Handwriting Analysis Indicates Spontaneous Dyskinesias in Neuroleptic Naïve Adolescents at High Risk for Psychosis

Summary

Handwriting analysis software significantly improves upon existing instruments measuring movement disorders. Individuals at risk for psychosis and healthy controls completed handwriting tasks to test for dyskinesia. Results suggest that youth at risk for psychosis exhibit dyskinesia and that handwriting analysis could significantly contribute to wider dissemination of early identification efforts

Abstract

Growing evidence suggests that movement abnormalities are a core feature of psychosis. One marker of movement abnormality, dyskinesia, is a result of impaired neuromodulation of dopamine in fronto-striatal pathways. The traditional methods for identifying movement abnormalities include observer-based reports and force stability gauges. The drawbacks of these methods are long training times for raters, experimenter bias, large site differences in instrumental apparatus, and suboptimal reliability. Taking these drawbacks into account has guided the development of better standardized and more efficient procedures to examine movement abnormalities through handwriting analysis software and tablet. Individuals at risk for psychosis showed significantly more dysfluent pen movements (a proximal measure for dyskinesia) in a handwriting task. Handwriting kinematics offers a great advance over previous methods of assessing dyskinesia, which could clearly be beneficial for understanding the etiology of psychosis.

Introduction

The period preceding the onset of psychosis is of clinical and research interest as it may shed light on formal psychosis (prior to when a number of third variable confounds such as medication obfuscate our understanding), and also serves as a viable point of intervention (roughly ⅓ of youth showing a prodromal syndrome go on to develop schizophrenia in a 2 year period, and several studies suggest that psychosocial, cognitive training, and pharmacological interventions may ameliorate the course of illness)¹. This prodromal period is marked by attenuated positive symptoms (perceptual abnormalities, suspiciousness, feelings of grandiosity, or unusual th....

Protocol

1. Participants

1. Provide approval for the protocol and informed consent procedures from the University Institutional Review Board.
2. Recruit adolescent and young adult UHR participants by using Craigslist (i.e. local classified advertisements on the internet), email postings, newspaper ads, and community professional referrals.
3. Recruit healthy control participants by craigslist, flyers and newspaper announcements.
   1. Advertise that the study looks at healthy development for volunteers with no family history of psychosis and no psychiatric symptoms.
   2. Exclude healthy controls based on the presence of any category ....

Results

There were no significant differences between groups on demographic characteristics including age, years of education, or parental education (see Table 1 for a demographic breakdown of the participants). Chi Square tests revealed significant differences between groups on gender χ² (1, N = 36) = 5.46, p≤0.05, with more males in the UHR group and more females in the control group. There was a significant group differences in tobacco usage frequency, t(22.9) = 2.15, p≤0.05, showing that UHR parti.......

Discussion

This study found significant evidence of more dysfluent pen movements and the presence of dyskinesia in an UHR sample using a handwriting analysis program to examine movement abnormalities.

Traditionally, observer based rating scales have been utilized to measure movement abnormalities in order to monitor drug side effects^15-17. However, the observer ratings suffer from significant drawbacks including long training times for raters, experimenter error, and suboptimal reliability

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Fujitsu Lifebook T901 Tablet Computer	Fujitsu Ltd.		http://www.shopfujitsu.com/store/
Neuroscript MovAlyzeR	Neuroscript LLC		http://www.neuroscript.net/movalyzer.php