Psychomotor semiology in depression: a standardized clinical psychomotor approach

A Paquet, A Lacroix, B Calvet, M Girard, A Paquet, A Lacroix, B Calvet, M Girard

Abstract

Background: Although psychomotor symptoms are associated with the clinical symptomatology of depression, they are rarely assessed and standardized clinical evaluation tools are lacking. Psychomotor retardation is sometimes assessed through direct patient observations by clinicians or through a clinical observation grid, in the absence of a standardized psychomotor assessment. In this pilot study, we evaluated the feasibility of standardized psychomotor examination of patients with major depressive disorder (MDD) and detailed a psychomotor semiology in these patients.

Methods: We used a standardized psychomotor assessment to examine 25 patients with MDD and 25 age- and sex-matched healthy controls (HC) and compared their psychomotor profiles. Using standardized tests, we assessed muscle tone and posture, gross motor skills, perceptual-motor skills, and body image/organization. Clinical assessments of depressive symptoms (levels of psychomotor retardation, anxiety, and self-esteem) comprised this detailed psychomotor examination.

Results: All participants were examined using the standardized psychomotor assessment. The main results of the psychomotor examination highlighted low body image of MDD participants (p < 0.001). Significant differences between groups were found in passive muscle tone, posture, emotional control, jumping, manual dexterity, walking, and praxis. Among these psychomotor variables, body image, passivity, jumping and rhythm scores predicted an MDD diagnosis.

Conclusions: Beyond the psychomotor retardation known to be present in MDD patients, this examination revealed an entire psychomotor symptomatology characterized by elevated muscle tone, poor body image associated with poor self-esteem, slowness in global motor skills and manual praxis, and poor rhythmic adaptation. In light of these results, we encourage clinicians to consider using a standardized tool to conduct detailed psychomotor examination of patients with depressive disorders.

Trial registration: ClinicalTrials.gov identifier: NCT04031937 , 24/07/2019.

Keywords: Body Image; Major Depression Disorder; Muscular Tone; Perceptual-Motor Skill; Psychomotor Semiology.

Conflict of interest statement

I declare that the authors have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Four domains assessed by the psychomotor examination

References

    1. Caligiuri MP, Ellwanger J. Motor and cognitive aspects of motor retardation in depression. J Affect Disord. 2000;57(1–3):83–93. doi: 10.1016/S0165-0327(99)00068-3.
    1. Lohr JB, May T, Caligiuri MP. Quantitative assessment of motor abnormalities in untreated patients with major depressive disorder. J Affect Disord. 2013;146(1):84–90. doi: 10.1016/j.jad.2012.08.043.
    1. APA . Diagnostic and Statistical Manual of mental disorders. 5. Arlington, VA: American Psychiatric Publishing; 2013.
    1. Bennabi D, Vandel P, Papaxanthis C, Pozzo T, Haffen E. Psychomotor Retardation in Depression: A Systematic Review of Diagnostic, Pathophysiologic, and Therapeutic Implications. BioMed Res Int. 2013;2013:e158746. doi: 10.1155/2013/158746.
    1. Hausdorff JM, Peng CK, Goldberger AL, Stoll AL. Gait unsteadiness and fall risk in two affective disorders: a preliminary study. BMC Psychiatry. 2004;4:39. doi: 10.1186/1471-244X-4-39.
    1. Michalak J, Troje NF, Fischer J, Vollmar P, Heidenreich T, Schulte D. Embodiment of sadness and depression–gait patterns associated with dysphoric mood. Psychosom Med juin. 2009;71(5):580–587. doi: 10.1097/PSY.0b013e3181a2515c.
    1. Parker G, Hadzi-Pavlovic D. Melancholia: a disorder of movement and mood: a phenomenological and neurobiological review. Cambridge: Cambridge University Press; 1996.
    1. Sobin C, Mayer L, Endicott J. The Motor Agitation and Retardation Scale. J Neuropsychiatry Clin Neurosci. 1998;10(1):85–92. doi: 10.1176/jnp.10.1.85.
    1. Schrijvers D, Hulstijn W, Sabbe BG. Psychomotor symptoms in depression: a diagnostic, pathophysiological and therapeutic tool. J Affect Disord. 2008;109(1):1–20. doi: 10.1016/j.jad.2007.10.019.
    1. Sobin C, Sackeim HA. Psychomotor symptoms of depression. Am J Psychiatry. 1997;154(1):4–17. doi: 10.1176/ajp.154.1.4.
    1. van Diermen L, Vanmarcke S, Walther S, Moens H, Veltman E, Fransen E, et al. Can psychomotor disturbance predict ect outcome in depression? J Psychiatr Res. 2019;1(117):122–128. doi: 10.1016/j.jpsychires.2019.07.009.
    1. Lacroix A, Calvet B, Laplace B, Lannaud M, Plansont B, Guignandon S, et al. Predictors of clinical response after rTMS treatment of patients suffering from drug-resistant depression. Transl Psychiatry. 2021;11(1):1–7. doi: 10.1038/s41398-021-01555-9.
    1. Damme KSF, Park JS, Vargas T, Walther S, Shankman SA, Mittal VA. Motor Abnormalities, Depression Risk, and Clinical Course in Adolescence. Biol Psychiatry Glob Open Sci. 2022;2(1):61–9. doi: 10.1016/j.bpsgos.2021.06.011.
    1. Greden JF, Carroll BJ. Psychomotor function in affective disorders: An overview of new monitoring techniques. Am J Psychiatry. 1981;138(11):1441–1448. doi: 10.1176/ajp.138.11.1441.
    1. Widlöcher D, Ghozlan A. The measurement of retardation in depression. Hum Psychopharmacol Meas Methods. 1989;2:1–22.
    1. Parker G, Hadzi-Pavlovic D, Boyce P, Wilhelm K, Brodaty H, Mitchell P, et al. Classifying Depression by Mental State Signs. Br J Psychiatry juill. 1990;157(1):55–65. doi: 10.1192/bjp.157.1.55.
    1. Parker G, Hadzi-Pavlovic D, Wilhelm K, Hickie I, Brodaty H, Boyce P, et al. Defining Melancholia: Properties of a Refined Sign-Based Measure. Br J Psychiatry mars. 1994;164(3):316–326. doi: 10.1192/bjp.164.3.316.
    1. BelvederiMurri M, Triolo F, Coni A, Tacconi C, Nerozzi E, Escelsior A, et al. Instrumental assessment of balance and gait in depression: A systematic review. Psychiatry Res. 2020;284:112687. doi: 10.1016/j.psychres.2019.112687.
    1. Wang Y, Wang J, Liu X, Zhu T. Detecting Depression Through Gait Data: Examining the Contribution of Gait Features in Recognizing Depression. Front Psychiatry. 2021;12:661213. doi: 10.3389/fpsyt.2021.661213.
    1. Mergl R, Pogarell O, Juckel G, Rihl J, Henkel V, Frodl T, et al. Hand-motor dysfunction in depression: characteristics and pharmacological effects. Clin EEG Neurosci avr. 2007;38(2):82–88. doi: 10.1177/155005940703800210.
    1. Pier M, Hulstijn W, Sabbe BGC. Differential patterns of psychomotor functioning in unmedicated melancholic and nonmelancholic depressed patients. J Psychiatr Res. 2004;38(4):425–435. doi: 10.1016/j.jpsychires.2003.11.008.
    1. Shankman SA, Mittal VA, Walther S. An Examination of Psychomotor Disturbance in Current and Remitted MDD: An RDoC Study. J Psychiatry Brain Sci. 2020;5:e200007.
    1. Janssens S, Moens H, Coppens V, Vandendriessche F, Hulstijn W, Sabbe B, et al. Psychomotor assessment as a tool to differentiate schizophrenia from other psychotic disorders. Schizophr Res. 30 juin 2017 [cité 10 oct 2017]; Disponible sur:
    1. Zhao Q, Ma Y tao, Lui SSY, Liu W hua, Xu T, Yu X, et al. Neurological soft signs discriminate schizophrenia from major depression but not bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2013;43:72–8. doi: 10.1016/j.pnpbp.2012.12.006.
    1. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23(1):56. doi: 10.1136/jnnp.23.1.56.
    1. Hamilton M. Development of a Rating Scale for Primary Depressive Illness. Br J Soc Clin Psychol. 1967;6(4):278–296. doi: 10.1111/j.2044-8260.1967.tb00530.x.
    1. Zimmerman M, Martinez JH, Young D, Chelminski I, Dalrymple K. Severity classification on the Hamilton Depression Rating Scale. J Affect Disord. 2013;150(2):384–8. doi: 10.1016/j.jad.2013.04.028.
    1. Hamilton M. The Assessment of Anxiety States by Rating. Br J Med Psychol. 1959;32(1):50–55. doi: 10.1111/j.2044-8341.1959.tb00467.x.
    1. Parker G. Classifying Depression: Should Paradigms Lost Be Regained? Am J Psychiatry. 2000;157(8):1195–203. doi: 10.1176/appi.ajp.157.8.1195.
    1. Rosenberg M. Rosenberg self-esteem scale (RSE) Accept Commit Ther Meas Package. 1965;61(52):18.
    1. Vaivre-Douret L. Batterie d’évaluation des fonctions neuro-psychomotrices de l’enfant. Paris: ECPA; 2006. p. 329.
    1. Paquet A, Olliac B, Bouvard MP, Golse B, Vaivre-Douret L. The semiology of motor disorders in Autism Spectrum Disorders as highlighted from a standardized neuro-psychomotor assessment. Front Psychol. 2016;7:1292. doi: 10.3389/fpsyg.2016.01292.
    1. Paquet A, Olliac B, Golse B, Vaivre-Douret L. Nature of motor impairments in autism spectrum disorder: A comparison with developmental coordination disorder. J Clin Exp Neuropsychol. 2018;41(1):1‑14.
    1. Rey A. Test de copie d’une figure complexe. Les Editions du Centre de Psychologie Appliquée. Paris: ECPA; 1959. p. 24.
    1. Bruchon-Schweitzer M. Dimensionality of the body-image: the body-image questionnaire. Percept Mot Skills. 1987;65(3):887–892. doi: 10.2466/pms.1987.65.3.887.
    1. Daurat-Meljac C, Stamback M, Bergès J. Manuel du test du Schéma Corporel. Paris: ECPA; 1966.
    1. Meljac C, Fauconnier E, Scalabrini J. Epreuve de Schéma Corporel-Révisée. ECPA. Montreuil: ECPA; 2010.
    1. Dubois B, Slachevsky A, Litvan I, Pillon B. The FAB: a frontal assessment battery at bedside. Neurology. 2000;55(11):1621–1626. doi: 10.1212/WNL.55.11.1621.
    1. Park C, Rosenblat JD, Lee Y, Pan Z, Cao B, Iacobucci M, et al. The neural systems of emotion regulation and abnormalities in major depressive disorder. Behav Brain Res. 2019;367:181–8. doi: 10.1016/j.bbr.2019.04.002.
    1. Vinkers CH, Kuzminskaite E, Lamers F, Giltay EJ, Penninx BWJH. An integrated approach to understand biological stress system dysregulation across depressive and anxiety disorders. J Affect Disord. 2021;283:139–46. doi: 10.1016/j.jad.2021.01.051.
    1. André-Thomas, de Ajuriaguerra J. Etude sémiologique du tonus musculaire. Paris: Fammarion; 1949. p. 844.
    1. Kober H, Barrett LF, Joseph J, Bliss-Moreau E, Lindquist K, Wager TD. Functional grouping and cortical–subcortical interactions in emotion: a meta-analysis of neuroimaging studies. Neuroimage. 2008;42(2):998–1031. doi: 10.1016/j.neuroimage.2008.03.059.
    1. Venkatraman A, Edlow BL, Immordino-Yang MH. The Brainstem in Emotion: A Review. Front Neuroanat. 2017 [cité 19 mai 2021];11. Disponible sur:
    1. Paillard J. Tonus, postures et mouvements. Physiologie. 1976;2:521–728.
    1. Takakusaki K, Oohinata-Sugimoto J, Saitoh K, Habaguchi T. Role of basal ganglia–brainstem systems in the control of postural muscle tone and locomotion. In: Progress in Brain Research [Internet]. Elsevier; 2004 [cité 19 mai 2021]. p. 231‑7. (Brain Mechanisms for the Integration of Posture and Movement; vol. 143). Disponible sur:
    1. Wallon H. Les origines du caractère chez l’enfant. Les préludes du sentiment de personnalité. 1934.
    1. de Ajuriaguerra J, Angelergues R. De la psychomotricité au corps dans la relation avec autrui; à propos de l’œuvre d’Henri Wallon. L’évolution Psychiatr. 1962;27:13–25.
    1. Pavlidou A, Viher PV, Bachofner H, Weiss F, Stegmayer K, Shankman SA, et al. Hand gesture performance is impaired in major depressive disorder: A matter of working memory performance? J Affect Disord. 2021;292:81–8. doi: 10.1016/j.jad.2021.05.055.
    1. Razavi N, Horn H, Koschorke P, Hügli S, Höfle O, Müller T, et al. Measuring motor activity in major depression: The association between the Hamilton Depression Rating Scale and actigraphy. Psychiatry Res. 2011;190(2):212–6. doi: 10.1016/j.psychres.2011.05.028.
    1. Sandmeir A, Schoenherr D, Altmann U, Nikendei C, Schauenburg H, Dinger U. Depression Severity Is Related to Less Gross Body Movement: A Motion Energy Analysis. Psychopathology. 2021;54(2):106–112. doi: 10.1159/000512959.
    1. Amini-Tehrani M, Zamanian H, Daryaafzoon M, Andikolaei S, Mohebbi M, Imani A, et al. Body image, internalized stigma and enacted stigma predict psychological distress in women with breast cancer: A serial mediation model. J Adv Nurs août. 2021;77(8):3412–3423. doi: 10.1111/jan.14881.
    1. Aquil A, El Kherchi O, El Azmaoui N, Mouallif M, Guerroumi M, Chokri A, et al. Body image dissatisfaction and lower self-esteem as major predictors of poor sleep quality in gynecological cancer patients after surgery: cross-sectional study. BMC Womens Health. 2021;21(1):229. doi: 10.1186/s12905-021-01375-5.
    1. Chopra D, De La Garza R, Lacourt TE. Clinical relevance of a Body Image Scale cut point of 10 as an indicator of psychological distress in cancer patients: results from a psychiatric oncology clinic. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 2021;29(1):231–7.
    1. Chopra D, De La Garza R. Depressive, anxiety, and distress symptoms among cancer patients who endorse appearance problems. Palliat Support Care juin. 2019;17(3):328–332. doi: 10.1017/S1478951518000494.
    1. Ahern E, Semkovska M. Cognitive functioning in the first-episode of major depressive disorder: A systematic review and meta-analysis. Neuropsychology janv. 2017;31(1):52–72. doi: 10.1037/neu0000319.
    1. Rock PL, Roiser JP, Riedel WJ, Blackwell AD. Cognitive impairment in depression: a systematic review and meta-analysis. Psychol Med juill. 2014;44(10):2029–2040. doi: 10.1017/S0033291713002535.
    1. Hirjak D, Fritze S, Northoff G, Kubera KM, Wolf RC. Die sensomotorische Domäne im Research-Domain-Criteria-System: Fortschritte und Perspektiven. Nervenarzt. 2021 [cité 18 mai 2022]; Disponible sur:
    1. Walther S, Bernard J a, Mittal VA, Shankman S a. The utility of an RDoC motor domain to understand psychomotor symptoms in depression. Psychol Med. 2019;49(2):212–6. doi: 10.1017/S0033291718003033.

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