Schizophrenia & the Hand:
47 Hand Signs!

(Major update: october 3, 2014)

Schizophrenia is a complex mental disorder characterized by abnormal social behavior and failure to recognize what is real (typically manifesting as: delusions, hallucinations and disorganized speech), which is typically featured with 'minor physical anomalies' combined with 'neurological soft signs'. According Multi-Perspective Palm Reading schizophrenia is described to become manifest in at least 4 out of the 5 major perspectives of the hand (key-words for the 5 major perspectives are: function, proportion, skin, palm & fingers; the role of the proportion perspective is least obvious in schizophrenia). This article presents an overview of 47 individual hand signs significant for schizophrenia.

The hand sign statistics reported in this article indicate that schizophrenia usually tends to become manifest at 2 minor levels: the skin-related level of the (major) lines/flexion creases & the function-related level of the hand motorics. Additionally, a minor role is often seen regarding multiple abnormalities at the level of the finger shapes and/or the dermatoglyphics. The hand zones that typically get involved are: the fingertips & the pinky finger; for the palm no specific zone is more significant than the others.


TOP 5 HAND SIGNS IN SCHIZOPHRENIA

1 - Back of hand: total lack of expression [S. hand sign 1-2: LOR = +4.22]
2 - Excessive secondary creases [S. hand sign 4-6: LOR = +3.40]
3 - Palmomental reflex [S. hand sign 7-4: LOR = +3.15]
4 - Pinky: immobility (ankylosis) [S. hand sign 7-1: LOR = +3.02]
5 - Thumb: weak to total lack of expression [S. hand sign 3-3: LOR = +2.77]


CONTENTS:

How to make a diagnostic-assessment for the hand in schizophrenia?
47 Hand signs significant for Schizophrenia
TOP 10 - Schizophrenia: the ten most significant hand signs!
The role of the simian line in schizophrenia!




Multi-perspective palm reading.

How to make a Palm Reading Assessment
for SCHIZOPHRENIA?

The following guidelines should by principle solely only be applied to the hands of persons who exhibit psychotic symptoms in thought, emotion or behavior that are associated with pschizophrenia

Key-elements of the hand in schizophrenia in a nutshell: in general a slightly narrow hand featured with a lack of 'expression', plus a slight tendency towards typically 'feminine' characteristics can be described to represent a typical feature regarding the impression of the full hand. Additionally, fingers & palm usually display a-typical features which are most likely to manifest visually in specific at: the fingertips, the pinky finger & the major lines/dermatoglypics of the palm. Nearly always combined with a-typical features in the hand motorics.

Schizophrenia.
Schizophrenia & the hand: phantom picture.

- Schizophrenia & the hand: phantom picture! -


A positive diagnostic hand-assessment for schizophrenia [S.] requires a person to have all four requirements (no.1-4) listed below:

-S. REQUIREMENT no.1: The person requires to have significant hand signs for schizophrenia in 4 of the 5 major perspectives of the hand, including: function, skin, palm & fingers.

- D.S. REQUIREMENT no.2: The person requires to have at least 1 of the 7 hand signs that relate to the (major) lines [= level 8] + at least 1 of the 7 hand signs that relate to the hand motorics [= level 2].

- D.S. REQUIREMENT no.3: The person requires to have at least 1 of the 13 possible hand signs that relate directly to the fingers [= level 5] + at least 1 of the 10 possible hand signs that relate to the fingertips [= involving level 5, 7, 8, or 9].

- D.S. REQUIREMENT no.4: The person requires to have at least 5 out of the 47 listed hand signs.




IMPORTANT: Only when all above REQUIREMENTS are fullfilled, then one can speak safely of 'confirmed' hand diagnosis for schizophrenia!

Some of the 47 significant hand markers for schizophrenia that are listed below became known in medical science as a 'physical minor anomaly' (such as: the simian crease & Sydney line regarding the lines/flexion creases, and clinodactyly regarding the fingers/digits); additionally, all 7 hand signs listed for minor level 2 represent 'neurological soft signs'.


In general all these individual visual & motoric hand signs can usually be described to represent harmless body characteristics when found in isolation; however, combinations of visual & motoric hand signs can be recognized to bare high significance.







- List of 47 hand signs for schizophrenia -


1st major perspective: FUNCTION:

• Level 1 - HAND BEHAVIORS in schizophrenia:

1-1: Decrease in expressive gestures (coverbal hand gestures).

• Level 2 - HAND MOTORICS in schizophrenia:

2-1: Atypical handedness.
2-2: Pinky: immobility (ankylosis);
2-3: Impaired hand movement;
2-4: Impaired finger coordination;
2-5: Postural tremors, hands;
2-6: Palmomental reflex;
2-7: Palmar grasp reflex.

2nd major perspective: PROPORTION

• Level 3 - HAND SHAPE in schizophrenia:

3-1: Conic handshape: long & narrow;
3-2: Back of hand: total lack of expression;

• Level 4 - PALM SHAPE in schizophrenia:

4-1: Relatively small mount of venus (thenar hypotrophy).

• Level 5 - FINGER SHAPES in schizophrenia:

5-1: Tapering/tapered fingers;
5-2: Spatulate fingertips;
5-3: Small distal phalanages (microphalangia);
5-4: Nail phalanges: ring finger >> middle finger (>3%).
5-5: Thumb: weak to total lack of expression;
5-6: Thumb: small + short;
5-7: Thumb: extraordinary long (above 2nd knuckl);
5-8: Index finger: extraordinary long (equal or longer than middle finger);
5-9: 'Female' finger ratio (2D:4D digit ratio > 1);
5-10: Middle finger: proximal interphalangeal joint poorly defined;
5-11: Pinky: curved inwards (clinodactyly);
5-12: Pinky: extraordinary short;
5-13: Pinky: extraordinary long.

3rd major perspective: SKIN

• Level 6 - SKIN RELATED QUALITIES in schizophrenia:

6-1: Nail fold: visible nail fold plexus (subpapillary plexus);
6-2: Skin: red/blue coloured + cold.

• Level 7 - FINGERNAILS in schizophrenia:

7-1: Nails: small & underdeveloped (rudimentary);
7-2: Nails: excessively curved outwards (hyperconvex fingernails);
7-3: Nail middle finger: eponychium growth over lunula.

• Level 8 - DERMATOGLYPHICS in schizophrenia:

8-1: Fingers: fingerprint type asymmetries (at least 3 out of 5 fingers);
8-2: Fingers: extralimital triradii;
8-3: Palm: ridge dissociation ('string of pearl type').
8-4: Palm: whorl or multiple loops on hypothenar;
8-5: Palm: multiple triradii on the hypothenar;
8-6: Palm: pattern on the mount of venus / mouse thumb (thenar);
8-7: Palm: pattern on mount of mars;
8-8: Palm: missing c triradius / merging of triradius b and triradius c;
8-9: Palm: abortive c line;
8-10: Palm: large ab ridge count fluctuating asymmetry: [LABRC-RABRC] > 5.

• Level 9 - (MAJOR) LINES in schizophrenia:

9-1: Simian crease;
9-2: Sydney line;
9-3: Short head line;
9-4: Broken head line (broken proximal transverse crease)
9-5: Broken heart line (broken distal transverse crease)
9-6: Indistinct / fragmented primary creases;
9-7: MINOR LINES: Excessive secondary creases;
9-8: MINOR LINES: Chaotic arrangement of secondary creases.

4th & 5th major perspectives:
PALM & FINGERS


The major perspectives 'PALM' & 'FINGERS' can be derived seperately from the first three perspectives (= function, proportion & skin).


NOTICE: About 0.5% of the world population suffers on symptoms that relate to Schizophrenia; the formerly known sub-types of schizophrenia (e.g. paranoid type, disorganized type, catatonic type & undifferentiated type) were dropped DSM-5 work group in the summer of 2013.



MORE DETAILS: statistical validation!

The 'phantom picture' for schizophrenia presented above displays only a some of the hand signs listed above; more details about the prevalence of all 47 hand signs in schizophrenia populations AND the general population are presented below (outside the box).

Additionally, there are three schizophrenia cases available:


Schizophrenia case 1:

The hand in schizofrenia: case 1.
Schizophrenia case 2:

The hand in schizofrenia: case 2.

Schizophrenia case 3:

The hand in schizofrenia: case 3.


(A more detailed analysis for these cases will be available later)


- MORE MULTI-PERSPECTIVE PALM READING -

The hand in DIABETES MELLITUS
The hand in RHEUMATOID ARTHRITIS
The hand in PSORIASIS
The hand in FRAGILE-X SYNDROME

More about Schizophrenia + related studies of the hand






47 Hand signs in schizophrenia:

STATISTICAL VALIDATION!


(The most significant hand signs represent those
which show a relatively large %-difference between
the schizophrenics and the control groups)



1st major perspective: FUNCTION


Level 1 - HAND BEHAVIORS in schizophrenia:

• 1-1 - Decrease in expressive gestures (coverbal hand gestures)
Prevalence: Schizophrenic patients: ??.? %; controls - ??.? % 34

LOG ODDS RATIO: +?.??


Level 2 - HAND MOTORICS in schizophrenia:

• 2-1 - Atypical handedness
Prevalence: Schizophrenic patients: 20 %; controls - 3.8 % 24,25

LOG ODDS RATIO: +1.84

• 2-2 - Pinky: immobility (ankylosis)
Prevalence: Schizophrenic patients: 2.0 %; controls - 0 % 5

LOG ODDS RATIO: +3.01

• 2-3 - Impaired hand movement function, related to eye-hand movements
Prevalence: Schizophrenic patients: ? %; controls - ? % 21-23

LOG ODDS RATIO: ? (unknown)

• 2-4 - Impaired finger coordination
Prevalence: Schizophrenic patients: ??.? %; controls - ??.? % 32

LOG ODDS RATIO: +?.??

• 2-5 - Postural tremors, hands
Prevalence: Schizophrenic patients: 21.6 %; controls - 1.8 % 31

LOG ODDS RATIO: +2.72

• 2-6 - Palmomental reflex
Prevalence: Schizophrenic patients: 10.5 %; controls - 0.5 % 30 (results summarized from 8 studies!)

LOG ODDS RATIO: +3.15

• 2-7 - Palmar grasp reflex
Prevalence: Schizophrenic patients: 8.0 %; controls - 2.8 % 30 (results summarized from 8 studies!)

LOG ODDS RATIO: +1.10



2nd major perspective: PROPORTION


Level 3 - HAND SHAPE in schizophrenia:

• 3-1 - Conic hand type: long & narrow
Prevalence: Schizophrenic patients: 48-96 %; controls - 34-62 % 5,7

LOG ODDS RATIO: +1.02

• 3-2 - Back of hand: total lack of expression
Prevalence: Schizophrenic patients: 40 %; controls: 0 % 7

LOG ODDS RATIO: +4.22


Level 4 - PALM SHAPE in schizophrenia:

• 4-1 - Relatively small mount of venus (thenar hypotrophy)
Prevalence: Schizophrenic patients: ? %; controls - ? % 6

LOG ODDS RATIO: ? (unknown)


Level 5 - FINGER SHAPES in schizophrenia:

• 5-1 - Tapering/tapered fingers
Prevalence: Schizophrenic patients: 3 %; controls - 0 % 17

LOG ODDS RATIO: +1.86

• 5-2 - Fingers: spatulate fingertips
Prevalence: Schizophrenic patients - 42.4 %; controls - 21.7 % 5

LOG ODDS RATIO: +0.98

• 5-3 - Fingers: small distal phalanages (microphalangia)
Prevalence: Schizophrenic patients - ? %; controls - ? % 6

LOG ODDS RATIO: ? (unknown)

• 5-4: Nail phalanges: ring finger >> middle finger (>3%)
Prevalence: Schizophrenic patients: 52.9 %; controls: 12.0 % (source: handresearch.com)

LOG ODDS RATIO: +2.11

• 5-5 - Thumb: weak to total lack of expression
Prevalence: Schizophrenic patients: 80 %; controls - 20 % 7

LOG ODDS RATIO: +2.77

• 5-6 - Thumbs: small + short
Prevalence: Schizophrenic patients: 15.1-20.0 %; controls - 0-10.0 % 5-7

LOG ODDS RATIO: +1.40 (average)

• 5-7 - Thumb: extraordinary long (above 2nd knuckl)
Prevalence: Schizophrenic patients: 2.6-4.5 %; controls - 0-2.2 % 4,5

LOG ODDS RATIO: +1.19 (average)

• 5-8 - Index finger: extraordinary long - equal or longer than middle finger
Prevalence: Schizophrenic patients: ? %; controls - ? % 4

LOG ODDS RATIO: ? (unknown)

• 5-9 - 'Female' finger ratio (2D:4D digit ratio > 1)
Prevalence: Schizophrenic patients: 33.1 %; controls - 10.8 % 5,18-20

LOG ODDS RATIO: +1.41

• 5-10 - Middle finger: proximal interphalangeal joint poorly defined
Prevalence (including borderline cases): Schizophrenic patients: 78.9 %; controls: 35.7 % 33

LOG ODDS RATIO: +1.69

• 5-11 - Pinky: curved inward (clinodactyly)
Prevalence: Schizophrenic patients: 68 %; controls - 41 % 17

LOG ODDS RATIO: +1.12

• 5-12 - Pinky: extraordinary short
Prevalence: Schizophrenic patients: 13.4 %; controls - 5.0-10.0 % 5

LOG ODDS RATIO: +0.65 (average)

• 5-13 - Pinky: extraordinary long
Prevalence: Schizophrenic patients: 44.5 %; controls - 12.5 % 5

LOG ODDS RATIO: +1.72



3rd major perspective: SKIN


Level 6 - SKIN RELATED QUALITIES in schizophrenia:

• 6-1 - Visible nail fold plexus
Prevalence: Schizophrenic patients: 20-70 %; controls - 3-7 % 26

LOG ODDS RATIO: +2.74 (average)

• 6-2 - Red/blue coloured + cold
Prevalence: Schizophrenic patients: ? %; controls - ? % 5

LOG ODDS RATIO: ? (unknown)


Level 7 - FINGERNAILS in schizophrenia:

• 7-1 - Nails: small & underdeveloped (rudimentary)
Prevalence: Schizophrenic patients: 18.8 %; controls - 2.0 % 5

LOG ODDS RATIO: +2.43

• 7-2 - Nails: excessively curved outwards (hyperconvex fingernails)
Prevalence: Schizophrenic patients: 15 %; controls - 3 % 17

LOG ODDS RATIO: +1.74

• 7-3 - Nail middle finger: eponychium growth over lunula
Prevalence: Schizophrenic patients: 24.0 %; controls: 14.9 % 33

LOG ODDS RATIO: +0.62


Level 8 - DERMATOGLYPHICS in schizophrenia:

• 8-1 - Fingerprint type asymmetries, on at least 4 out of 5 fingers
Prevalence: Schizophrenic patients: ? %; controls - ? % 15,27-29

LOG ODDS RATIO: ? (unknown)

• 8-2 - Extralimital triradii
Prevalence: Schizophrenic patients: 6.6 %; controls - 1.5 % 10

LOG ODDS RATIO: +1.53

• 8-3 - Rige dissocations, multiple areas e.g. on distal hypothenar (string of pearl type)
Prevalence: Schizophrenic patients: 10.5-22.65 %; controls - 6.5-7.3 % 1,2,11

LOG ODDS RATIO: +0.99 (average)

• 8-4 - Whorl or multiple loops on hypothenar
Prevalence: Schizophrenic patients: 15.9 %; controls - 7.7 % 1,12,13

LOG ODDS RATIO: +0.82

• 8-5 - Multiple triradii on the mount of moon (multiple hypothenar triradii)
Prevalence: Schizophrenic patients: 15.9 %; controls - 7.7 % 1

LOG ODDS RATIO: +0.82

• 8-6 - Pattern on the mount of venus / mouse thumb (thenar)
Prevalence: Schizophrenic patients: 19.8 %; controls - 8.3 % 1

LOG ODDS RATIO: +1.00

• 8-7 - Pattern on the mount of mars (interdigital area II)
Prevalence: Schizophrenic patients: 19.8 %; controls - 8.3 % 1

LOG ODDS RATIO: +1.00

• 8-8 - Missing c triradius / merging of triradius c and triradius b
Prevalence: Schizophrenic patients - ? %; controls - ? % 6

LOG ODDS RATIO: ? (unknown)

• 8-9 - Abortive c line
Prevalence: Schizophrenic patients - 1.5 %; controls - 0.5 % 1

LOG ODDS RATIO: +1.11

• 8-10 - Large ab ridge count asymmetry: [LABRC - RABRC] > 5
Prevalence: Schizophrenic patients - ? %; controls - ? % 14-16

LOG ODDS RATIO: ? (unknown)


Level 9 - (MAJOR) LINES in schizophrenia:

• 9-1 - Simian crease (SRBC)
Prevalence: Schizophrenic patients: 10.0-53.0 %; controls - 1.2-7.9 % 1-5

LOG ODDS RATIO: +2.27 (average)

• 9-2 - Sydney line
Prevalence: Schizophrenic patients: 15.0 %; controls - 1.5 % 1-3

LOG ODDS RATIO: +2.45

• 9-3 - Short head line
Prevalence: Schizophrenic patients: 24.0 %; controls: 14.9 % 33

LOG ODDS RATIO: +1.02


• 9-4 - Broken head line (broken proximal transverse crease)
Prevalence: Schizophrenic patients - 26.9 %; controls - 19.0 % 5,6

LOG ODDS RATIO: +0.45

• 9-5 - Broken heart line (broken distal transverse crease)
Prevalence: Schizophrenic patients - ? %; controls - ? % 6

LOG ODDS RATIO: ? (unknown)

• 9-6 - Indistinct / fragmented (multiple) primary creases
Prevalence: Schizophrenic patients - 30.7 %; controls - 6.7 % 7

LOG ODDS RATIO: +1.82

• 9-7 - MINOR LINES: Excessive secondary creases
Prevalence: Schizophrenic patients - 15.0-40.0 %; controls - 0-2.5 % 7-9

LOG ODDS RATIO: +3.40 (average)

• 9-8 - MINOR LINES: Chaotic arrangement of secondary creases
Prevalence: Schizophrenic patients - 7.3-95.3 %; controls - 0-18.8 % 7

LOG ODDS RATIO: +2.32 (average)


SOURCES:

1)
Dermatoglyphics of Schizophrenics. A. Bagga, 1989

2) Congenital Dermatoglyphic Malformations and Psychosis: A Twin Study. A. Rosa, et al., 2000

3) Dermatoglyphics in female schizophrenia: A preliminary report. D. Stowens, et al., 1970

4) Significance of morphological features in schizophrenia of a Chinese population. C.J. Huang, et al., 2009

5) The Hand in Psychological Diagnosis. C. Wolff, 1951

6) Subtle signs of prenatal maldevelopment of the hand ectoderm in schizophrenia: a preliminary monozygotic twin study. H.S. Bracha, et al., 1991

7) Differences between Schizophrenics and Normal Controls Using Chirological (Hand) Testing. Y. Haft, et al., 1982

8) Further evidence for anomalies in the hand-prints of patients with schizophrenia: a study of secondary creases. M. Cannon, et al., 1994

9) Ein Versuch, Handabdrücke in die Diagnostik von Psychosen aus dem schizophrenen Formenkreis einzubeziehen (mit acht Abbildungen) B. Ismail, et al., 1998

10) Extralimital triradii as a putative marker of schizotypy. J.T. Chok & T.R. Kwapil, 2005

11) Further Evidence That Congenital Dermatoglyphic Abnormalities Are Associated With Psychosis: A Twin Study. A. Rosa, et al., 2002

12) 'Dermatoglyphics in hungarian schizophrenic patients' in : Trends in Dermatoglyphic Research. G. Gyenis, et al., 1990

13) A palmar dermatoglyphic study in schizophrenia. O.R. Chackravortty, et al., 2007

14) Prenatal growth markers in schizophrenia: a monozygotic co-twin control study. J.O. Davis & H.S. Bracha, 1996

15) Fluctuating Dermatoglyphic Asymmetry and the Genetics of Liability to Schizophrenia. T.A. Markow & K. Wandler, 1986

16) Dermatoglyphic study of positive and negative symptoms of schizophrenia. F. Páez, et al., 2001

17) Minor Physical Anomalies in Schizophrenic Patients and Their Siblings. B. Ismail, et al., 1998

18) Increased ratio of 2nd to 4th digit (2D:4D) in schizophrenia. S.L. Collinson, et al., 2010

19) Digit length pattern in schizophrenia suggests disturbed prenatal hemispheric lateralization. M. Arató, et al., 2004

20) Sex differences in digit ratio (2D:4D) are disrupted in adolescents with schizotypal personality disorder: Altered prenatal gonadal hormone levels as a risk factor. D.J. Walder, et al., 2006

21) Digitized analysis of abnormal hand-motor performance in schizophrenic patients. P. Tigges, et al., 1999

22) Predictive eye and hand movements are differentially affected by schizophrenia. U. Sailer, et al., 2007

23) Neuromotor Precursors of Schizophrenia. E.F. Walker, et al., 1994

24) Is There Atypical Handedness in Schizophrenia? M.F. Green, et al., 1988

25) Handedness in schizophrenia: a quantitative review of evidence. M. Dragovich & G. Hammond, 2005

26) Relationship between nailfold plexus visibility and clinical, neuropsychological, and brain structural measures in schizophrenia. C.E. Curtis et al., 1999

27) Determining the association between dermatoglyphics and schizophrenia by using fingerprint asymmetry measures. J.-F. Wang et al., 2008

28) Neurodevelopmental Interactions Conferring Risk for Schizophrenia: A Study of Dermatoglyphic Markers in Patients and Relatives. M.T. Avila, 2003

29) Dermatoglyphic evidence of fluctuating asymmetry in schizophrenia. C.S. Mellor, 1992

30) The specificity of neurological signs in schizophrenia: a review. M.P.M. Boks et al., 1999

31) Neurological signs and psychomotor performance in patients with schizophrenia, their relatives and healthy controls. L. Flyckt et al., 1999

32) Neurological soft signs and cerebral measurements investigated by means of MRI in schizophrenic patients. G. Bersani et al., 2006

33) Biometric parameters of the hand as an index of schizophrenia - A preliminary study. E.Z. Shamir et al., 2013

34) Subdomains Within the Negative Symptoms of Schizophrenia: Commentary. B. Kirkpatrick & B. Fischer, 2006

35) Subdomains Within the Negative Symptoms of Schizophrenia: Commentary. T. Brill & S. Stier, 1999 (None of the 12 hand signs are listed so far)

Martijn van Mensvoort - Hand Research

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