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From the jumping Frenchmen of Maine to posttraumatic stress disorder: the startle response in neuropsychiatry

Published online by Cambridge University Press:  09 July 2009

Robert Howard  and
Rodney Ford
Robert Howard*
Affiliation:
Maudsley Hospital; Department of Psychiatry, St George's Hospital, London
Rodney Ford
Affiliation:
Maudsley Hospital; Department of Psychiatry, St George's Hospital, London
*
1 Address for correspondence: Dr Robert Howard, The Maudsley Hospital, Denmark Hill, London SE5 8AZ.
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Synopsis

The startle response is a universal and phylogenetically ancient reflex. Pathological exaggerations and modifications of startle underlie the symptomatology of a surprisingly diverse range of neuropsychiatric disorders, a fact that seems to have gone largely unappreciated. We review the available literature on the physiology of the normal human startle response and examine the neuropsychiatric conditions characterized by pathological startle. Startle epilepsy and primary hyperekplexia are considered as neurological disorders involving abnormal startle. Patients with hyperstartle and exotic culture-bound syndromes characterized by excessive startle are considered by the authors to represent extreme variants of the normal startle response. Post-traumatic stress disorder, drug and alcohol withdrawal states and schizophrenia all have abnormal startle as a clinical feature secondary to increased arousal and presumed disturbance of central neurotransmitter systems. The neurophysiological mechanisms by which abnormalities of the startle response may occur are discussed and a system of classification of neuropsychiatric hyperstartles is suggested.

Type
Original Articles
Information
Psychological Medicine , Volume 22 , Issue 3 , August 1992 , pp. 695 - 707
Copyright
Copyright © Cambridge University Press 1992

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