Graphology and psychiatric diagnosis: Is the writing on the wall?

To review the role of handwriting analysis in psychiatry.

Case-report and review of key papers.

M, a 27-year-old man, presented with incoherent speech, palilalia, logoclonia, incongruous affect, paranoid delusions and auditory hallucinations. M was diagnosed with schizophrenia and cannabis misuse, complicated by speech and language difficulties. M spent long periods writing on pieces of paper; towards the start of his admission, his writing was unintelligible but became more intelligible as his psychosis resolved. M's handwriting demonstrates clinical features of psychosis (e.g. clang associations) and graphological abnormalities associated with schizophrenia in the literature (rigidity in letter-formation, mechanical expressions, and tendency toward over-use of straight lines).

Analysis of handwriting is likely to play a limited role in psychiatric diagnosis but may prove useful in monitoring clinical improvement in certain patients.