Subjective motor Disorders Objective motor Disorders Disorders of adaptive movements Disorders of reactive movements Disorders of goal directed movements Disorders of non adaptive movements Sterotype Parakinesia Involuntary movements Tremors, chorea, athetosis, spasmodic torticollis Abnormal induced movements Motor speech disturbances Disorders of posture Abnormal complex patterns of behaviour Movement Disorders associated with antipsychotic medication

1. Motor disorders
Psychologist stella

2. Motor disorders
• Subjective motor disorders
• Objective motor disorders

3. Subjective motor disorders
• Obsession and compulsions:
Patient experience them against their will but
sense of personal possession of act is not lost
although control over voluntary activity.
• Delusion of passivity:
Here control over thought, action and feeling is
lost as well as they are experienced as being
manufactured against his will by some foreign
influences.

4. Objective motor disorders
1. DISORDERS OF ADAPTIVE MOVEMENTS
a. Disorder of expressive movement
b. Disorder of reactive movement
c. Disorder of goal directed movement
2. DISORDERS OF NON ADAPTIVE MOVEMENTS
a. Spontaneous movements.
b. Abnormal induced movements.
3. MOTOR SPEECH DISTURBANCES
4. DISORDERS OF POSTURE
5. ABNORMAL COMPLEX PATTERNS OF BEHAVIOUR
a. Non-goal directed abnormal patterns of behavior
b. Goal directed abnormal patterns of behavior
6. DRUG INDUCED MOVEMENT DISORDERS

5. 1. DISORDERS OF ADAPTIVE
MOVEMENTS
a. Disorder of expressive movement
Involve face, arms, hands and
the upper trunk
Varies with emotions

6. 1. Omega sign / omega melancholicum –
Wrinkling of the skin above the nose and
between the eyebrows that resembles the
Greek letter ‘omega’ produced by the
excessive action of corrugators muscle
• First described by Charles Darwin in ‘The
expressions of the emotions in man and
animals’

7. 2.Veragath fold – The main fold in upper eyelid is
angulated upwards and backwards . Corners
of mouth drawn downwards; Seen in
depression
3.Other expressive movement disorder in
depression
4. Expression movement disorder in catatonia.
5. Expressive movement disorder in mania.

8. b. Disorders of reactive movements
• Immediate automatic adjustments to new
stimuli
• Anxiety states- excessive reactive movements
• Reactive movements are affected by
obstruction in catatonia or stupor

9. c. Disorders of goal directed
movements
• voluntary movements that are organized
around behavioral goals, environmental
context, and task specificity, as distinguished
from reflexive movements.
• Reflect both the personality and their present
mood state
• In Depression - actions become more difficult
to initiate and carry out

10. • In mania - increased involvement in goal
directed activities especially pleasurable
• overall pattern of behavior not consistent
• In catatonia, blocking or obstruction gives rise
to an irregular hindrance to motor activity.
• Stupor occurs with severe grades of
obstruction

11. • Mannerisms
–Unusual repeated performances of a goal
directed action or the maintenance of an
unusual modification of an adaptive
posture
–The strange use of words, high flown
expressions and movements and postures
out of keeping with the total situation
–Bizarreries- grotesque distorted
movements and postures in which no goal
or aim can be seen.

12. 2.Disorders of non adaptive
movements
• Spontaneous movements – motor habits that
are not goal oriented like scratching of the
head , clearing the throat
• Displacement activity – the normal motor
habits occurring when the individual is
frustrated or is uncertain about their choice of
behavior pattern.

13. stereotypy
Repetitive , ritualistic movement , posture or utterance
Stereotypies may be simple movements such as body
rocking, or complex, such as self-caressing, crossing and
uncrossing of legs, and marching in place.
It may be possible to discern the remnants of a goal
directed movement in stereotypy
They are found in people with Schizophrenia, intellectual
disabilities, autism spectrum disorders, tardive dyskinesia
and stereotypic movement disorder

14. parakinesia
• Seen in catatonia ,Described by Kleist(1943)
• Continuous . Irregular movement of the
musculature
• Patients grimace , twitch or jerk continuously
• Parakinetic catatonia , a type of
schizophrenia–Karl Leonhard

15. Involuntary movements
• Tics - sudden repetitive non rhythmic motor
movement or vocalization involving discrete
muscle groups
• Commonly the face is affected . E.g. Blinking ,
clearing the throat, twitching of the shoulders
• They can occur after encephalitis or indicate
the onset of Gilles de la Tourette's syndrome
• Psychogenically determined motor habits

16. Tremors
• Rhythmic oscillatory movements involving one or
more body parts.
• Most common of all involuntary movements
• Can involve hands, arms, eyes, face, head, vocal
cords, trunks, legs
• Static / intentional / postural tremors
• Seen in anxiety disorders, conversion reaction ,
drug withdrawal, parkinsonism, thyrotoxicosis
• Organic tremors can vary in intensity from day to
day are made worse by emotional disturbances

17. Chorea
- brief, semi-directed, irregular movements that
are not repetitive or rhythmic, but appear to flow
from one muscle to the next.
- Often associated with athetosis
- Causes- Huntington's, Sydenham chorea , drug
induced, pregnancy
Athetosis
- Slow writhing movements involving fingers,
hands, toes, feet, which bring about strange
postures of the body
- Can be seen in catatonia

18. Spasmodic torticollis
There is a spasm of the neck muscles,
especially the sternomastoid, which pulls the head
towards the same side and twists the face in the
opposite direction
Involuntary movements are associated with
antipsychotic medication
They are also relatively common in drug naïve
patients
11.4 % of drug naive schizophrenia pts had
orofacial dyskinetic movements and 7.4% had
tardive dyskinesia (Gervin et al)

19. Abnormal induced movements
• Automatic obedience
Patient carries out every instruction regardless of
the consequence (Hamilton 1985)
• Echopraxia
Patients imitate simple actions of examiners
Completely automatic, Echopraxia to mirror
images & voluntary echopraxia
• Echolalia
patient echoes a part or whole of what has been
said to them

20. Mitmachen (cooperation )-
Body can be put into any position without any
resistance on the part of the patient, although
they have been instructed to resist all
movements.
Mitgehen- very extreme form of cooperation
Patient moves their body in the direction
of the slightest pressure on the part of the
examiner “Angle poise lamp sign” (Hamilton).
Gegenhalten or opposition-
patient opposes all passive movements
with same degree of force as examiner

21. Negativism
apparently motiveless resistance to all
interference and may or may not be associated
with outspoken defensive attitude may be active
or passive
Ambitendency
patient makes a series of tentative
movements that do not reach the desired goal
when they are expected to carry out a voluntary
action patient appears to be in conflict about
moving their body and this presence of opposing
tendencies to action may be regarded as
ambivalence

22. Perseveration
Senseless repetition of a goal directed
action that has already served its purpose
Freeman & Gothercole (1966) described 3 types
1. compulsive repetition
2. Impairment of switching
3. Ideational perseveration
Logoclonia and palilalia (Hamilton)
Stereotypy is spontaneous and perseveration is
induced

23. Forced grasping
Despite frequent instructions not to touch the
examiners hands the patient continues to do so.
Grasp reflex
patient automatically grasps all objects placed
in his hand.
Magnet reaction
If the examiner rapidly touches the palm and
steadily withdraws his fingers the patients hand may
follow the examiner’s finger like a piece of iron
following a magnet.
Occurs in catatonia and organic brain disorders

24. 3.Motor speech disturbances
Verbal stereotypy – words or phrases repeated
continuously , spontaneous or set off by a question
Verbigeration – compulsive repetition of seemingly
meaningless words, phrases or sentences without
regard to stimulus. Different from schizophasia which is
gross thought disorder.
Wurgstimme - unusual strangled voice or whisper in
schizophrenia patients
Mannerism- mispronounced or distorting words
Echolalia /echologia

25. 4. Disorders of posture
• Manneristic posture-odd stilted posture that is
an exaggeration of a normal posture not
rigidly preserved.
• Stereotyped posture- abnormal and non-
adaptive posture that is rigidly maintained.
• Psychological pillow- pts lie with their head off
the pillow and maintains this posture for
hours.

26. Posturing or preservation of posture
The patient tends to maintain for long periods
postures that have arisen fortuitously or which have
been imposed by the examiner.
Catalepsy (nervous condition characterized by rigidity
, posturing and decreased sensitivity to pain)
Waxy flexibility
There is a feeling of plastic resistance as the examiner
moves the patients body which resembles the
bending of a soft wax rod and when the passive
movement stops the final posture is preserved.

27. 5. Abnormal complex patterns of
behavior
a. Non goal directed
Stupor –state of more or less complete loss of
activity where there is no reaction to external
stimuli.
Extreme form of hypokinesia and mute
– May occur in severe psychological shock ,
dissociative states ,depression , psychosis,
catatonia and organic brain disease like epilepsy
– Space occupying lesions affecting the third
ventricle ,thalamus and midbrain – akinetic
mutism –eyes open and pt appears to be alert

28. Catatonic stupor
• Pure akinesia
• muscle tension is markedly increased and patient
feels like a block of wood
• Snout spasm , psychological pillow is sometimes
seen
• Face is usually stiff and devoid of expression –
deadpan expression
• No emotional response to affect laden questions
• Response to painful stimuli is absent
• Double incontinence may occur

29. Depressive stupor-
• Depressed look
• Facial expression is of anxiety and
bewilderment
• Catalepsy, obstruction , Stereotypies, changes
in muscle tone and incontinence doesn’t occur
Dissociative stupor-
acute psychogenic reaction to severe trauma
and becomes a goal directed action though pt is
not aware of his hidden motivation

30. Excitement
• Opposite of stupor, but can occur in the same mental
illnesses
• Extreme hyperactivity. Constant motor unrest which is
apparently non purposeful
• Psychogenic excitements may be acute reactions or
goal directed reactions
• Goal directed may be seen in predisposed subjects on
exposure to stressors
• Commonly seen in mania and catatonic schizophrenia
• In manic excitement patient is cheerful or irritable,
restless and interfering with flight of ideas
• In catatonic excitement face is deadpan and
movements are often stiff and stilted and violence is
usually senseless and purposeless

31. • In delirium there may be ill directed over
activity and are extremely frightened at
times
• Pathological drunkenness (mania a potu)
• Excitement with senseless violence after
the patient has drunk a small quantity of
alcohol

32. B. Goal directed abnormal patterns of behaviour
-occur nearly in all mental illnesses
• Aggressive behaviour
• Compulsive rituals
• Suicidal or self injurious behaviour
• Disinhibited behaviour
• Wandering behaviour or fugue

33. 6. Movement disorders associated
with antipsychotic medication
• Dystonia –acute or chronic
syndrome of sustained muscle contractions,
frequently causing twisting and repetitive movements
or abnormal postures.
• Akathisia – A subjective feeling of restlessness
accompanied by motor Stereotypies.
• Tardive dyskinesia –delayed effect of antipsychotics
.usually after 6 months. Characterized by abnormal
involuntary movements irregular choreiform or
athetoid movements of the muscles of the head,
limbs and trunk.

34. Thank you