Behavioural manifestations of depressive, schizophrenic and non-psychiatric patients on the ward

Background

Only very few quantitative studies have been carried out of the behaviour of psychiatric patients. The objective of this investigation was to conduct ethological studies of the behaviour of psychiatric patients in order to provide psychiatry with new theoretical and practical knowledge.

Material and methods

Eleven depressed, 11 schizophrenic, and 11 nonpsychiatric patients were observed. The observations were carried out systematically and quantitatively on the ward by means of an observation sheet including 166 detailed behavioural items. Statistics: Data were treated by nonparametric statistics.

Results

The following results are derived from three studies: 1) The behaviours of the first and the last hospital weeks of the depressed patients were compared. Thus depression and improvement markers could be singled out. Examples of depression markers were: high frequencies of nonspecific gaze, social withdrawal, no mouth movements, and fumbling-finger-movements. Of improvement: increased frequencies of verbal-social-initiative, talk, nod, smile, laugh, gesticulate, help, point, and give. The clinical relevance of these markers is that doctors and nurses can use them to recognize progress, stability, lability, or direct relapse in the patient's mental state. In addition, the data of this study indicated a tendency towards two subtypes of depressives: one being non-social and non-self-active, the other being non-social, but self-active. The last subtype improved at a much higher social level than the first subtype. 2) The control study revealed three findings: a) a substantial discrepancy between depressives and controls in the first hospital week 49 detailed items and six general parameters constituted the difference. The parameters were: Introvert-Eye-Fixation which showed significantly higher frequencies in depressives; Diversity (the number of different items shown per week), Activity, Receive-Social-Behaviour, Send-Verbal-Communication, and Send-Nonverbal-Communication all had significantly lower frequencies in depressives. The significance of this result is that depression is first of all a dramatic reduction of social interaction; b) from the first to the last week, controls habituated to the hospital environment by reducing their social interaction and increasing their self-activity. On the contrary, improved depressives showed a clear increase of their social interaction from first to last week. The significance of that finding is that this social increase is not a habituation to the hospital environment, but a consequence of the treatment (medicine, ECT); c) the third finding was that Verbal-Communication of the depressives in their last hospital week showed a significantly lower frequency than that of the controls. This means that the remitted depressives had not fully recovered at discharge. 3) The schizophrenics revealed a still greater discrepancy from the controls than did the depressives. The difference consisted of 48 detailed behaviours and seven parameters in the illness phase of the schizophrenics: the frequencies of Posture-Flexibility (body-mobility) and Introvert-Eye-Fixation were significantly increased in schizophrenics; Diversity, Activity, Receive-Social-Behaviour, Send-Verbal-Communication, and Send-Nonverbal-Communication all showed significantly lower frequencies in schizophrenics. A specific feature in the schizophrenics was a certain kind of behaviours that did not occur either among controls or depressives. Examples of such unique and endemic behaviours are bizarre postures, stereotypies, talk-to-himself, smile-to-himself, laugh-to-himself, penetrating staring, distorted voice tonality, and aggression. Many schizophrenics still show these peculiar behaviours after discharge. Hereby they are easily looked upon as deviants and are therefore exposed to social isolation which is a serious handicap for these patients.

Discussion

Based on the above findings, it is estimated that this ethological-psychiatric investigation has provided psychiatry with knowledge of a novel and important character, both theoretically and in clinical practice.