The symptoms of chronic

schizophrenia
A Re-examination of the positive –Negative dichotomy

PETER F LIDDLE -1987

BRITISH JOURNAL OF PSYCHIATRY
PETER LIDDLE

• PHD in Physics

• Studied medicine at oxford university

• Chairperson in psychiatry at Nottingham University, London.

Aim of study

• This study attempted to delineate the segregation of symptoms in a

sample of schizophrenic patients selected in a manner intended to
discriminate in favour of cases with persistent symptoms .
• 40 Patients were selected with persistent symptoms

SELECTION OF PATIENTS
.. Have satisfied DSM-III criteria for the diagnosis of schizophrenia

.. The time since onset of illness must be 3-18 years.

.. The patient must be under regular psychiatric care , but no increase in

neuroleptic medication or re-admission within last 6 months .

.. Age must be less then 55 year

The mean duration of illness was 10.5 years and mean age was 35 years.
Assesment of Schizophrenic Symptoms
• Symptoms were rated according to

• section –II of the comprehensive Assesment of Symptoms and

History (CASH) , rated on a scale of 0-5.

• Section 13-20 of the Present State Examination .

• The symptom ratings were subjected to factor analysis using the

program Factor .
The symptoms segregated into three
syndromes
• 1. Psychomotor poverty .

• poverty of speech
• lack of spontaneous movements
• Blunting affect
• Unchanging facial expressions
• paucity of expressive gestures
• lack of vocal inflection

The psychomotor poverty syndrome was associated with impairment of

personal relationships.
2. Disorganization Syndrome
• Poverty of content of speech
• Disturbances of form of thought
• Tangentiality
• Derailment
• Distractibility

The disorganization syndrome was associated with poor-self care and

impersistence at work.
3. Reality distortion syndrome
• Auditory hallucinations

• Delusions of persecution

• Delusions of reffrence
Results from factor analysis of CASH ratings
• The three syndromes are not strongly correlated. There is a weak
negative correlation between the factors associated with the
psychomotor povetrty syndrome and the disorganization syndrome
and the other correlations are near zero .
• E.g : the probability that a patient has symptoms of the
pshychomotor poverty syndrome is independent of wether he has
symptoms of reality distortions syndrome
Resuilts for Factor analysis of PSE rating
• The factor analysis of PSE ratings reveals a pattern of segregation of
symptoms similar to that obtained for the CASH ratings .