Received Dec 22; Accepted Jan
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. Handwriting kinematics offers a great advance over previous methods of assessing dyskinesia, which could clearly be beneficial for understanding the etiology of psychosis.
Behavior, Issue 81, Schizophrenia, Disorders with Psychotic Features, Psychology, Clinical, Psychopathology, behavioral sciences, Movement abnormalities, Ultra High Risk, psychosis, handwriting, computer tablet, dyskinesia Download video file.
This prodromal period is marked by attenuated positive symptoms perceptual abnormalities, suspiciousness, feelings of grandiosity, or unusual thoughts and a decline in functioning2. Current etiological conceptions of psychosis suggest that it is a neurodevelopmental disorder that affects an individual during late adolescence or early adulthood4.
Constitutional factors such as genetics and prenatal insults result in vulnerability for psychosis4. Movement abnormalities are of keen interest to this model, as the same mechanisms believed to be contributing to psychotic symptoms are also responsible for governing the motor system5.
Researchers argue that by understanding movement behavior prior to the onset of schizophrenia, we may improve our ability to predict, understand, and intervene in the development of schizophrenia6. It is well known that individuals who later go on to develop schizophrenia often show subtle movement abnormalities prior to the onset of illness7,8.
Walker and colleagues collected videotapes of patients with schizophrenia during childhood and rated the videos for movement abnormalities, showing that movement abnormalities are present long before the onset of illness and are indicative of a neurological constitutional vulnerability9, Research suggests that the basal ganglia may be implicated in this neurological constitutional vulnerability, as UHR individuals show impaired neural development and neurocognitive deficits related to basal ganglia function8, Additionally, Mittal and colleagues have used observer ratings to show that movement abnormalities, closely linked to basal ganglia function, could successfully classify UHR individuals likely to convert to psychosis8, These findings provide strong evidence for the idea that movement abnormalities may be a core feature of risk of psychosis.
Clearly, research that can improve detection and understanding of movement abnormalities is crucial for the understanding of the etiology of psychosis and for preventive efforts.
Antipsychotic medication may lead to the development of tardive dyskinesia, characterized by slow involuntary repetitive movements Nicotine use has also been shown to affect dopamine regulation and handwriting kinematics For example, Tucha and Lange showed that pen movement fluency improved during a computerized handwriting task when healthy participants were given chewing gum containing nicotine During assessment, participants generally write in a western cursive handwriting with larger and smaller vertical strokes.
Western cursive handwriting is optimal for examining pen movement smoothness because of the predominance of vertical strokes that require complex coordination of muscles to perform well Dysfluent pen movements result when the muscles that coordinate the movement receive disregulated signals from the basal ganglia15, The software segments and analyzes pen movements per stroke and extracts a variable that is thought to be a proximal measure of dyskinesia, called average normalized jerk Jerk is defined as the change in acceleration over time per stroke Because of the different lengths in vertical strokes in most western style handwritings, jerk is normalized across strokes.
Within each stroke, dysfluent pen movements are characterized by a greater number of acceleration peaks over a given distance. Thus, dysfluent pen movements are characterized by a lack of smoothness, a greater number of acceleration peaks, and a larger value of jerk.
The improvement of measures used to rate movement abnormalities in UHR youth is critical for improving our etiological conceptions of the illness and our understanding of movement disorders in general.
We hypothesized that the UHR individuals would show more dysfluent pen movements, characterized by a larger value of jerk, when asked to write on a tablet computer than a group of healthy controls. Participants Provide approval for the protocol and informed consent procedures from the University Institutional Review Board.
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Facebook gives people the power. Nov 21, · Handwriting Analysis Indicates Spontaneous Dyskinesias in Neuroleptic Naïve Adolescents at High Risk for Psychosis Derek J. Dean, 1 Hans-Leo Teulings, .