Nonverbal Behavior During Standardized Interviews in Patients With Schizophrenia Spectrum Disorders

Abstract

Several studies have consistently shown that patients with schizophrenia or schizophrenia spectrum disorders (SSD) can be distinguished from normal controls on the basis of their nonverbal behavior during standardized interviews, with considerable interactions between negative symptoms and poor facial expressivity. However, most studies have examined unmedicated patients, and gender of both interviewer and interviewee has not been taken into account. In this study we assessed the nonverbal behavior of male and female patients with SSD who were receiving second-generation antipsychotic medication (SGA) using the Ethological Coding System for Interviews (Troisi, 1998). In addition, we used a novel 5-factor model of the Positive and Negative Symptom Scale (PANSS, van der Gaag et al., 2006) to correlate nonverbal behavior with standard psychopathology ratings. Our findings strongly resembled results of previous studies into nonverbal behavior of patients with SSD, despite differences in cultural backgrounds and gender of the interviewer. Negative symptoms were inversely correlated with several of the nonverbal behavioral dimensions. Medication dose did not correlate with any one of the behavioral or psychopathological measures. Patients with SSD make less use of their nonverbal behavioral repertoire compared with controls, independent of antipsychotic treatment. Culture-specific nonverbal expressivity seems to play an additional (minor) role in distinguishing patients from healthy controls.

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

“…In an Italian study of young men with a diagnosis of recent-onset schizophrenia, non-verbal behavioural patterns clearly distinguished schizophrenia patients from control subjects, with a global restriction of non-verbal expressiveness in the patient group [22] . However, our findings of an association of more flight behaviour with a diagnosis of schizophrenia and higher symptom levels within the group of schizophrenia patients are inconsistent with a study by Brüne et al [23] . They examined a heterogeneous group of acute adult inpatients with schizophrenia spectrum disorders and reported less flight behaviour in patients as compared to healthy subjects.…”

“…An association between conventional psychopathology measures and non-verbal behaviour has also been found in other studies on patients with schizophrenia [23][24][25] . These authors analysed videotaped interviews that were specifically arranged for the research and not real-life situations.…”

“…In the patient group, they found more flight behaviour to be correlated with lower scores of negative symptoms, as well as higher levels of excitement. Whether this inconsistency is due to differences in patient characteristics between the 2 studies or the different context of the behaviour -especially arranged research interviews in the study of Brüne et al [23] and real-life consultations in this study -remains unclear. Yet, clarifying such inconsistencies appears important for the use of similar assessment methods in future research.…”

“…The study of Troisi et al [22] reported a weak correlation between non-verbal behaviour and psychiatric symptoms, whilst newer research found a strong correlation between less facial expressivity, measured on the ethological prosocial score, and more negative symptoms, in particular anergia [24,25] . In addition, Brüne et al [23] reported multiple associations of psychopathology, particularly negative symptoms with non-verbal behaviour in patients with schizophrenia spectrum illness. The relationship between flight and symptom levels in patients with schizophrenia in this study was moderate, yet found only in participants with schizophrenia.…”

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

“…Independent raters later analysed the videos for non-verbal behaviour, using a modified version of the Ethological Coding System for Interviews (ECSI). Results: Patients with a higher level of negative symptoms displayed significantly fewer prosocial (e.g., nodding and smiling), gesture, and displacement behaviours (e.g., fumbling), but significantly more flight behav-schizophrenia display less non-verbal behaviour [3][4][5][6] and, in turn, these reductions in expressivity have been linked with poorer social functioning and social competence [7,8]. Patients with schizophrenia have also been shown to have non-verbal profiles that differ from those with different psychiatric diagnoses [6,7,[9][10][11][12].…”