Observe movement before interpreting it #
Psychomotor assessment concerns spontaneous activity, posture, initiation, speed, coordination and unusual movements. Record what happens, when and under which conditions. “Agitated” or “slow” should be supported by observations and the person’s experience. Behaviour may reflect distress, pain, medicines, neurological illness or psychiatric symptoms.
| Dimension | Examples to observe |
|---|---|
| Amount | Reduced spontaneous movement, pacing or repeated activity. |
| Initiation and speed | Delay before acting, slowed actions or unusually rapid movement. |
| Posture | Comfortable, sustained unusual or repeatedly changing positions. |
| Pattern | Rhythmic, repetitive, purposeless, goal-directed or stimulus-linked movement. |
| Subjective experience | Restlessness, stiffness, weakness, urge to move or a sense of imposed action. |
Reduced and increased activity #
Psychomotor slowing may involve movement, speech latency and initiation. It can occur with mood disturbance, neurological illness, medicines or other contributors. Distinguish apparent lack of motivation from physical difficulty initiating or carrying out an action. Agitation may involve restless movement and distress; it does not determine the cause or imply a single diagnosis.
Ask what the person is experiencing and what movement accomplishes. Pacing because of fear, pain, boredom or an inner urge may look similar. Reduced movement with poor intake or responsiveness also needs assessment of physical state and causes, rather than being interpreted as simple unwillingness.
Compare common movement findings #
| Finding | Central feature | Useful context |
|---|---|---|
| Akathisia | Subjective inner restlessness, often with difficulty remaining still. | Medicine exposure and dose changes; distress can be substantial. |
| Tremor | Oscillatory movement. | Rest, posture or action; medicines and neurological or systemic contributors. |
| Dystonia | Sustained or intermittent muscle contraction producing abnormal postures. | Onset, affected muscles, medicine changes and physical consequences. |
| Stereotypy | Repeated, relatively uniform movement that may appear purposeless. | Developmental and neurological context, duration and associated findings. |
| Mannerism | An unusual stylized or exaggerated version of an action. | Describe the action and context rather than relying on the label. |
| Tic | Brief recurrent movement or vocalization, sometimes with a preceding urge. | Course, suppressibility and developmental history. |
Medicine-associated and primary neurological movement problems can coexist. Do not attribute every movement to treatment without examining timing, baseline and alternative causes. Conversely, a new treatment-associated complaint deserves attention even if the movement is not prominent in a brief interview.
Catatonic phenomena form a broader pattern #
Catatonic presentations may include marked reduction in movement or responsiveness, unusual postures, negativism, echophenomena or excitement. A single sign is insufficient to establish the syndrome. Catatonia is not restricted to schizophrenia and can occur in mood, medical and other contexts.
Observation, respectful engagement and an appropriate trained examination are more useful than labelling someone “uncooperative.” Explain the limits of communication and record which domains could not be assessed.
History and examination #
- Establish onset, progression, fluctuation and the previous movement baseline.
- Review all medicines, recent changes, missed doses and substances.
- Ask about pain, restlessness, stiffness, weakness, falls and swallowing or breathing difficulty.
- Observe at rest, during ordinary movement and while speaking where appropriate.
- Record distribution, pattern, duration and effects on daily activities.
- Consider associated cognition, arousal, mood, psychosis and neurological findings.
- Document actual findings and uncertainty about cause.
Care implications #
Treatment depends on cause, physical consequences and the complete presentation. This atlas does not generate a medicine change from a movement label. Follow-up should compare subjective discomfort, observable movement, function and treatment burden, rather than considering reduced visible movement sufficient evidence of improvement.
Distinguish sedation from resolution of a motor syndrome. A person can become quieter while underlying illness, medication effects or physical risks remain unresolved.