23. Motor disorders (psychomotor disorders)
Movement disorders(psychomotor disorders) include hypokinesia, dyskinesia and hyperkinesia. These disorders are based on mental disorders
Hypokinesia is manifested by slowing down and impoverishment of movements up to the state of akinesia.
Stupor – psychopathological disorder in the form of oppression on all sides mental activity, primarily motor skills, thinking and speech.
Depressive stupor (melancholic stupor)– the patient’s posture reflects depressive affect. Typically, patients retain the ability to respond in the simplest way to calls (head tilt, monosyllabic answers in a whisper). Some patients may spontaneously experience “heavy” sighs and groans. The duration of this condition can reach several weeks.
Hallucinatory stupor develops under the influence of hallucinatory experiences. General immobility is combined with various facial reactions (fear, delight, surprise, detachment). Occurs in intoxication, organic psychoses, and schizophrenia. The duration of the condition is up to several hours.
Apathetic (asthenic) stupor- complete indifference and indifference to everything. Patients lie on their backs in a state of prostration. The expression on his face is devastated. Patients are able to respond to simple questions, but often answer “I don’t know.” Patients often do not take care of themselves and do not follow basic hygiene rules.
Hysterical stupor usually occurs in individuals with hysterical character traits.
Often the development of stupor is preceded by other hysterical disorders (hysterical paresis, pseudodementia, hysterical seizures, etc.). Patients do not answer questions and lie in bed all day. When trying to get them out of bed, feed or change them, patients resist.
Psychogenic stupor develops acutely as a result of intense shock psychotrauma or a traumatic situation.
Motor immobility is combined with somato-vegetative disorders (tachycardia, sweating, fluctuations blood pressure). There are no manifestations of negativism, as in hysterical stupor; the patients can be changed and fed. Consciousness is affectively narrowed.
Manic stupor observed during a sharp transition depressive state to manic (and vice versa). It is typical that the patient, being in a state of immobility (sitting or standing), follows what is happening with his eyes alone, maintaining a cheerful expression on his face. Occurs in schizophrenia, manic depressive psychosis.
Alcoholic stupor is extremely rare. Patients passively submit to examination, medical procedures. Occurs with alcoholic oneiroid, Heine-Wernicke encephalopathy.
Psychomotor is a complex of human motor acts that are closely related to mental activity and reflect the peculiarities of the constitution. The term “psychomotor” is used to distinguish complex movements associated with mental activity from elementary motor reactions associated with the simpler reflex activity of the central nervous system.
What are psychomotor disorders
Psychomotor disorders are disorders of complex motor behavior that can occur with various nervous and mental diseases. 
. With severe focal brain lesions (for example, with cerebral atherosclerosis) motor function disorders occur in the form of paralysis or paresis; with generalized organic processes (for example, with brain atrophy - a decrease in its volume), such disorders may be limited by general slowness, poverty voluntary movements, lethargy of facial expressions and gestures, monotony of speech, general stiffness and changes in gait (small steps).
Psychomotor disturbances occur and with some mental disorders. For example, in manic-depressive psychosis 
during depressive phases, general depression of the psyche occurs, with manic states- general motor agitation.
With a number psychogenic disorders changes in psychomotor behavior are sharply painful; for example, with hysterical reactions, complete or partial loss of movements in the limbs (hysterical paralysis), decreased strength of movements, and various coordination disorders are relatively often observed. During a hysterical attack, various facial movements of an expressive and defensive nature are observed.
Of particular importance are psychomotor disorders that occur with catotonic syndrome. These include motor disorders from minor changes in motor skills in the form of lethargy of facial expressions, mannerisms, pretentiousness of posture, movements and gait to pronounced manifestations of catatonic stupor (catatonia is neuropsychiatric disorder, expressed in muscle spasms and disturbance of voluntary movements) and phenomena of catalepsy (numbness or freezing with loss of the ability to make voluntary movements, occurs, for example, in hysteria).
Psychomotor disorders are divided into disorders accompanied by a decrease in range of motion (hypokinesia), an increase in range of motion (hyperkinesia) and involuntary movements that are part of normally smooth and controlled movements of the face and limbs (dyskinesia).
Hypokinesia
Hypokinesias include various shapes stupor – mental disorders 
in the form of suppression of all mental activity, including movements, thinking and speech. The following types of stupor occur:
- depressive stupor or melancholic numbness - melancholy, immobility, but at the same time maintaining the ability to react in some way to calls;
- hallucinatory stupor - occurs during hallucinations, while immobility is combined with facial reactions to the content of hallucinations - facial expressions express fear, surprise, joy; this condition can occur with certain poisonings, organic psychoses, and schizophrenia;
- asthenic stupor - lethargy and indifference to everything, patients understand what is being asked of them, but do not have the strength or desire to answer;
- hysterical stupor usually occurs in individuals with hysterical character traits (emotionality, desire to be the center of attention, demonstrativeness) - the patient may lie motionless for days and not respond to calls; if you force him to rise, he will resist;
- psychogenic stupor – the body’s reaction to mental trauma; in this case, immobility is combined with various disorders of the autonomic nervous system (it innervates internal organs And blood vessels) – rapid heartbeat, sweating, increased or decreased blood pressure;
- cataleptic stupor or waxy flexibility is a condition in which, against the background of increased muscle tone patients develop the ability to maintain long time the pose given to them.
In addition, hypokinesia includes a condition such as mutism - complete silence, when the patient does not answer questions and does not come into contact with anyone.
Violation psychomotor development in children early age(formation of cortical functions) is manifested by a lack of research interest in toys, in others, poverty of emotions, lack of object-manipulative activity, delay in the formation of impressive and expressive speech, play activity. Delayed motor development is closely related to mental skills. Assessment of psychomotor development (PMD) is proposed to be carried out according to the calendar of critical periods in the 1st, 3rd, 6th, 9th and 12th months ( calendar method) with determining whether the child’s chronological age corresponds to the age standard of psychomotor skills:
If the chronological age deviates from the calendar age by no more than 3 months, it is diagnosed mild degree violations of VMR or delay of VMR (“tempo” delay). A delay in certain motor skills is observed in rickets and in children who have suffered from somatic diseases. The outcome of this form of PMR is usually full recovery motor and mental functions, if there are no signs of brain damage according to neuroimaging. At the same time, the presence in a full-term three-month-old baby of a psychomotor status corresponding to 4 weeks of development may be alarming symptom deviations in the PMR.
A developmental delay of 3 to 6 months is recognized as a moderate violation of VUR, which determines the tactics of a detailed examination in order to find the cause of the disease. The average degree of PMR occurs in patients with neonatal hypoxic-ischemic encephalopathy with leukomalacia, periventricular hemorrhage of the second degree, in children who have had meningitis, with epilepsy, gene syndromes, and brain dysgenesis.
A delay in the development of a child for more than 6 months is recognized as a violation of severe VUR, which is combined with brain defects: aplasia frontal lobes, cerebellum, hypoxic-ischemic encephalopathy and periventricular hemorrhage III degree, metabolic disorders of amino acids and organic acids, necrotizing encephalopathy, leukodystrophy, tuberous sclerosis, chromosomal and gene syndromes, intrauterine encephalitis, congenital hypothyroidism.
In countries Western Europe to assess spontaneous motor activity baby infancy The Prechtl method is used (H.F.R.Prechtl). The child is observed for 30 - 60 minutes (including using video recording), then the table is filled out various types movements with a score. Illustrative is normal type motor activity at 3 - 5 months, which is called “fidgety” and represents multiple rapid movements of the neck, head, shoulder, torso, hip, fingers, feet, Special attention is given to “hand-face”, “hand-hand”, “leg-leg” contact. Convulsive synchronous movements of the arms and legs at 2–4 months reflect early manifestations of tetraparesis. A significant decrease in spontaneous movements of the arms and legs on one side in 2–3 months of life may subsequently manifest as spastic hemiparesis. Markers of spastic and dyskinetic forms of cerebral palsy at 3-5 months are the absence of leg lifting in a supine position, the absence of fussy movements (fidgety).
Additional Information :
Stages of sequential replacement of hand movements in a child up to one year old :
In a newborn and a child of 1 month. the hands are clenched into a fist, he cannot open the brush on his own. The grasping reflex is evoked. At 2 months the brushes are slightly open. At 3 months You can put a small rattle in the child’s hands, he grabs it, holds it in his hand, but he himself is not yet able to open his hand and release the toy. At the age of 3 - 5 months. the grasping reflex gradually reduces and is replaced by the ability to voluntarily and purposefully pick up objects. At 5 months the child can arbitrarily pick up an object lying in his field of vision. At the same time, he extends both hands and touches it. Delayed reduction of the grasping reflex leads to late formation of voluntary movements in the hands and is a clinically unfavorable sign. At 6 - 8 months. the accuracy of grasping an object is improved. The child takes it with the entire surface of his palm. Can transfer an object from one hand to another. At 9 months The child randomly releases toys from his hands. At 10 months a “pincer-like grip” appears with opposition thumb. The child can take small objects, while he pulls out a large one and index fingers and holds the object with them like tweezers. At 11 months a “pincer grip” appears: the thumb and index finger form a “claw” when grasping. The difference between a pincer grip and a pincer grip is that in the former the fingers are straight, while in the latter the fingers are bent. At 12 months a child can place an object precisely in a large dish or in the hand of an adult. Further improvement occurs fine motor skills and manipulation.
Stages of sequential replacement of movements in lower limbs in a child under one year old :
In a newborn and a child 1 - 2 months old. life there is a primitive reaction of support and automatic gait, which fades away by the end of 1 month. life. Child 3 - 5 months. holds your head well vertical position, but if you try to stand him up, he draws his legs in and hangs in the arms of an adult (physiological astasia-abasia). At 5 - 6 months. The ability to stand with the support of an adult, leaning on a full foot, gradually appears. During this period, the “jumping phase” appears. The child begins to jump, being placed on his feet: the adult holds him under the armpits, the child squats and pushes off, straightening his hips, legs and ankle joints. The appearance of the “jumping” phase important sign correct motor development, and its absence leads to delay and impairment of independent walking and is a prognostically unfavorable sign. At 10 months The child, holding onto the support, stands up independently. At 11 months the child can walk with support or along a support. At 12 months it becomes possible to walk holding one hand and, finally, take several independent steps.
source: article “Neurobiological and ontogenetic bases of the formation of motor functions” by A.S. Petrukhin, N.S. Sozaeva, G.S. Voice; Department of Neurology and Neurosurgery, State Educational Institution of Higher Professional Education, Russian State Medical University of Roszdrav, Maternity hospital 15, Moscow (Russian Journal of Child Neurology, Volume IV Issue No. 2, 2009)
read also:
article“Development of a child’s psychomotor skills in the first year of life and early diagnosis of its disorders” E.P. Kharchenko, M.N. Telnova; Federal State Budgetary Institution of Science Institute of Evolutionary Physiology and Biochemistry named after. THEM. Sechenov RAS, St. Petersburg, Russia (scientific and practical journal “Neurosurgery and Neurology childhood» No. 3, 2017) [read] or [read];
article (lecture for doctors) “Diagnostics and treatment of movement disorders in young children” by V.P. Zykov, T.Z. Akhmadov, S.I. Nesterova, D.L. Safonov; GOU DPO "RMAPO" Roszdrav, Moscow; Chechen State University, Grozny; Center Chinese medicine, Moscow (magazine " Effective pharmacotherapy"[Pediatrics], December, 2011) [read]
read the post: Early diagnosis children's cerebral palsy (to the website)
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In milder cases of oppression, the patient’s behavior is not disturbed so much that it is noticeable, and some patients skillfully hide their depressed mood and dissatisfaction with themselves. However, they complain of helplessness, delayed memory, thinking, etc., i.e., those phenomena that characterize mental inhibition. Patients of this kind have difficulty retaining the events of the past period in their memory, the vividness of memories fades, the mood “without hopes for the future” prevails, the consciousness of their inferiority, helplessness, and the feeling of their “worthlessness” prevails.
On the basis of a depressive mood, a misinterpretation of the surrounding, property situation, and underestimation is often created. good attitude loved ones and relatives, self-flagellation for innocent actions in the past. Some of the patients consider themselves sinners, guilty of something, etc. A delusional attitude with depressive overtones takes various forms: it can be directed in its own somatic sphere (hypochondriacal delusions) to others, transforming into the so-called delusional relationship or persecution. And here's the content depressive delirium depends largely on" individual characteristics the patient, his age, gender, previous lifestyle.
Psychomotor inhibition often gives a picture of depressive stupor: difficulty in speech, scant inexpressive gestures, negativism, refusal to eat, reluctance to move, etc. Sometimes depressed patients develop a feeling of fear, anxiety and attempts to commit suicide.
Psychomotor is understood as a set of consciously controlled motor actions. Symptoms psychomotor disorders may be presented by difficulty, slowdown in the performance of motor acts (hypokinesia) and complete immobility (akinesia) or symptoms of motor agitation or inadequacy of movements.
Symptoms of difficulty with motor activity include the following disorders:
catalepsy, waxy flexibility, in which, against the background of increased muscle tone, the patient has the ability to maintain a given position for a long time;
symptom air cushion, relating to manifestations of waxy flexibility and expressed in tension in the neck muscles, while the patient freezes with his head raised above the pillow;
/10 Part II. General psychopathology
hood symptom, in which patients lie or sit motionless, pulling a blanket, sheet or robe over their head, leaving open face;
passive subordination of the state, when the patient does not have resistance to changes in the position of his body, posture, position of the limbs, in contrast to catalepsy, muscle tone is not increased;
negativism, characterized by the patient’s unmotivated resistance to the actions and requests of others. Passive negativism is distinguished, which is characterized by the fact that the patient does not fulfill the request made to him, when trying to get him out of bed, he resists with muscle tension; with active negativism, the patient performs the opposite actions to the required ones. When asked to open his mouth, he compresses his lips when they extend their hand to him to say hello, and hides his hand behind his back. The patient refuses to eat, but when the plate is removed, he grabs it and quickly eats the food.
Mutism (silence) is a condition when the patient does not answer questions and does not even make it clear by signs that he agrees to come into contact with others
Symptoms with motor agitation and inappropriate movements include:
impulsiveness, when patients suddenly commit inappropriate acts, run away from home, commit aggressive actions, attack other patients, etc.;
stereotypies - repeated repetition of the same movements;
echopraxia - repetition of gestures, movements and postures of others;
paramimia - discrepancy between the patient’s facial expressions and actions and experiences;
echolalia - repetition of words and phrases of others;
Verbigeration - repetition of the same words and phrases;
passing, passing - a discrepancy in the meaning of the answers to the questions asked.
Speech disorders
Stuttering is a difficulty in pronouncing individual words or sounds, accompanied by a disturbance in the fluency of speech.
Dysarthria is slurred, halting speech. Difficulty in correctly articulating sounds. At progressive paralysis The patient's speech is so unclear that they say that he has “porridge in his mouth.” To identify dysarthria, the patient is asked to say tongue twisters.
Dyslalia - tongue-tiedness - a speech disorder characterized by incorrect pronunciation of individual sounds (omissions, replacement with another sound or its distortion).
Oligophasia - impoverished speech, small vocabulary. Oligophasia can be observed in patients with epilepsy after a seizure.
Chapter 10. Psychomotor disorders 111
Logoclony is a spastic repeated repetition of individual syllables of a word.
Bradyphasia is slowing of speech as a manifestation of inhibition of thinking.
Aphasia is a speech disorder characterized by a complete or partial loss of the ability to understand someone else’s speech or to use words and phrases to express one’s thoughts, caused by damage to the cortex of the dominant hemisphere of the brain, in the absence of disorders of the articulatory apparatus and hearing.
Paraphasia is a manifestation of aphasia in the form of incorrect speech construction (violation of the order of words in a sentence, replacement of individual words and sounds with others).
Akatophasia is a speech disorder, the use of words that sound similar but do not have the same meaning.
Schizophasia is broken speech, a meaningless set of individual words, expressed in a grammatically correct sentence.
Cryptolalia - creation of the sick own language or a special font.
Logorrhea is the uncontrollability of the patient’s speech, combined with its speed and verbosity, with a predominance of associations of consonance or contrast.
Movement disorder syndromes
Movement disorders can be represented by stuporous states, motor agitation, various obsessive movements, actions and seizures.
Stupor
Stupor - complete immobility with mutism and weakened reactions to irritation, including pain. I highlight! " various options stuporous states, catatonic, reactive, depressive stupor. The most commonly observed is catatonic stupor, which develops as a manifestation of the cponic syndrome and is characterized by passive pennivism or waxy flexibility or (in the most severe form) severe muscle hypertension with numbness of the patient and note With bent limbs
Being in a stupor, patients do not come into contact with others, do not react to current events, can we tell? No amenities, noise, wet and dirty bed. They can in- iu»iiiph# pour if a fire, earthquake or some other extreme event occurs. Patients usually lie down and the muscles are tense; the tension often begins with the left i i muscles, then goes down to the neck, later on the muscles.
/12 Part P. General psychopathology
on your back, arms and legs. In this state, there is no emotional or pupillary response to pain. Bumke's symptom - dilation of the pupils in response to pain - is absent.
Stupor with waxy flexibility is distinguished, in which, in addition to mutism and immobility, the patient maintains the given position for a long time, freezes with a raised leg or arm in an uncomfortable position. Pavlov's symptom is often observed: the patient does not respond to questions asked in a normal voice, but responds to whispered speech. At night, such patients can get up, walk, put themselves in order, sometimes eat and answer questions.
Negativistic stupor is characterized by the fact that with complete immobility and mutism, any attempt to change the patient’s position, lift him or turn him over causes resistance or opposition. It is difficult to get such a patient out of bed, but once raised, it is impossible to put him back down. When trying to be brought into the office, the patient resists and does not sit down on the chair, but the seated person does not get up and actively resists. Sometimes active negativism is added to passive negativism. If the doctor extends his hand to him, he hides his hand behind his back, grabs food when it is about to be taken away, closes his eyes when asked to open, turns away from the doctor when asked a question, turns and tries to speak when the doctor leaves, etc.
Stupor with muscle numbness is characterized by the fact that patients lie in the intrauterine position, muscles are tense, eyes are closed, lips are pulled forward (proboscis symptom). Patients usually refuse to eat and have to be fed through a tube or undergo amytalcaffeine disinhibition and feed at a time when the manifestations of muscle numbness decrease or disappear.
In a substuporous state, immobility is incomplete, mutism persists, but patients can sometimes utter a few words spontaneously. Such patients move slowly around the department, freezing in uncomfortable, pretentious positions. Refusal to eat is not complete; patients can most often be fed from the hands of staff and relatives.
With depressive stupor with almost complete immobility, patients are characterized by a depressed, pained expression on their face. You manage to make contact with them and get a monosyllabic answer. Patients in a depressive stupor are rarely untidy in bed. This stupor can suddenly change acute condition excitement - melancholic raptus, in which patients jump up and hurt themselves, can tear their mouths, tear out an eye, break their heads, tear their underwear, and can roll on the floor howling. Depressive stupor is observed in severe endogenous depression.
Chapter 10. Psychomotor disorders 113
With apathetic stupor, patients usually lie on their backs, do not react to what is happening, and muscle tone is reduced. Questions are answered in monosyllables with a long delay. When contacting relatives, the reaction is adequate emotional. Sleep and appetite are disturbed. They are untidy in bed. Apathetic stupor is observed during prolonged symptomatic psychoses, with Gaye-Wernicke encephalopathy.
Psychomotor agitation- psychopathological condition with a pronounced increase in mental and motor activity. There are catatonic, hebephrenic, manic, impulsive and other types of excitation.
Catatonic arousal is manifested by mannered, pretentious, impulsive, uncoordinated, sometimes rhythmic, monotonously repeated movements and talkative speech, even to the point of incoherence. The behavior of patients is devoid of purposefulness, impulsive, monotonous, and there is a repetition of the actions of others (echopraxia). Facial expressions do not correspond to any feelings; there is an elaborate grimace. Catatonic excitement can take on a confused-pathetic character, negativism is replaced by passive submission.
There are lucid catatonia, in which catatonic arousal is combined with other psychopathological symptoms: delusions, hallucinations, mental automatisms, but without clouding of consciousness, and oneiric catatonia, characterized by oneiric clouding of consciousness.
Motor excitement
Hebephrenic arousal is manifested by absurdly foolish behavior (grimacing, antics, unmotivated laughter, etc.). Patients jump, gallop, mimic those around them, pester them with ridiculous or cynical questions, tug at others, push them, and sometimes roll on the floor. The mood is often elevated, but gaiety can quickly give way to crying, sobs, and cynical abuse. Speech is accelerated, there are a lot of pretentious words and neologisms.
Manic arousal is manifested by increased mood and well-being, characterized by expressive facial expressions and gestures, acceleration of associative processes and speech, and increased, often chaotic, activity. Each action of the patient is purposeful, but since the motivation for activity and distractibility quickly change, not a single action is completed, so the state gives the impression of chaotic excitement. Speech is also accelerated, leading to a race of ideas.
