Handwriting movement kinematics for quantifying extrapyramidal side effects in patients treated with atypical antipsychotics

Michael P. Caligiuri, Hans Leo Teulings, Charles E. Dean, Alexander Niculescu, James B. Lohr

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Ongoing monitoring of neuroleptic-induced extrapyramidal side effects (EPS) is important to maximize treatment outcome, improve medication adherence and reduce re-hospitalization. Traditional approaches for assessing EPS such as Parkinsonism, tardive akathisia, or dyskinesia rely upon clinical ratings. However, these observer-based EPS severity ratings can be unreliable and are subject to examiner bias. In contrast, quantitative instrumental methods are less subject to bias. Most instrumental methods have only limited clinical utility because of their complexity and costs. This paper describes an easy-to-use instrumental approach based on handwriting movements for quantifying EPS. Here, we present findings from psychiatric patients treated with atypical (second generation) antipsychotics. The handwriting task consisted of a sentence written several times within a 2 cm vertical boundary at a comfortable speed using an inkless pen and digitizing tablet. Kinematic variables including movement duration, peak vertical velocity and the number of acceleration peaks, and average normalized jerk (a measure of smoothness) for each up or down stroke and their submovements were analyzed. Results from 59 psychosis patients and 46 healthy comparison subjects revealed significant slowing and dysfluency in patients compared to controls. We observed differences across medications and daily dose. These findings support the ecological validity of handwriting movement analysis as an objective behavioral biomarker for quantifying the effects of antipsychotic medication and dose on the motor system.

Original languageEnglish
Pages (from-to)77-83
Number of pages7
JournalPsychiatry Research
Volume177
Issue number1-2
DOIs
StatePublished - May 2010

Fingerprint

Handwriting
Biomechanical Phenomena
Antipsychotic Agents
Drug-Induced Akathisia
Medication Adherence
Parkinsonian Disorders
Psychotic Disorders
Tablets
Psychiatry
Healthy Volunteers
Hospitalization
Biomarkers
Stroke
Costs and Cost Analysis

Keywords

  • Atypical antipsychotics
  • Extrapyramidal side effects
  • Handwriting movements
  • Instrumentation
  • Schizophrenia

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry

Cite this

Handwriting movement kinematics for quantifying extrapyramidal side effects in patients treated with atypical antipsychotics. / Caligiuri, Michael P.; Teulings, Hans Leo; Dean, Charles E.; Niculescu, Alexander; Lohr, James B.

In: Psychiatry Research, Vol. 177, No. 1-2, 05.2010, p. 77-83.

Research output: Contribution to journalArticle

Caligiuri, Michael P. ; Teulings, Hans Leo ; Dean, Charles E. ; Niculescu, Alexander ; Lohr, James B. / Handwriting movement kinematics for quantifying extrapyramidal side effects in patients treated with atypical antipsychotics. In: Psychiatry Research. 2010 ; Vol. 177, No. 1-2. pp. 77-83.
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