Non-verbal behaviour of patients with schizophrenia in medical consultations--a comparison with depressed patients and association with symptom levels.
BACKGROUND
The Dutch psychiatrist Rümke 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.


METHODS
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.


CONCLUSIONS
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.
Dimic
Sara
S
Unit for Social and Community Psychiatry, Queen Mary University of London, Newham Centre for Mental Health, London, UK. sara.dimic@eastlondon.nhs.uk
Wildgrube
Christiane
C
McCabe
Rosemarie
R
Hassan
Imren
I
Barnes
Thomas R E
TR
Priebe
Stefan
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003866:Depressive Disorder / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009633:Nonverbal Communication / Q000523:psychology*; D010045:Outpatients / Q000523:psychology; D010817:Physician-Patient Relations; D012017:Referral and Consultation; D012565:Schizophrenic Psychology; D012720:Severity of Illness Index; D014741:Video Recording