Psychomotor
What psychomotor means in a mental status exam, psychomotor agitation vs retardation, other movement findings such as akathisia and catatonia, and how to chart them.
Quick Answer
Psychomotor activity is the part of the mental status exam that describes how a person moves: the amount, speed and quality of movement and any unusual movements. A typical normal finding is “no psychomotor agitation or retardation.” Psychomotor agitation is increased, restless activity such as pacing, fidgeting or hand-wringing. Psychomotor retardation is slowed movement and speech, with long pauses before answers. Both are DSM-5-TR criteria for a major depressive episode when observable by others. Also chart akathisia, tremor, tics, involuntary movements and signs of catatonia.
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Definition
Psychomotor refers to the link between mental state and physical movement. In a mental status exam, psychomotor activity (also called motor activity or psychomotor behavior) describes what you observe about the person’s movement: how much they move, how fast, and whether any movements are unusual.
Changes in psychomotor activity are common in depression, mania, anxiety, psychosis, intoxication and withdrawal, and can also come from medications and medical or neurological conditions. For a major depressive episode, the DSM-5-TR counts psychomotor agitation or retardation nearly every day only when it is observable by others, not just a feeling of being restless or slowed down. That is why your own observation matters.
Common psychomotor findings
Describe what you saw. A label plus a short example is clearer than either alone.
| Finding | What it looks like | Example wording |
|---|---|---|
| Within normal limits | Usual amount and speed of movement for the setting | “No psychomotor agitation or retardation observed.” |
| Psychomotor agitation | Increased, purposeless activity: pacing, fidgeting, hand-wringing, unable to sit still | “Psychomotor agitation: stood and paced three times, wrung hands throughout.” |
| Psychomotor retardation | Slowed movement and speech, long pauses before answering, few gestures | “Psychomotor retardation: 5–10 second pauses before answers, slow gait, minimal gestures.” |
| Akathisia | Inner restlessness with an urge to move, such as shifting legs or rocking; often linked to antipsychotics and some antidepressants | “Constant leg shifting; describes feeling ‘like I have to move’ since dose increase two weeks ago.” |
| Tremor | Rhythmic shaking, at rest or with movement | “Fine tremor of both hands when holding a cup.” |
| Tics | Sudden, brief, repeated movements or sounds | “Frequent eye-blinking and shoulder-shrugging tics, unchanged from baseline.” |
| Involuntary movements (for example tardive dyskinesia) | Repetitive movements, often of the mouth, tongue or face, after long-term use of some medications | “Repetitive lip-smacking and tongue movements noted; not seen at last visit.” |
| Catatonic signs | Stupor, mutism, holding odd postures, resisting being moved, or copying the clinician’s words or movements | “Mute, held arm raised for 2 minutes, did not respond to questions.” |
Agitation vs akathisia. Agitation is restlessness that reflects the person’s emotional state. Akathisia is a medication side effect with an inner urge to move. They can look alike, so ask about recent medication starts or dose changes and tell the prescriber promptly if akathisia is possible, because it is very distressing and can raise risk.
How to chart psychomotor activity in an MSE or progress note
Record what you saw, how often, and how it compares with baseline. For new movements, note any recent medication changes and who you told.
Weak documentation: “Psychomotor slowed.”
Stronger documentation: “Psychomotor retardation: walked slowly to the chair, 5–10 second pauses before most answers, few gestures. More slowed than at intake three weeks ago, when answers were prompt.”
Psychomotor findings in a SOAP note
Psychomotor findings go in Objective with the rest of the mental status exam. A short fictional example:
Subjective: Fictional adult client, 52, outpatient, session 4 for depression. Reports feeling “slowed down, like walking through mud,” sleeping 10 hours and still tired, and eating one meal a day. Has not missed work but is struggling to finish tasks. No medication changes; does not take psychiatric medication.
Objective: PHQ-9: 19 (moderately severe), up from 14 at intake; item 9 scored 0. Psychomotor retardation: slow gait, 5–10 second pauses before most answers, monotone speech, minimal gestures; no tremor or abnormal movements. Mood “flat”; affect blunted and congruent. Thought process slowed but linear. On direct questioning, denied thoughts of death or suicide, intent or plan; no past suicide attempts or self-harm. Drinking fluids normally; weight stable per client.
Assessment: Depressive symptoms worse over three weeks, with observable psychomotor retardation. No suicidal thoughts reported. No new medications to suggest a medication effect; medical causes such as thyroid problems have not been checked recently.
Plan: With client’s consent, therapist contacted his primary care physician today; appointment this week for a medical review, including labs, and to discuss medication. Continue weekly sessions with behavioral activation, starting with one short daily walk. Client and his partner know to call 911 or go to the nearest emergency department if he stops eating or drinking, becomes unresponsive or cannot keep himself safe, and to call or text 988 if thoughts of suicide arise.
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Tips for documenting psychomotor activity
Describe, then label: Write what you saw, such as pacing or long pauses, then the term. A label alone is hard to compare between sessions.
Separate observed from reported: For depression criteria, agitation or retardation must be observable by others. Chart what you saw in Objective and what the person feels in Subjective.
Ask about medications: New restlessness, tremor or abnormal movements after a medication start or dose change should be reported to the prescriber.
Compare with baseline: Note whether the finding is new, better or worse than at earlier sessions.
Know the emergencies: Signs of catatonia with fever, muscle stiffness, confusion or not eating or drinking need emergency care: call 911 or go to the nearest emergency department.
Consider the setting: Pain, physical illness, fatigue and cultural norms affect how people move; note anything that may explain what you see.
Common mistakes to avoid
- Only writing “PMA” or “PMR”: abbreviations without an example do not show how severe the change is
- Calling akathisia anxiety: missing a medication side effect delays the fix
- Skipping abnormal movements: tremor, tics and involuntary movements belong in the motor section too
- Charting reported slowness as observed: only what you saw counts as observed psychomotor retardation
- Copying it forward: record this session’s movement, not last session’s line
Frequently asked questions
What does psychomotor mean in a mental status exam?
Psychomotor activity describes how a person moves: the amount, speed and quality of movement and any unusual movements. A typical normal finding is “no psychomotor agitation or retardation.” Abnormal findings include agitation, retardation, akathisia, tremor, tics, involuntary movements and catatonic signs.
What is the difference between psychomotor agitation and psychomotor retardation?
Psychomotor agitation is increased, restless activity such as pacing, fidgeting or hand-wringing. Psychomotor retardation is slowed movement and speech, such as a slow walk, long pauses before answering and few gestures. Both can occur in depression; agitation is also common in mania, anxiety and withdrawal.
Is psychomotor retardation a symptom of depression?
Yes. The DSM-5-TR lists psychomotor agitation or retardation nearly every day as one of the criteria for a major depressive episode, but only when it is observable by others, not just a feeling of being slowed down. It can also have other causes, such as medical conditions or medication effects.
How is akathisia different from agitation?
Akathisia is a medication side effect, most often linked to antipsychotics and sometimes antidepressants, with an inner urge to keep moving. Agitation is restlessness that reflects the person’s emotional state. Ask about recent medication changes and tell the prescriber promptly if akathisia is possible.
How do you document psychomotor activity in a progress note?
In Objective, describe what you observed, name the finding and compare it with baseline. For example: “Psychomotor agitation: paced twice and wrung hands throughout; new since last week.” Note any recent medication changes and who you informed about new abnormal movements.
Related guides: mental status exam · mental status exam template · affect · anhedonia · avolition.
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Further Reading
- DSM-5-TR — The American Psychiatric Association’s diagnostic manual. It includes psychomotor agitation or retardation among the criteria for a major depressive episode and describes catatonia and medication-induced movement disorders such as akathisia; it does not prescribe how to write a mental status exam.
- NIMH (National Institute of Mental Health) — Plain-language information on mental health conditions, their symptoms and current research.
- Mental status exam template and examples — How this domain fits with the other parts of a mental status exam, with example wording and a fictional completed MSE.