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Behavioural Neurology
Volume 6 (1993), Issue 1, Pages 5-14

The Psychomotor Disorders: Disorders of the Supervisory Mental Processes

P. F. Liddle

Royal Postgraduate Medical School, Hammersmith Hospital, Ducane Rd, London W12 0HS, UK

Received 10 January 1993; Accepted 15 February 1993

Copyright © 1993 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Clinical evidence suggests that three major patterns of disturbance of the supervisory mental processes that regulate self-generated mental activity can occur, either alone or together, in a variety of neurological and psychiatric conditions. Psychomotor poverty involves a diminished ability to initiate activity. Psychomotor disorganization reflects impaired ability to select between activities. Reality distortion, which is manifest as delusions and hallucinations, appears to reflect an abnormality of internal monitoring of mental activity. Each of these three syndromes is associated with a specific pattern of disordered function in multimodal association cortex and related subcortical nuclei. The evidence suggests that the neurotransmitter dopamine plays a major role in modulating the supervisory mental processes, though serotonin and noradrenaline are also implicated. While a particular neurotransmitter might have conflicting influences on different syndromes, the differential involvement of different anatomic sites and different neuroreceptor types offers the possibility of successful treatment even when different syndromes co-exist.