![]() One such approach to quantifying drug-induced motor side effects involves the analysis of handwriting movements. Currently, no techniques for the quantitative and objective measurement of EPS severity are available that can be easily used by neurologists, psychiatrists, and other practitioners in the clinical setting. The main reason is because these procedures require levels of technical expertise not always available in clinical settings. While these instruments enjoyed appeal in research settings, they have not been adopted for routine clinical or bedside use. To overcome these limitations, investigators have developed instruments for quantifying EPS (e.g., load cells, strain gauges, accelerometers, and electromyograms). Different examiners show different average judgments of the same patients, resulting in examiner bias. Traditional means of assessing EPS rely upon observer judgments of severity, but these subjective ratings suffer from low reliability, even after the required extensive training, and are insensitive to mild subclinical abnormalities ( Lohr & Caligiuri, 1992 Caligiuri, 1997). Early detection of EPS requires sensitive and reliable measurement. Effective management of EPS begins with early detection, and eventually, prevention. Ongoing monitoring of EPS is important to maximize treatment outcome, improve medication adherence and reduce re-hospitalization. ![]() Even after the emergence of a second generation of antipsychotics, EPS continue to cause concern ( Miller et al., 2008), particularly in vulnerable populations, such as the elderly ( Caligiuri et al., 2000). While neuroleptics improve the lives of schizophrenic patients, the occurrence of neuroleptic-induced extrapyramidal side effects (EPS) with increasing dosage often imposes limits on the dosage actually required to treat the disease. Neuroleptic medications have been the mainstay for treating psychotic illness for over 50 years. 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. We observed differences across medications and daily dose. Results from 59 psychosis patients and 46 healthy comparison subjects revealed significant slowing and dysfluency in patients compared to controls. 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. 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. Here, we present findings from psychiatric patients treated with atypical (second generation) antipsychotics. ![]() This paper describes an easy-to-use instrumental approach based on handwriting movements for quantifying EPS. Most instrumental methods have only limited clinical utility because of their complexity and costs. In contrast, quantitative instrumental methods are less subject to bias. ![]() However, these observer-based EPS severity ratings can be unreliable and are subject to examiner bias. Traditional approaches for assessing EPS such as parkinsonism, tardive akathisia, or dyskinesia rely upon clinical ratings. Ongoing monitoring of neuroleptic-induced extrapyramidal side effects (EPS) is important to maximize treatment outcome, improve medication adherence and reduce re-hospitalization.
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