The Use of Handwriting Changes for the Follow-up of Patients with Bipolar Disorder

Abstract

Introduction: Patients with bipolar disorder have motor skill deficiency and cognitive dysfunction. It is suggested that these deficiencies are related to the neurodevelopmental course of the disease. The aim of this study was to examine whether or not there was a change in the handwriting of patients with bipolar disorder in periods of mania and remission.

Method: Two samples of handwriting and signature were taken from the cases, one on admission before treatment and one just after discharge. The first sample was taken in the period when the patients hospitalised with manic episode before medications and the second sample was taken in remission when the decision for discharge was made. The handwriting changes betwen the manic episode and the remission period were examined.

Results: In the examination of the handwriting between the two periods, there was an increase in the size of the writing, pen pressure, the length of words, the spaces between words, and missing and incorrect punctuation marks in the manic episode. There were no differences in any handwriting measure on function of the specific diagnosis or the antipsychotic dose but tremor count was higher in patients using antipsychotics (p<0.05). Most of the parameters showing a change were found to be related to the Young Mania Rating Scale (YMRS) scores.

Conclusion: The results of this study determined severe changes in the handwriting of patients with bipolar disorder in a period of mania. Handwriting features can be used to screen patients for discharge and can be used for prediction when a patient might switch into manic episode. Also intake YMRS scores were found as the most important feature that affect handwriting parameters in manic patients.

Keywords: Handwriting; bipolar affective disorder; mania.

Figure 1

Measurement of some parameters; A: Area covered by the writing (mm2), B: Word length and space between words (mm).

Figure 2

Handwriting of a thirty-year-old male; A: Handwriting in mania, there are many mistakes, B: In remission, original text has been written, and corrected mistakes (Irregularity in rhythm is significant, especially in character size during mania).

Figure 3

Handwriting of a twenty-year-old female, showing differences between mania and remission; A: Manic period, B: Remission period. Enlargement of writing and decrease in writing quality are determined.

Figure 4

Pen pressure of handwriting evaluated with HS 525 document detector (30× magnified); A: pen pressure is much more during manic episode, B: pen pressure is less during remission.

Figure 5

Samples of a 43-year-old housewife, shown overwritten words and letters in mania (A), overwritten words and letters are diminished in remission (B).