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Can Motor Skills Flag Psychosis?

Psychologist Vijay Mittal looks at movement to prevent and treat a devastating mental illness. By Clare Milliken

Psychology professor Vijay Mittal is studying the impact of exercise on psychosis symptoms.Image: Monika Wnuk

How we feel. How we think. How we move.

Northwestern psychologist Vijay Mittal says human behavior is made up of three primary components: emotion, cognition and motor activity. In psychosis — Mittal’s research focus — feelings and thoughts are often disconnected from reality.

But in a recent research study, Mittal found that the third component, movement, may actually help clinicians spot psychosis before it develops — and even repair the damage it does to the brain.

Psychology professor Vijay Mittal studies psychosis

Vijay Mittal

Mittal’s lab is a honeycomb of small rooms, each housing high-tech tools like virtual reality headsets, hand gesture detectors and eye-tracking devices. In one of these rooms, study participants run intervals on a treadmill, working out at 80 to 95 percent of their capacity several times per week. “We have them run like the wind,” says Mittal, a psychology professor in Northwestern’s Weinberg College of Arts and Sciences.

After three months, these patients’ symptoms eased, their cognitive ability increased, and their brains were actually healthier.

“Before they exercised, we saw parts of the brain talking to each other that shouldn’t be, and areas that should be talking just weren’t,” says Mittal. “But after this period of exercise, the brain’s cross-talk looked more like healthy controls.”

Examining motor behavior as both an early signal and a treatment tool, Mittal hopes to stop psychosis in its tracks.

Mittal describes the benefits of exercise among people at risk of psychosis.

Psychosis in motion

Mittal believes that studying motor skills can offer critical insight into psychosis because movement is involuntary, more objective and less variable than feelings and thoughts.

“Emotion and cognition are impacted by situational factors, like being in a new environment or motivation or fear,” says Mittal. “But motor behavior — whether it’s balance ability or texting speed — is pretty easy to observe objectively. And if you can see abnormalities, you can get a good idea of what areas in the brain are being affected.”

And from there, Mittal says, it may be possible to spot psychosis sooner and even target treatment to individual symptoms, which range from crippling depression and intrusive and disordered thoughts to social isolation and uncontrollable tics.


“Motor behavior — whether it’s balance ability or texting speed — is pretty easy to observe objectively.”

A Critical Juncture

Mittal studies motor abnormalities in the psychosis “prodrome,” which he likens to a sort of precursor to full-blown psychosis. The prodrome does not always progress to psychosis, but it does suggest a significantly increased risk for the illness. As many as one-third of people designated as having a prodromal syndrome will go on to develop a psychotic disorder like schizophrenia, according to Mittal.

Understanding the differences between those who progress to psychosis and those who do not is also a key component of Mittal’s work, with potential for more targeted, effective treatments.

Mittal has been building on prior research that showed psychosis patients, as babies, tended to be unusually unbalanced. Home videos showed these infants teetering on their feet and toppling over, and while this lack of coordination often disappeared in childhood, Mittal sought to find out if it recurred later and thus could be used as an early marker for psychosis.

Using a “sway scale,” a square metal plate about double the size of a bathroom scale, Mittal’s team looked at tiny variations in stability among adult psychosis patients. He’s found that even when standing still with their feet planted firmly on the plate, psychosis patients move much more, and in a much more haphazard way, than healthy individuals.

A sway scale to assess psychosis in Vijay Mittal's lab

The sway scale measures tiny variations in stability among adult psychosis patients.

Compared with healthy controls (left), individuals at high risk for psychosis (right) tend to make more tiny swaying movements when standing still on Mittal’s sway scale.

Compared with healthy controls (left), individuals at high risk for psychosis (right) tend to make more tiny swaying movements when standing still on Mittal’s sway scale.

Assessing balance and movement with a sway scale could provide a less expensive, more objective way to differentiate prodromal patients who will develop psychosis from those who will not.

“We can train a computer to look at sway and shed light on what’s going on in this area of the brain,” Mittal says. “We think it’s possible to really improve diagnostics by looking at motor behavior.”

Vijay Mittal Psychosis Hero
Mittal (right) uses a sway scale to assess motor abnormalities in psychosis. Image: Monika Wnuk

From Talking to Texting

Mittal understands psychosis affects each person differently. “Psychosis isn’t just one disease,” he says, comparing its variability to that of clinical depression. And like depression, psychosis impacts millions. According to Mittal, psychosis impacts 3% of the population and costs $10 million per patient in medical care, lost labor and more.

Given these stakes, Mittal is working on multiple fronts, collaborating with linguistics professor Matt Goldrick to probe whether subtle fluctuations in speech could be an indicator of psychosis. Mittal is also working with psychiatry professor Stewart Shankman ’97 to see if changes in texting rate could predict worsening depression, a common trait in psychosis patients.

“We’re focused on symptoms because psychosis manifests very differently across patients,” says Mittal. “But I also believe motor behaviors could be uniquely helpful in predicting whether people will become ill, determining how their disease will manifest and developing treatments tailored to each individual’s specific symptoms.”

In short, harnessing movement may help reconnect patients with reality.

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