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, 28 (5), 633-42

Handwriting Movement Analyses for Monitoring Drug-Induced Motor Side Effects in Schizophrenia Patients Treated With Risperidone

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Handwriting Movement Analyses for Monitoring Drug-Induced Motor Side Effects in Schizophrenia Patients Treated With Risperidone

Michael P Caligiuri et al. Hum Mov Sci.

Abstract

Epidemiologic studies indicate that nearly 60% of schizophrenia (SZ) patients treated with conventional antipsychotic drugs develop extrapyramidal side effects (EPS) such as parkinsonism and tardive dyskinesia. Although the prevalence of EPS has decreased due to the newer antipsychotics, EPS continue to limit the effectiveness of these medicines. Ongoing monitoring of EPS is likely to improve treatment outcome or compliance and reduce the frequency of re-hospitalization. A quantitative analysis of handwriting kinematics was used to evaluate effects of antipsychotic medication type and dose in schizophrenia patients. Twenty-seven schizophrenia patients treated with risperidone, six schizophrenia patients who received no antipsychotic medication and 47 healthy comparison participants were enrolled. Participants performed a 20-min handwriting task consisting of loops of various sizes and a sentence. Data were captured and analyzed using MovAlyzeR software. Results indicated that risperidone-treated participants exhibited significantly more dysfluent handwriting movements than either healthy or untreated SZ participants. Risperidone-treated participants exhibited lower movement velocities during production of simple loops compared to unmedicated patients. Handwriting dysfluency during sentence writing increased with dose. A 3-factor model consisting of kinematic variables derived from sentence writing accounted for 83% (r=.91) of the variability in medication dose. In contrast, we found no association between observer-based EPS severity ratings and medication dose. These findings support the importance of handwriting-based measures to monitor EPS in medicated schizophrenia patients.

Figures

Fig. 1
Fig. 1
Mean vertical stroke size and 95th confidence intervals for the three participant groups for each handwriting conditions. The handwriting conditions are coded as D0 for dominant hand overlapping loops, N0 for non-dominant overlapping loops, LL for left-to-right loops, C0 for complex loops, SEN for sentence, and DMX and NMX for dominant and nondominant hand maximum speed overlaid circles. The numbers 1, 2, and 4 represent 1 cm, 2 cm, and 4 cm targets, respectively.
Fig. 2
Fig. 2
Mean peak vertical velocity and 95th confidence intervals for the three participant groups for each handwriting task. See Fig. 1 for key to conditions.
Fig. 3
Fig. 3
Mean velocity scaling score and 95th confidence intervals for the three participant groups for each handwriting task. See Fig. 1 for key to conditions.
Fig. 4
Fig. 4
Mean average normalized jerk score and 95th confidence intervals for the three participant groups for each handwriting task. See Fig. 1 for key to conditions.
Fig. 5
Fig. 5
Relationship between average normalized jerk score during sentence writing and daily dose of risperidone (in mg) for 21 medicated patients (r = .78, p < .0001).
Fig. 6
Fig. 6
Relationship between vertical stroke size during sentence writing and daily dose of risperidone (in mg) for 21 medicated patients (r = -.54, p < .01).

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