Psychomotor Retardation
Psychomotor retardation is a generalised slowing of physical movement, speech, and thinking, seen in more severe forms of depressive illness, so that the person moves, speaks, and responds noticeably more slowly than usual, with delayed replies, reduced spontaneous movement, and a subjective sense of being physically and mentally weighed down.
This has traditionally been recognised as a marker of more severe depressive illness, and at its most extreme can progress to depressive stupor, in which movement and speech slow to the point of near or complete cessation, representing a psychiatric emergency.
Recognition features
- Slowed physical movement, including reduced spontaneous gesture and slowed gait
- Delayed responses in conversation, with noticeably longer pauses before answering
- Slowed, sometimes quiet or monotonous speech
- A subjective sense, often reported by the person themselves, of feeling physically weighed down or as though moving through treacle
Eliciting it at interview
- Observe the pace of movement, gesture, and speech directly during the interview, noting response latency
- Ask the person directly whether they feel physically slowed down, and how this compares with their usual pace
- In severe cases, assess carefully for progression toward stupor, including hydration, nutrition, and physical safety, given the emergency nature of that presentation
Distinguishing features
- Differs from apathy in being specifically a physical and cognitive slowing rather than primarily a reduction in interest or concern
- Differs from catatonic presentations of motor disorder in typically being a smooth, generalised slowing rather than the specific postural and motor phenomena seen there, though severe retardation can shade into stupor
- A marker of depressive illness severity, distinguishing a more advanced presentation from milder depressive states
Common misconceptions
- That psychomotor retardation is the same as simple tiredness or low energy; the slowing here is a more global, observable change in the pace of movement, speech, and thought
- That this feature is always obvious; milder degrees of slowing can be subtle and are better appreciated by comparing the person's current pace with their known usual manner
Related phenomena
Depressive Illness · Apathy · Obstruction (Blocking) · Disorders of Expressive Movement · Depressive Stupor
Diagnostically relevant to
Major Depressive Disorder (links open the DSM-5 Learning Lab)
Practice this
A 60-year-old man with severe depressive illness takes noticeably long pauses before answering even simple questions, moves slowly and with little spontaneous gesture, and describes feeling as though he is "moving through treacle." What is this? · A 68-year-old woman with severe depressive illness sits mostly motionless during the interview, answers only after long pauses, and her daughter reports she now takes over an hour to get dressed in the morning, compared with about ten minutes previously. Before revealing the answer: is this psychomotor retardation? · A severely depressed patient shows profound slowing. Before revealing the answer, decide what distinguishes depressive stupor from psychomotor retardation more broadly. · A patient's movements are slowed or hindered. Before revealing the answer, decide what distinguishes obstruction from psychomotor retardation. · You are assessing a patient with known depressive illness and want to establish whether psychomotor retardation is present. Which single question or approach would most efficiently confirm it at interview? · A patient's family reports she now takes far longer to complete everyday tasks than she used to, though she denies feeling unusually tired. Why is comparing her current pace against her own previous baseline more useful than asking about tiredness alone?
Illustration
During an assessment, a 62-year-old man takes ten to fifteen seconds to answer even simple questions, his voice barely above a murmur, and he describes feeling as though every small movement, even lifting a cup of tea, requires an effort out of all proportion to the task, a change his daughter says has crept up over the past month.
References
- Casey, P. & Kelly, B. (2019). Fish's Clinical Psychopathology, 4th ed. Ch. 6, 'Disorders of Emotion'.