Wohlfart's account of one patient, onset is sometimes characterized by absentmindedness: the patient K.R. stared straight ahead and only responded in monosyllables in the minutes leading up to the incident. An oculogyric spasm then developed, during which he demonstrated
255:, increased blood pressure, retraction of lips, barking, grunting, and rage just as an animal would if presenting sham rage. Bates and colleagues (1996) say that neuroimaging and pathology results do not support evidence of hypothalamic involvement similar to that found in sham rage.
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apologized for the incident, suggesting awareness of the behavior. From this, ThurzĂł and Katona proposed that there is no loss of consciousness during klazomania and that individuals may remain fully aware of their surroundings.
275:), Tourette's may be diagnosed when the other diagnostic criteria are met and symptoms cannot be attributed to another general medical condition. Hence, other medical conditions that include tics or tic-like movements—such as
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tired. The patient continued to suffer from the attacks for the next few years before coming under observation of
Wohlfart and colleagues. He subsequently served as a model to describe klazomania from beginning to end.
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were accompanied by vocal tics and occasionally klazomania. They hypothesized that the cause of klazomania is linked to the combined effects of brain damage due to alcohol use disorder or encephalitis.
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349:, another symptom of postencephalitic Parkinsonian syndrome. Klazomania was proposed to be associated with long-term excessive use of alcohol and carbon monoxide poisoning in 1996. Bates
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Jankovic and Mejia's 2006 review indicated that autopsies of victims of the 1917 to 1926 encephalitis lethargica pandemic revealed "neurofibrillary tangles and neuronal loss in the
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Wohlfart and colleagues hypothesized that the stimulation of the autonomic nervous system by the posterior hypothalamus is involved in klazomania, adding that klazomania resembles
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Although the cause of klazomania is unknown, it is considered to be associated with encephalitis lethargica; a 2006 journal review by
Jankovic and Mejia attributes klazomania to
310:(also known as Artane) were also made. Phenobarbital acts as an anticonvulsant and is generally used to treat seizures, while Artane is used to treat involuntary movements in
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comes from the Greek κλάζω ("klazo"), meaning "to scream". The term was coined by L. Benedek in 1925 when he witnessed bouts of compulsive shouting in a patient with
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The observation of klazomania in encephalitis patients helped establish the neurological underpinning of tics in other conditions, including
Tourette syndrome.
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Wohlfart G, Ingvar DH, Hellberg AM (1961). "Compulsory shouting (Benedek's "klazomania") associated with oculogyric spasms in chronic epidemic encephalitis".
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114:, although the two can be distinguished by the duration of the attack and the fact that the patient experiencing klazomania appears to retain consciousness.
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314:; however, this combination was found to have no beneficial effect in treating klazomania. Klazomania does not respond to anti-epileptic medications.
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movements after a few seconds of stillness. The episode lasted an hour and a half and was accompanied by salivation, sweating, and
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helped control the involuntary movements associated with klazomania in one patient; attempts to treat with a combination of
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Leckman JF, Bloch MH, King RA, Scahill L (2006). "Phenomenology of tics and natural history of tic disorders".
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Bates GD, Lampert I, Prendergast M, Van
Woerkom AE (1996). "Klazomania: the screaming tic".
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or other involuntary movements. The presentation of klazomania has been compared to
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Howard RS, Lees AJ (1987). "Encephalitis lethargica: a report of 4 recent cases".
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vocalizations of blocking, echolalia, palilalia, and oculogyric crises.
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Jankovic J, Mejia NI (2006). "Tics associated with other disorders".
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Spinal muscular atrophy with lower extremity predominance (SMALED)
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postulated that klazomania is similar to the vocal tics of
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588:. Available at BehaveNet.com Retrieved on August 10, 2009.
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Klazomania is similar to other complex tics including
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625:Larner, A. J. (2002). "klazomania".
182:In a 1996 report of one case, Bates
42:, but has been seen in people with
1636:Symptoms and signs: Nervous system
1584:Infantile progressive bulbar palsy
627:A Dictionary of Neurological Signs
465:10.1111/j.1600-0447.1961.tb01051.x
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1287:Template:Cerebrovascular diseases
1090:Frontotemporal lobar degeneration
1307:For more detailed coverage, see
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1256:For more detailed coverage, see
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560:American Psychiatric Association
158:encephalitic lethargica pandemic
564:DSM-IV-TR: Tourette's Disorder.
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241:sympathetic nervous system
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1475:Primary lateral sclerosis
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1113:Creutzfeldt–Jakob disease
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762:Herpesviral encephalitis
635:10.1007/0-306-47505-7_11
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1406:Static encephalopathy
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1396:Toxic encephalopathy
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933:Hemiballismus
931:
929:
926:
922:
919:
918:
917:
914:
910:
907:
906:
905:
902:
898:
895:
893:
890:
888:
885:
884:
883:
880:
879:
878:
875:
874:
872:
870:
865:
861:
858:
856:
852:
849:
847:
842:
838:
828:
825:
823:
820:
816:
813:
812:
811:
808:
807:
805:
803:
798:
790:
787:
786:
785:
784:Brain abscess
782:
780:
777:
773:
770:
768:
765:
763:
760:
758:
755:
754:
753:
750:
749:
747:
745:
741:
738:
736:
732:
728:
724:
716:
711:
709:
704:
702:
697:
696:
693:
685:
681:
677:
673:
669:
665:
660:
659:
655:
646:
644:1-4020-0043-X
640:
636:
632:
628:
621:
618:
613:
609:
605:
601:
594:
591:
587:
586:0-89042-025-4
583:
579:
575:
572:
568:
565:
561:
556:
553:
548:
544:
540:
536:
529:
527:
525:
523:
521:
519:
517:
515:
513:
511:
509:
507:
505:
503:
501:
499:
497:
495:
493:
491:
487:
482:
478:
474:
470:
466:
462:
459:(2): 369–77.
458:
454:
453:
445:
443:
441:
439:
437:
435:
433:
431:
429:
427:
425:
423:
421:
419:
417:
415:
413:
409:
404:
400:
396:
392:
385:
383:
381:
379:
377:
375:
373:
371:
367:
360:
358:
355:
352:
348:
344:
339:
335:
331:
329:
325:
317:
315:
313:
309:
305:
304:phenobarbital
301:
293:
291:
289:
285:
280:
278:
274:
270:
266:
258:
256:
254:
250:
246:
242:
238:
233:
228:
226:
222:
218:
214:
210:
206:
198:
196:
193:
189:
185:
180:
178:
174:
170:
166:
165:mesencephalon
161:
159:
155:
147:
145:
143:
138:
134:
128:
125:
120:
115:
113:
109:
105:
101:
97:
89:
87:
85:
81:
77:
73:
72:tic disorders
69:
61:
59:
57:
53:
49:
45:
41:
40:tic disorders
37:
33:
29:
25:
21:
1594:
1493:
1466:
1427:Degenerative
1164:Inflammatory
1111:
1044:Stiff-person
882:Parkinsonism
855:Degenerative
752:Encephalitis
735:Inflammation
725:, primarily
670:(1): 19–33.
667:
663:
626:
620:
603:
599:
593:
573:
555:
541:(1): 31–34.
538:
534:
456:
450:
394:
390:
356:
350:
342:
340:
336:
332:
323:
321:
297:
281:
268:
262:
231:
229:
209:hypothalamus
202:
192:encephalitis
183:
181:
162:
151:
136:
129:
116:
93:
83:
65:
19:
18:
1579:Fazio–Londe
1419:Both/either
1213:Generalised
1072:Early-onset
1067:Alzheimer's
802:spinal cord
249:tachycardia
211:, midbrain
142:tachycardia
124:dyskinesias
1625:Categories
1187:paroxysmal
1159:Autoimmune
952:Dyskinesia
822:Meningitis
800:Brain and
600:Adv Neurol
391:Adv Neurol
361:References
324:klazomania
277:tourettism
265:tourettism
253:salivation
223:, and the
154:tourettism
104:coprolalia
80:tourettism
74:including
36:coprolalia
20:Klazomania
1184:Episodic/
1062:Tauopathy
1013:Akathisia
1001:Myoclonus
984:Athetosis
916:Tauopathy
578:DSM-IV-TR
535:Neurocase
322:The word
294:Treatment
273:DSM-IV-TR
259:Diagnosis
237:sham rage
230:Wohlfart
213:tegmentum
133:echolalia
100:palilalia
96:echolalia
32:palilalia
28:echolalia
1550:SMALED2B
1545:SMALED2A
1242:Migraine
1234:Headache
1200:epilepsy
1196:Seizures
1054:Dementia
957:Dystonia
612:16536348
606:: 1–16.
567:Archived
562:(2000).
481:45720489
473:13786189
403:16536352
397:: 61–8.
288:seizures
221:striatum
219:matter,
177:striatum
70:seen in
38:seen in
26:such as
1562:SMA-PME
1557:SMA-PCH
1540:SMALED1
1252:Tension
1247:Cluster
972:Meige's
789:Amoebic
684:3801849
318:History
175:in the
1281:Stroke
1095:Pick's
1022:Tremor
989:Chorea
682:
641:
610:
584:
479:
471:
401:
351:et al.
343:et al.
184:et al.
148:Causes
137:et al.
50:, and
1641:Mania
1595:both:
1527:DSMA1
1522:SMAX2
1517:SMAX1
1497:only:
1470:only:
1374:Other
1296:Other
1208:Focal
841:Brain
744:Brain
664:Brain
477:S2CID
232:et al
84:et al
1198:and
909:PKAN
904:NBIA
680:PMID
639:ISBN
608:PMID
582:ISBN
469:PMID
399:PMID
306:and
102:and
68:tics
34:and
24:tics
1512:SMA
1495:LMN
1468:UMN
1459:MND
1325:CSF
1276:TIA
921:PSP
897:NMS
866:and
727:CNS
672:doi
668:110
631:doi
580:),
543:doi
461:doi
227:".
1627::
1436:SA
943:OA
938:HD
887:PD
678:.
666:.
637:.
604:99
602:.
537:.
489:^
475:.
467:.
457:36
455:.
411:^
395:99
393:.
369:^
251:,
247:,
215:,
207:,
98:,
46:,
30:,
1088:/
843:/
714:e
707:t
700:v
686:.
674::
647:.
633::
614:.
549:.
545::
539:2
483:.
463::
405:.
271:(
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