Review Article : Motor disorder: A psychological perspective 1 2 3 Shivani, Neha Sayeed, Sujit Sarkhel, ABSTRACT: From the point of view of the ‘psychic reflex arc’ all psychiatric events merge into motor phenomena, which assist the final inner elaboration of stimuli into external world. We can therefore examine the many, often grotesque, movements of mental patients from two points of view. Either we try to acquaint ourselves with the disturbances of motor mechanism itself, which can show disturbances independent of any psychiatric anomaly and this is the approach adopted by neurology. Or we try to know the abnormal psychic life and the patient’s volitional awareness, which these conspicuous movements exhibit. In so far as we know the meaningful connections, the movement becomes behavior we understand, for instance the delight in activity shown by the manic patients in their exuberance or the increased urge to move shown by the patients who are desperately anxious. Somewhat between neurological phenomena and the psychological phenomena lie the psychotic motor phenomena which we register without being able to comprehend them satisfactorily one way or the other. They can be explained psychologically. Some of the disorders various culturally. Motor disorder can be assessed and managed psychologically Key words: motor disorder ,assessment, management INTRODUCTION: Motor behavior is normally finely coordinated, purposeful, and adaptive, and necessary activities are usually carried out efficiently. Abnormal movements have been recognized as aspects of behavioral illness for millennia, and all severe psychiatric conditions are associated with changes in motor functioning. In so far as we know the meaningful connections, the movement becomes behavior we understand, for instance the delight in activity shown by the manic patients in their exuberance or the increased urge to move shown by the patients who are desperately anxious. Somewhat between neurological phenomena and the psychological phenomena lie the psychotic motor phenomena which we register without being able to comprehend them satisfactorily one way or the other. MOTOR DISORDER, IS IT NEUROGENIC OR PSYCHOGENIC? Much of the terminology used to describe motor disorder is for several reasons unsatisfactory because of the ancient but still persistent mind brain dichotomy. With advances in neuroscience and neuropsychiatry it is become increasingly difficult to differentiate between what were an earlier, simpler time called abnormal movement due to organic brain disorder and those due to psychiatric or psychogenic disorder. Fahn et al (1998) define psychogenic movement disorders as abnormal movements that do not result from a known organic cause but are caused by psychological condition. While that may be true, it is not a particularly helpful definition. Because what is the known organic cause for essential tremors, spasmodic dystonia, torsion dystonia and so on? They are universally thought to be organic disorder but are still without any demonstrable neuroimaging, neuropathological, or neurochemical abnormalities. Stress makes most movement disorder temporarily worse and in sleep, almost all of them disappear. So where does psychology end and neurology begin? (Joseph & Young, 1999). CLINICALASSESSMENT OF MOTOR DISORDER In psychiatric disturbances, motor abnormalities can involve generalized over activity or under activity or manifest in a wide range of specific disorders of movement. General appearance and behavior is more informative than any available tool and thus any assessment of motor disorder should start as soon as the patient walks towards the examiner. Look for level of arousal and attention, hygiene, grooming and dress, activity level, spontaneity or imitation of act, symbolic movements like gestures, grimaces or any tics or mannerisms, swing of arms and dyskinetic movements if any. Any real or hallucinatory perceptions seem to modify behavior of patient. If inactive is he resisting movement or maintaining postures or can be re-postured abnormally. Is he obeying command, is he over-compliant or he does exact opposite of instruction. Is there any expressive movement over face or any signs of emotional responsiveness? Look for rigidity of limbs. Take note of Eastern J. Psychiatry Vol. 14, No. 1-2 7