Research Article: Handwriting movements for assessment of motor symptoms in schizophrenia spectrum disorders and bipolar disorder

Date Published: March 14, 2019

Publisher: Public Library of Science

Author(s): Yasmina Crespo, Antonio Ibañez, María Felipa Soriano, Sergio Iglesias, Jose Ignacio Aznarte, Vincenzo De Luca.


The main aim of the present study was to explore the value of several measures of handwriting in the study of motor abnormalities in patients with bipolar or psychotic disorders. 54 adult participants with a schizophrenia spectrum disorder or bipolar disorder and 44 matched healthy controls, participated in the study. Participants were asked to copy a handwriting pattern consisting of four loops, with an inking pen on a digitizing tablet. We collected a number of classical, non-linear and geometrical measures of handwriting. The handwriting of patients was characterized by a significant decrease in velocity and acceleration and an increase in the length, disfluency and pressure with respect to controls. Concerning non-linear measures, we found significant differences between patients and controls in the Sample Entropy of velocity and pressure, Lempel-Ziv of velocity and pressure, and Higuchi Fractal Dimension of pressure. Finally, Lacunarity, a measure of geometrical heterogeneity, was significantly greater in handwriting patterns from patients than from controls. We did not find differences in any handwriting measure on function of the specific diagnosis or the antipsychotic dose. Results indicate that participants with a schizophrenia spectrum disorder or bipolar disorder exhibit significant motor impairments and that these impairments can be readily quantified using measures of handwriting movements. Besides, they suggest that motor abnormalities are a core feature of several mental disorders and they seem to be unrelated to the pharmacological treatment.

Partial Text

Motor abnormalities (MA) are a relevant feature of several mental disorders [1]. MA have been widely studied in schizophrenia, from early descriptions of the disorder [2]. Later, with the discovery of antipsychotic drugs, MA were mainly studied as side effects of the pharmacological treatment. Nevertheless, recent research has shown a renewed interest in the study of MA in schizophrenia. It has been suggested that spontaneous and medication- independent motor phenomena can represent a specific dimension within the schizophrenia-spectrum [3]. MA have been detected in antipsychotic naïve patients with a first psychotic episode and even in individuals at high risk of psychosis [4–7]. Furthermore, MA have been observed in studies with children who later developed schizophrenia [8–12], as well as in chronic patients who had never been medicated [13]. These results seem to imply that MA have a central role in the prognosis and evolution of the disease and it has been signaled that they could facilitate accurate early detection and tailored intervention [14]. MA have been less studied in bipolar disorder. However, a wide amount of research has highlighted the commonalities between schizophrenia spectrum disorders and bipolar disorder [15–19]. Both disorders share genetic liability and some clinical features [20]. It has been shown that cognitive deficits and functioning is similar in early-onset schizophrenia and early-onset bipolar disorder, suggesting that cognitive dysfunction is more related to the neurodevelopmental course of the disorder than to the specific diagnosis [21].

Motor abnormalities are included among the diagnosis criteria of many mental disorders such as schizophrenia [67]. Motor abnormalities have an important implication for the etiology of schizophrenia [68,69]. However, they have been neglected in other mental disorder as bipolar disorder, although many features in common between schizophrenia and bipolar disorder have been pointed out [18,19]. In this line, both disorders are genetically related [23,70] and have overlapping clinical phenomenology [71,72].




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