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The syndromes of "imitation behaviour," "utilisation behaviour," and "environmental dependency" were described by Lhermitte and colleagues in a series of presentations, video demonstrations, and publications in the 1980s. 1-5 Since then, these striking clinical phenomena have been abundantly detailed. 6-12
The term "utilisation behaviour" is applied to a peculiar pattern of actions, linked to frontal lobe dysfunction, in which patients display an exaggerated dependency on the environment for behavioural cues. When an object is placed before them they tend to act on that object (for example, use a hammer, pour water from a pitcher, write on a piece of paper), even when told not to, and even when they admit that they were told not to.
The term "imitation behaviour" refers to a condition in which patients imitate the gestures and behaviour of an examiner, even when asked not to. Imitation behaviour is considered to be a milder version of utilisation behaviour, and both are part of the more comprehensive environmental dependency syndrome.
In this report we describe a distinctive, language related fragment of the environmental dependency syndrome: compulsive, involuntary, environmentally dependent speaking. We describe an elderly woman who was unable to prevent herself from speaking about objects or events in her immediate environment, even though she was asked not to. Because this clinical phenomenon contrasts with aphasia and resembles the syndrome of compulsive writing called "forced hypergraphia", 13 we propose the term "forced hyperphasia".
Case report
An 84 year old, right handed woman was admitted to the hospital for evaluation of memory impairment and gait disturbance. One month before admission she had sudden onset of right sided weakness. After that episode she developed increasing complaints of memory impairment and gait disturbance.
Positive neurological findings on admission included bilateral grasp reflexes with forced visual groping with the right hand (visual grasp reflex). She also had other evidence of frontal system dysfunction, including snout, suck, and palmomental reflexes. She had a mild right hemiparesis; she could not walk unaided; deep tendon reflexes were increased bilaterally; Babinski's sign was present on the right. Pain sensation was decreased on the right.
Orientation to time, place, and person was within normal limits. Speech output was fluent with phonemic paraphasias. Repetition was limited to short sentences. She could not follow...