Hypergraphia is a behavioral condition characterized by the intense desire to write or draw. Forms of hypergraphia can vary in writing style and content. It is a symptom associated with temporal lobe changes in epilepsy and in Geschwind syndrome. [1] Structures that may have an effect on hypergraphia when damaged due to temporal lobe epilepsy are the hippocampus and Wernicke's area. Aside from temporal lobe epilepsy, chemical causes may be responsible for inducing hypergraphia.
American neurologists Stephen Waxman and Norman Geschwind were the first to describe hypergraphia, in the 1970s. [2] The patients they observed displayed highly compulsive detailed writing, sometimes with literary creativity. The patients kept diaries, which some used to meticulously document minute details of their everyday activities, write poetry, or create lists. Case 1 of their study wrote lists of her relatives, her likes and dislikes, and the furniture in her apartment. Beside lists, the patient wrote poetry, often with a moral or philosophical undertone. She described an incident in which she wrote the lyrics of a song she learned when she was 17 several hundred times and another incident in which she felt the urge to write a word over and over again. Another patient wrote aphorisms and certain sentences in repetition. [2]
A patient from a separate study experienced continuous "rhyming in his head" for five years after a seizure and said that he "felt the need to write them down." [3] The patient did not talk in rhyme, nor did he read poetry. Language capacity and mental status were normal for this patient, except for recorded right-temporal spikes on electroencephalograms. This patient had right-hemisphere epilepsy. Functional MRI scans of other studies suggest that rhyming behavior is produced in the left hemisphere, but Mendez proposed that postictal hypoactivity of the right hemisphere may induce a release of writing and rhyming abilities in the left hemisphere. [3]
In addition to writing in different forms (poetry, books, repetition of one word), hypergraphia patients differ in the complexity of their writings. While some writers (e.g. Alice Flaherty [4] and Dyane Harwood [5] ) use their hypergraphia to help them write extensive papers and books, most patients do not write things of substance. Flaherty describes hypergraphia as a result of decreased temporal lobe function which disinhibits frontal lobe idea and language generation, "sometimes at the expense of quality." [6] Patients hospitalized with temporal lobe epilepsy and other disorders causing hypergraphia have written memos and lists (like their favorite songs) and recorded their dreams in extreme length and detail. [6]
There are many accounts of patients writing in nonsensical patterns including writing in a center-seeking spiral starting around the edges of a piece of paper. [7] In one case study, a patient even wrote backward, so that the writing could only be interpreted with the aid of a mirror. [2] Sometimes the writing can consist of scribbles and frantic, random thoughts that are quickly jotted down on paper very frequently. Grammar can be present, but the meaning of these thoughts is generally hard to grasp and the sentences are loose. [7] In some cases, patients write extremely detailed accounts of events that are occurring or descriptions of where they are. [7]
In some cases, hypergraphia can manifest with compulsive drawing. [8] The composer Robert Schumann, during periods of high musical output, also wrote many long letters to his sister Clara; similarly, Vincent van Gogh had much more written correspondence during bouts of intense painting. [4] Many drawings by patients with hypergraphia exhibit repetition and a high level of detail, sometimes mixing both compulsive writing and drawing together. [9]
Some studies have suggested that hypergraphia is related to bipolar disorder, hypomania, and schizophrenia. [10] Although creative ability was observed in the patients of these studies, signs of creativity were observed, not hypergraphia specifically. Therefore, it is difficult to say with absolute certainty that hypergraphia is a symptom of these psychiatric illnesses because creativity in patients with bipolar disorder, hypomania, or schizophrenia may manifest into something aside from writing. However, other studies have shown significant accounts between hypergraphia and temporal lobe epilepsy [11] and chemical causes. [12]
Hypergraphia was first studied as a symptom of temporal lobe epilepsy, a condition of reoccurring seizures caused by excessive neuronal activity, but it is not a common symptom among patients. Less than 10 percent of patients with temporal lobe epilepsy exhibit characteristics of hypergraphia.[ medical citation needed ] Temporal lobe epilepsy patients may exhibit irritability, discomfort, or an increasing feeling of dread if their writing activity is disrupted. [13] To elicit such responses when interrupting their writing suggests that hypergraphia is a compulsive condition, resulting in an obsessive motivation to write. [10] A temporal lobe epilepsy may influence frontotemporal connections in such a way that the drive to write is increased in the frontal lobe, beginning with the prefrontal and premotor cortex planning out what to write, and then leading to the motor cortex (located next to the central fissure) executing the physical movement of writing. [10]
Most temporal lobe epilepsy patients who suffer from hypergraphia can write words, but not all may have the capacity to write complete sentences that have meaning. [7]
The disorder most often associated with high-output writers is bipolar disorder, especially during hypomania. [14] In fact, temporal lobe epilepsy is more likely to produce hypergraphia if it also produces manic symptoms. While depression has been linked to increased writing, it appears that most writers with depression write little while depressed, and high output periods correspond to rebound mood elevation after the end of a depression, or in mixed mood states. [14]
Drugs that boost mood and energy have been known to induce hypergraphia, possibly by increasing activity in brain networks utilizing one of the body's neurotransmitters, dopamine. Dopamine has been known to decrease latent inhibition, which causes a decrease in the ability to habituate to screen out unexpected stimuli. Low latent inhibition leads to an excessive level of stimulation and could contribute to the onset of hypergraphia and general creativity. [15] This research implies that there is a direct correlation between the levels of dopamine between neuronal synapses and the level of creativity exhibited by the patient. Dopamine agonists increase the levels of dopamine between synapses which results in higher levels of creativity, and the opposite is true for dopamine antagonists.
In one case study, a patient taking donepezil reported an elevation in mood and energy levels which led to hypergraphia and other excessive forms of speech (such as singing). [16] Six other cases of patients taking donepezil and experiencing mania have been previously reported. These patients also had cases of dementia, cognitive impairment from a cerebral aneurysm, bipolar I disorder, and/or depression. Researchers are unsure why donepezil can induce mania and hypergraphia. It could potentially result from an increase in acetylcholine levels, which would have an effect on the other neurotransmitters in the brain. [16]
Another potential cause of hypergraphia is
Several regions of the brain are involved in the act of written composition. Handwriting depends on the superior parietal cortex, and motor control areas in the frontal lobe and cerebellum. [17] An area of the frontal lobe that is especially active is Exner's area, located in the premotor cortex. [17] Writing creatively and generating ideas, on the other hand, activates multiple sites in the limbic system and cerebral cortex, including the left inferior frontal gyrus (BA 45) and the left temporal pole (BA 38). [18] Lesions to Wernicke's area (in the left temporal lobe) can increase speech output, which can sometimes manifest itself in writing. [6] In one study, patients with hippocampal atrophy showed signs of having Geschwind syndrome, including hypergraphia. [19] While epilepsy-induced hypergraphia is usually lateralized to the left cerebral hemisphere in the language areas, hypergraphia associated with lesions and other brain damage usually occurs in the right cerebral hemisphere. [20] Lesions to the right side of the brain usually cause hypergraphia because they can disinhibit language function on the left side of the brain. [6] Hypergraphia has also been known to be caused by right hemisphere strokes and tumors. [7] [21]
Hypergraphia was one of the central issues in the 1999 trial of Alvin Ridley for the imprisonment and murder of his wife Virginia Ridley. [22] The mysterious woman, who had died in bed of apparent suffocation, had remained secluded in her home for 27 years in the small town of Ringgold, Georgia, United States. Her 10,000-page journal, which provided abundant evidence that she suffered from epilepsy and had remained housebound of her own will, was instrumental in the acquittal of her husband. [22]
In 1969, Isaac Asimov said "I am a compulsive writer". [23] Other artistic figures reported to have been affected by hypergraphia include Vincent van Gogh,[ citation needed ] Fyodor Dostoevsky, [24] and Robert Burns. [25] Alice in Wonderland author Lewis Carroll is also said to have had the condition, [26] having written more than 98,000 letters in various formats throughout his life. Some were written backward, in rebus, and in patterns, as with "The Mouse's Tale" in Alice.
Eleanor Alice Burford, whose pen-names included Jean Plaidy, Victoria Holt, Philippa Carr, Eleanor Burford, Elbur Ford, Kathleen Kellow, Anna Percival, and Ellalice Tate, described herself as a compulsive writer.
Naomi Mitchison, often called a doyenne of Scottish literature, writing over 90 books of historical and science fiction, travel writing and autobiography, has been described as a compulsive writer.
Alien hand syndrome (AHS) or Dr. Strangelove syndrome is a category of conditions in which a person experiences their limbs acting seemingly on their own, without conscious control over the actions. There are a variety of clinical conditions that fall under this category, which most commonly affects the left hand. There are many similar terms for the various forms of the condition, but they are often used inappropriately. The affected person may sometimes reach for objects and manipulate them without wanting to do so, even to the point of having to use the controllable hand to restrain the alien hand. Under normal circumstances however, given that intent and action can be assumed to be deeply mutually entangled, the occurrence of alien hand syndrome can be usefully conceptualized as a phenomenon reflecting a functional "disentanglement" between thought and action.
The Fregoli delusion is a rare disorder in which a person holds a delusional belief that different people are in fact a single person who changes appearance or is in disguise. The syndrome may be related to a brain lesion and is often of a paranoid nature, with the delusional person believing themselves persecuted by the person they believe is in disguise.
The vertebrate cerebrum (brain) is formed by two cerebral hemispheres that are separated by a groove, the longitudinal fissure. The brain can thus be described as being divided into left and right cerebral hemispheres. Each of these hemispheres has an outer layer of grey matter, the cerebral cortex, that is supported by an inner layer of white matter. In eutherian (placental) mammals, the hemispheres are linked by the corpus callosum, a very large bundle of nerve fibers. Smaller commissures, including the anterior commissure, the posterior commissure and the fornix, also join the hemispheres and these are also present in other vertebrates. These commissures transfer information between the two hemispheres to coordinate localized functions.
The frontal lobe is the largest of the four major lobes of the brain in mammals, and is located at the front of each cerebral hemisphere. It is parted from the parietal lobe by a groove between tissues called the central sulcus and from the temporal lobe by a deeper groove called the lateral sulcus. The most anterior rounded part of the frontal lobe is known as the frontal pole, one of the three poles of the cerebrum.
Gourmand syndrome is a very rare and benign eating disorder that usually occurs six to twelve months after an injury to the frontal lobe. Those with the disorder usually have a right hemisphere frontal or temporal brain lesion typically affecting the cortical areas, basal ganglia or limbic structures. These people develop a new, post-injury passion for gourmet food.
The lobes of the brain are the major identifiable zones of the human cerebral cortex, and they comprise the surface of each hemisphere of the cerebrum. The two hemispheres are roughly symmetrical in structure, and are connected by the corpus callosum. They traditionally have been divided into four lobes, but are today considered as having six lobes each. The lobes are large areas that are anatomically distinguishable, and are also functionally distinct to some degree. Each lobe of the brain has numerous ridges, or gyri, and furrows, the sulci that constitute further subzones of the cortex. The expression "lobes of the brain" usually refers only to those of the cerebrum, not to the distinct areas of the cerebellum.
In the field of neurology, temporal lobe epilepsy is an enduring brain disorder that causes unprovoked seizures from the temporal lobe. Temporal lobe epilepsy is the most common type of focal onset epilepsy among adults. Seizure symptoms and behavior distinguish seizures arising from the medial temporal lobe from seizures arising from the lateral (neocortical) temporal lobe. Memory and psychiatric comorbidities may occur. Diagnosis relies on electroencephalographic (EEG) and neuroimaging studies. Anticonvulsant medications, epilepsy surgery and dietary treatments may improve seizure control.
The orbitofrontal cortex (OFC) is a prefrontal cortex region in the frontal lobes of the brain which is involved in the cognitive process of decision-making. In non-human primates it consists of the association cortex areas Brodmann area 11, 12 and 13; in humans it consists of Brodmann area 10, 11 and 47.
Frontal lobe disorder, also frontal lobe syndrome, is an impairment of the frontal lobe of the brain due to disease or frontal lobe injury. The frontal lobe plays a key role in executive functions such as motivation, planning, social behaviour, and speech production. Frontal lobe syndrome can be caused by a range of conditions including head trauma, tumours, neurodegenerative diseases, neurodevelopmental disorders, neurosurgery and cerebrovascular disease. Frontal lobe impairment can be detected by recognition of typical signs and symptoms, use of simple screening tests, and specialist neurological testing.
An auditory hallucination, or paracusia, is a form of hallucination that involves perceiving sounds without auditory stimulus. While experiencing an auditory hallucination, the affected person hears a sound or sounds that did not come from the natural environment.
Geschwind syndrome, also known as Gastaut-Geschwind, is a group of behavioral phenomena evident in some people with temporal lobe epilepsy. It is named for one of the first individuals to categorize the symptoms, Norman Geschwind, who published prolifically on the topic from 1973 to 1984. There is controversy surrounding whether it is a true neuropsychiatric disorder. Temporal lobe epilepsy causes chronic, mild, interictal changes in personality, which slowly intensify over time. Geschwind syndrome includes five primary changes; hypergraphia, hyperreligiosity, atypical sexuality, circumstantiality, and intensified mental life. Not all symptoms must be present for a diagnosis. Only some people with epilepsy or temporal lobe epilepsy show features of Geschwind syndrome.
Grandiose delusions (GD), also known as delusions of grandeur or expansive delusions, and also informally known in Japan as eighth-grade syndrome or chūnibyō, are a subtype of delusion that occur in patients with a wide range of psychiatric disorders, including two-thirds of patients in a manic state of bipolar disorder, half of those with schizophrenia, patients with the grandiose subtype of delusional disorder, frequently as a comorbid condition in narcissistic personality disorder, and a substantial portion of those with substance abuse disorders. GDs are characterized by fantastical beliefs that one is famous, omnipotent, wealthy, or otherwise very powerful. The delusions are generally fantastic and typically have a religious, science fictional, or supernatural theme. There is a relative lack of research into GD, in contrast to persecutory delusions and auditory hallucinations. Around 10% of healthy people experience grandiose thoughts at some point in their lives but do not meet full criteria for a diagnosis of GD.
Derealization is an alteration in the perception of the external world, causing those with the condition to perceive it as unreal, distant, distorted or falsified. Other symptoms include feeling as if one's environment is lacking in spontaneity, emotional coloring, and depth. It is a dissociative symptom that may appear in moments of severe stress.
Auditory agnosia is a form of agnosia that manifests itself primarily in the inability to recognize or differentiate between sounds. It is not a defect of the ear or "hearing", but rather a neurological inability of the brain to process sound meaning. While auditory agnosia impairs the understanding of sounds, other abilities such as reading, writing, and speaking are not hindered. It is caused by bilateral damage to the anterior superior temporal gyrus, which is part of the auditory pathway responsible for sound recognition, the auditory "what" pathway.
Spiritual crisis is a form of identity crisis where an individual experiences drastic changes to their meaning system typically because of a spontaneous spiritual experience. A spiritual crisis may cause significant disruption in psychological, social, and occupational functioning. Among the spiritual experiences thought to lead to episodes of spiritual crisis or spiritual emergency are psychiatric complications related to existential crisis, mystical experience, near-death experiences, Kundalini syndrome, paranormal experiences, religious ecstasy, or other spiritual practices.
Musical hallucinations describes a neurological disorder in which the patient will hallucinate songs, tunes, instruments and melodies. The source of these hallucinations are derived from underlying psychotic illness or hearing impairment. These hallucinations are often rare and are followed by mental decline. A majority of patients who have symptoms of musical hallucinations are older and have onset conditions predisposing them to the disease. While there is no set form of treatment, research has discovered medications and alternative therapies to be successful in alleviating the hallucinations.
The McGill Picture Anomaly Test (MPAT) is a scientific test that was created by Donald O. Hebb of McGill University and N.W. Morton that assists in testing visual intelligence as well as understanding human behavior. The test includes a series of pictures that each show a typical situation but have something out of place in the photo and provides evidence that supports the idea that the right temporal lobe is involved in visual recognition. When patients with lesions to the right temporal lobe were given the MPAT, they were unable to point to the absurdity in the photo and perceived that nothing was out of place. The test is used to measure a cultural comprehension which allows for a basis to then estimate an individual's intelligence. However, this test alone is not enough to accurately give a single score or representation of a person's overall intelligence. The MPAT is not meant to be used across a variety of populations due to the fact that the social norms of varied populations can be tremendously different, causing the results of the test to be indeterminate.
In psychology, graphorrhea, or graphorrhoea, is a communication disorder expressed by excessive wordiness with minor or sometimes incoherent rambling, specifically in written work. Graphorrhea is most commonly associated with schizophrenia but can also result from several psychiatric and neurological disorders such as aphasia, thalamic lesions, temporal lobe epilepsy and mania. Some ramblings may follow some or all grammatical rules but still leave the reader confused and unsure about what the piece is about.
Hyperreligiosity is a psychiatric disturbance in which a person experiences intense religious beliefs or episodes that interfere with normal functioning. Hyperreligiosity generally includes abnormal beliefs and a focus on religious content or even atheistic content, which interferes with work and social functioning. Hyperreligiosity may occur in a variety of disorders including epilepsy, psychotic disorders and frontotemporal lobar degeneration. Hyperreligiosity is a symptom of Geschwind syndrome, which is associated with temporal lobe epilepsy.
Bipolar disorder is an affective disorder characterized by periods of elevated and depressed mood. The cause and mechanism of bipolar disorder is not yet known, and the study of its biological origins is ongoing. Although no single gene causes the disorder, a number of genes are linked to increase risk of the disorder, and various gene environment interactions may play a role in predisposing individuals to developing bipolar disorder. Neuroimaging and postmortem studies have found abnormalities in a variety of brain regions, and most commonly implicated regions include the ventral prefrontal cortex and amygdala. Dysfunction in emotional circuits located in these regions have been hypothesized as a mechanism for bipolar disorder. A number of lines of evidence suggests abnormalities in neurotransmission, intracellular signalling, and cellular functioning as possibly playing a role in bipolar disorder.
Patients with temporal lobe epilepsy tended to reply more frequently to a standard questionnaire, and wrote extensively (mean: 1301 words) as compared to others (mean: 106 words). The incidence of temporal lobe epilepsy was 73% in patients exhibiting hypergraphia compared to 17% in patients without this trait. These findings suggest that hypergraphia may be a quantitative index of behaviour change in temporal lobe epilepsy.