Non-Verbal Behaviour of Patients with Schizophrenia in Medical Consultations – A Comparison with Depressed Patients and Association with Symptom Levels

Abstract

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. 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.

Negative Symptoms and Avoidance of Social Interaction: A Study of Non-Verbal Behaviour

“…The results support past findings on the importance of prosocial and flight behaviours with strengthened methodology [9,11,28]. However, in contrast to some past findings, associations with non-verbal behaviour were only found with negative symptoms and not with other symptom domains.…”

“…In total, there are 27 distinct types of behaviour that can either be considered individually or be classified according to broader behaviour categories. The modified version, used previously by Dimic et al [11], focuses on 14 of these distinct behaviours which can be grouped together to form 6 broader categories ( Table 1). The behavioural categories used, and relevant behaviours within these categories, are as follows: prosocial (look at the interviewer, smile, nod), flight (look down, crouch, look away, freeze), assertion (lean forward), gesture (variable hand and arm movement used during speech), displacement (handface movements, fumbling), and relaxation (fold arm across chest, laugh, neutral face).…”

“…In total, six 30-s sections were analysed for each patient, totalling 3 min. The end of each 30-s section was marked with a beep, and raters recorded the frequency of the behaviours using a 3-point scoring system, as previously used in two studies [11,28] (0 = behaviour not present, 1 = behaviour present at least once, and 2 = behaviour present more than once). A 3-point scoring system was used to capture a greater variance of behaviours, in contrast to the onezero sampling method applied in previous studies.…”

“…In other studies, different symptom domains have been associated with differing symptom severities. For example, increased negative symptoms have been associated with decreases in prosocial behaviour [9,13,14], and a higher general severity of symptoms has been linked with increased flight behaviour [9,11]. By contrast, Brüne et al [4] found that reduced symptoms were associated with an increase in flight behaviour.…”

Head Position and Expressed Emotion of Adolescents with Schizophrenia and Their Caregivers Compared to Non-Patient Controls

“…Bodily movements away from the interaction partner might indicate social withdrawal [20] or flight behaviour [35]. In schizophrenic adolescents, this behaviour might be regarded as a stress reaction [36] towards the high EE caregiver and may be due to inferior social communication skills or cognitive skills of the patient [9].…”