Non-verbal behaviour of patients with schizophrenia in medical consultations--a comparison with depressed patients and association with symptom levels.

摘要

BACKGROUND: The Dutch psychiatrist Rumke introduced the notion that patients with schizophrenia could be recognised intuitively by an experienced psychiatrist, naming the process as the 'praecox feeling'. This feeling may reflect aspects of the non-verbal behaviour of patients as shown in a medical consultation. The aim of this study was to test whether aspects of the initial non-verbal behaviour of patients with schizophrenia and depression in medical consultations differ and are associated with symptom levels in each group. SAMPLING AND METHOD: The first 2 min of videotaped outpatient consultations with 78 patients (39 each with schizophrenia and depression) were analysed by researchers who were masked to the diagnosis and symptom levels of the patients. Non-verbal behaviour was assessed using a modified Ethological Coding System for Interviews. Symptom levels were rated by independent researchers on the Positive and Negative Syndrome Scale and Beck Depression Inventory. RESULTS: The 2 diagnostic groups showed significant differences on 1 out of 6 aspects of non-verbal communication, with patients with schizophrenia exhibiting more 'flight' behaviour, i.e. more looking down or away, crouching and freezing. Within the group of patients with schizophrenia, more 'flight' and less 'assertion' were associated with higher symptom levels. CONCLUSION: Initial 'flight' behaviour of patients in medical consultations may be specific for schizophrenia and associated with the symptoms of that illness. Such behaviour might indicate an avoidance of potentially adverse communication, and future research should investigate whether it can also be identified in everyday social interactions other than medical consultations.