Psychomotor disturbances in psychiatric patients as a possible basis for new attempts at differential diagnosis and therapy

This study investigates the presence and course of motor symptoms in endogenous (n = 42) and non-endogenous (n = 15) depressed patients (both medicated and unmedicated) in comparison to 15 healthy control persons. As in our previous studies on schizophrenic and depressed patients, we used a motor test battery, which consisted of the Motorische Leistungsserie, a modified version of the Lincoln Oseretzky Motor Development Scale and the motor subtest of the Luria Nebraska Neuropsychological Battery. Previous findings had suggested the existence of a psychotic motor syndrome (PMS) in endogenous depressed patients (and schizophrenics), involving disturbances of the lips and tongue, fine and gross movements of the dominant right hand and the complex motor coordination of the extremities. We re-confirmed the PMS in acute endogenous depressed patients, both medicated and unmedicated. Such a motor syndrome did not exist in healthy controls, or in non-endogenous depressed patients, irrespective of the severity of the depressive syndrome. This PMS showed a clear improvement with the amelioration of the depressive symptoms in endogenous depressed patients towards the end of the hospital treatment period and disappeared entirely in patients in a symptom free interval. This may be suggestive of a possible role for the PMS as a state marker for endogenous depression, in contrast to the persistence of the PMS in schizophrenics (trait marker), described previously. The results of factorial analyses on motor performance did not reveal differences in the factorial structure between depressives, schizophrenics and normals. However, they indicated disturbances on a general motor factor, which may account for the performance deficits in psychotic patients. This may be in accordance with signs of diffuse alterations of brain function during analogous motor activation in these patients demonstrated recently with neuro-imaging methods.