Medical history / Brief
- Greeting and personal data
- Current medical history
- Previous complaints and treatments
- Pre-existing conditions
- Medications
- Allergies and intolerances
- Smoking, alcohol and other substances
- School, work and daily life
- Family and social contacts
- Additional information from mother
- Expectations for treatment
👨⚕️ Hello, my name is Dr. Schneider. I’m responsible for you today. How may I address you?
👨 My name is Daniel Weber.
👨⚕️ Mr. Weber, I would like to ask you a few questions to better understand how you are doing. Is that okay with you?
👨 Yes. But I don’t know whether you will believe me.
👨⚕️ You can first tell me calmly what is bothering you. How old are you?
👨 I’m 27.
👨⚕️ How tall are you and approximately how much do you weigh?
👨 Approximately 1,78 Meter. I weigh about 70 Kilo.
👨⚕️ Where do you currently live?
👨 In Nuremberg, with my parents.
👨⚕️ Your mother accompanied you today. Would you like to speak with me alone for now?
👨 Yes, alone for now.
- Current complaints
- Hearing voices
- Beliefs and other perceptions
- Anxiety and panic attacks
- Mood and motivation
- Sleep, appetite and concentration
- Safety and coping with stress
Current complaints
👨⚕️ What brings you to us today?
👨 My mother insisted that I come. I hardly go out anymore. It’s simply not safe outside.
👨⚕️ What exactly makes you afraid outside?
👨 I have the feeling that certain people are watching me. When I go out, they immediately know where I am.
👨⚕️ How do you notice that?
👨 From the looks. And sometimes the same cars are parked on the street. That’s not a coincidence.
👨⚕️ What do you fear might happen?
👨 That they will intercept me or do something to me. That’s why I prefer to stay at home.
👨⚕️ That sounds very distressing. Since when have you been experiencing this?
👨 It started at about 19 or 20. Sometimes it’s less, sometimes worse. Lately it’s been stronger again.
👨⚕️ What has changed recently?
👨 The voices are present more often. I’m constantly tense and can’t concentrate on anything else.
👨⚕️ Can you describe to me what you mean by the voices?
👨 People are talking, even though no one is in the room.
👨⚕️ Do you hear the voices like a voice from outside or rather like thoughts in your head?
👨 Like from outside. Not like I’m thinking myself.
👨⚕️ What do the voices say?
👨 That I shouldn’t go out. That there is danger outside and I have to be careful. They keep talking to me until I don’t want to go out at all.
👨⚕️ Do the voices speak directly to you or do they talk about you?
👨 Mostly directly to me. Sometimes they also talk among themselves about me.
👨⚕️ How many voices do you hear?
👨 Usually two. But I don’t know the people.
👨⚕️ How often does this happen?
👨 At the moment almost every day. Sometimes only briefly, sometimes repeatedly over hours.
👨⚕️ Have there been longer periods when you didn’t hear any voices?
👨 Yes. Sometimes they were gone for weeks. But the feeling that something was wrong outside was still there.
👨⚕️ Do the voices urge you to harm yourself or someone else?
👨 No. They mainly tell me to stay at home and be careful.
👨⚕️ Can you resist the voices?
👨 Sometimes I turn on the TV so I hear them less. But when they are that clear, I can’t just ignore them.
👨⚕️ Do you also see things that other people do not see, or perceive unusual smells?
👨 No, actually only the voices.
👨⚕️ Do you have any idea who these people are and why they might be interested in you?
👨 I think they belong together. Why me in particular, I don’t know exactly. But they have been watching me for a long time.
👨⚕️ From your perspective, could there also be another explanation for the looks or the cars?
👨 My parents say I’m imagining it. But it happens too often for that.
👨⚕️ Do you sometimes get the impression that news on TV or posts on the internet are directed specifically at you?
👨 Sometimes I think that something is aimed at me. But I can’t give you a specific example right now.
👨⚕️ Do you feel that someone can read, take away, or externally influence your thoughts?
👨 No, I wouldn’t put it that way.
👨⚕️ Can you usually keep your thoughts organized well?
👨 Mostly, yes. But when the voices are present, I think about everything at once. Then I can’t calm down.
👨⚕️ What happens physically when the anxiety becomes particularly strong?
👨 My heart races, I sweat and have trouble breathing. Then I think something terrible is about to happen.
👨⚕️ Does it start suddenly or does it build up slowly?
👨 It comes quite suddenly and quickly becomes really intense.
👨⚕️ Approximately how long does such an attack last?
👨 Maybe ten or fifteen minutes. After that I’m tense for a long time.
👨⚕️ Do these attacks mainly occur when you hear voices?
👨 Yes, mostly then. When the voices talk a lot or warn me.
👨⚕️ Does this also happen independently of that, for example on quiet days without voices?
👨 Actually not.
👨⚕️ What do you do in such moments?
👨 I go to my room, close the door and wait until it subsides.
👨⚕️ How has your mood been recently?
👨 Mostly I’m tense. Sometimes I’m really down because all this doesn’t stop.
👨⚕️ Are there times when your mood changes particularly?
👨 Before the voices get worse again, I often already feel worse. And afterwards I’m sometimes pretty exhausted for a while.
👨⚕️ Apart from the voices and anxieties, have there been longer periods in which you were continuously very sad and no longer took pleasure in anything?
👨 Not that I can remember. It’s mostly connected somehow.
👨⚕️ Conversely, have there been times when you were unusually hyper, needed little sleep and were still full of energy?
👨 No.
👨⚕️ Do you find it difficult to motivate yourself for everyday tasks?
👨 Yes. Even showering or tidying my room is often too much for me.
👨⚕️ Has this been the case only since the last deterioration?
👨 No, it’s been this way for a while. My mother often has to remind me of things.
👨⚕️ Is there anything that still gives you pleasure?
👨 Sometimes music or a game on the computer. But often I don’t feel like that either.
👨⚕️ How are you sleeping currently?
👨 Not particularly well. When the voices are there, I lie awake for a long time.
👨⚕️ How many hours do you sleep, roughly?
👨 Maybe four or five. Sometimes I sleep a bit during the day.
👨⚕️ How is your appetite?
👨 It varies. Sometimes I forget to eat. If my mother puts something out, I usually eat it.
👨⚕️ Have you lost a noticeable amount of weight recently?
👨 Not that I know of.
👨⚕️ Can you concentrate on a film or a text?
👨 Not for long. I drift off quickly, especially if I’m paying attention to the voices.
👨⚕️ When someone feels burdened like this for a long time, thoughts can come up about not wanting to live anymore. Do you know such thoughts?
👨 Not at the moment. I just want this anxiety and the voices to stop.
👨⚕️ Have you ever tried to hurt yourself or deliberately injured yourself in the past?
👨 No.
👨⚕️ Have you had thoughts of harming someone else, perhaps because you feel threatened?
👨 No. I prefer to avoid people.
👨⚕️ Have you prepared anything for self-defense or are you carrying anything with you?
👨 No.
👨⚕️ What do you do when you become very tense or angry?
👨 I withdraw. Sometimes I get loud when my parents won’t stop arguing with me.
👨⚕️ Have you ever seen a doctor because of the voices or the feeling of being watched?
👨 No. My parents have wanted that for a while, but I didn’t want to.
👨⚕️ What stopped you from doing it?
👨 I thought they wouldn’t listen to me anyway and would just say I was crazy.
👨⚕️ Have you ever taken medication for these complaints?
👨 No.
👨⚕️ Have you ever been in a psychiatric clinic or in psychotherapy?
👨 No.
👨⚕️ What physical illnesses are known for you?
👨 My thyroid works too much. I take tablets for that.
👨⚕️ Do you know when that was diagnosed?
👨 About two years ago.
👨⚕️ Did the voices start before that?
👨 Yes, much earlier.
👨⚕️ Is the thyroid checked regularly?
👨 Yes. Last time they said the results were fine.
👨⚕️ Do you currently have palpitations, heavy sweating or shaky hands even without panic attacks?
👨 No, actually only when I get that anxiety.
👨⚕️ Have you ever had seizures, a severe head injury or an inflammation of the brain?
👨 No.
👨⚕️ Do you currently have a fever, severe headaches or other new physical complaints?
👨 No.
👨⚕️ Have you ever had surgery?
👨 No.
👨⚕️ What is the name of your thyroid medication?
👨 Propylthiouracil. I can hardly remember the name.
👨⚕️ What dose are you taking?
👨 I don’t know exactly right now. My mother has the medication plan with her.
👨⚕️ Do you take it regularly?
👨 Most of the time my mother reminds me. Then I take it.
👨⚕️ Do you take any other medications, herbal remedies, or dietary supplements?
👨 No.
👨⚕️ Do you have any allergies or have you ever had a medication you couldn’t tolerate?
👨 Not that I know of.
👨⚕️ Do you smoke?
👨 Yes, about a pack a day.
👨⚕️ Since when?
👨 Since I was about 17.
👨⚕️ Do you drink alcohol?
👨 Mostly a few beers on the weekend.
👨⚕️ How much roughly?
👨 About three or four bottles in one evening.
👨⚕️ Do you use cannabis or other drugs?
👨 I smoke cannabis every day. I don’t take other stuff.
👨⚕️ How much cannabis do you consume roughly?
👨 Usually one or two joints in the evening. Sometimes during the day as well.
👨⚕️ Since when have you been using regularly?
👨 Since I was about 18.
👨⚕️ What do you hope to gain from it?
👨 That I become calmer and can sleep better.
👨⚕️ Have you noticed whether the voices or the anxiety change afterwards?
👨 Sometimes I’m calmer at first. Sometimes I become even more suspicious.
👨⚕️ Have there been longer periods since the onset of the complaints in which you didn’t consume cannabis at all?
👨 No, at most a few days.
👨⚕️ Have you ever taken cocaine, amphetamines, ecstasy or hallucinogenic substances?
👨 No.
👨⚕️ How were your school years?
👨 I wasn’t particularly good at school. I also didn’t have much to do with the others.
👨⚕️ What school leaving qualification do you have?
👨 I left school before completing upper secondary school.
👨⚕️ Did you start vocational training afterwards?
👨 Yes, in a warehouse. But I quit it.
👨⚕️ What was difficult back then?
👨 I didn’t feel comfortable among the people. At some point I also thought people were talking about me there.
👨⚕️ Are you currently working?
👨 No.
👨⚕️ How do you spend a normal day?
👨 I’m mostly in my room. I listen to music, watch videos or just lie there.
👨⚕️ Do you do the shopping yourself or take care of other things outside the apartment?
👨 Rarely. My parents mostly do that.
👨⚕️ Who takes care of your laundry, your meals and your appointments?
👨 Mainly my mother.
👨⚕️ How do you get along with your parents?
👨 Mostly okay. But we argue when they say that it’s all in my head.
👨⚕️ Do you have siblings?
👨 An older sister. She no longer lives with us.
👨⚕️ Do you have friends or someone outside the family you trust?
👨 Not really. I preferred being alone even earlier.
👨⚕️ Do you have a partner?
👨 No.
👨⚕️ Are similar complaints or other mental illnesses known in your family?
👨 I don’t know of anyone.
👨⚕️ Mr. Weber, would it be okay with you if your mother joined now and said a bit about your development and the course so far?
👨 Yes, that’s okay.
👨⚕️ Mrs. Weber, what have you particularly noticed recently?
👩 He withdraws even more. Sometimes I hear him talking in his room, although no one is with him. When we ask, he says we wouldn’t understand anyway.
👨⚕️ Since when have you been observing such changes?
👩 The mistrust and the talking about these people started at about 19 or 20. Since then it has been sometimes better and sometimes worse. The mistrust never completely went away.
👨⚕️ What was he like before, as a teenager?
👩 He was always very much to himself. He usually didn’t want to take part in group activities. He never really had a close friend.
👨⚕️ How did he develop as a young child?
👩 As a baby he was able to hold his head up later than other children. This was also mentioned at the pediatrician back then.
👨⚕️ How would you describe his cognitive abilities and his school development?
👩 Actually average. He could understand things, but sometimes needed more time. Later he often lacked drive.
👨⚕️ Has he only recently needed support with personal hygiene and around the house?
👩 No, for years. I often have to remind him to shower or to put on fresh clothes. He does little on his own.
👨⚕️ Were there clearly defined periods of very severe depression or unusually elevated mood during which the voices and the mistrust were completely gone?
👩 No. His mood changes more shortly before the complaints worsen and also afterwards. Regardless, we have not experienced such pronounced phases.
👨⚕️ Do you know whether similar illnesses occur in the family?
👩 No, as far as we know, not.
👨⚕️ Mr. Weber, what would be the most important change for you at the moment?
👨 That I have my peace again. That the voices decrease and I don’t have to be afraid all the time.
👨⚕️ What would help you feel more secure during the conversations here?
👨 If you listen to me and tell me beforehand what you want to do.
- Information
- Allergies
- Social history
- Substance use / drugs
- Family history
- Past illnesses / operations
- Medications
- Medical history
- Suspected diagnosis – differential diagnosis
Patient: Daniel Weber
Date: 15.10.2026
Dear Senior Consultant (female), dear Senior Consultant (male),
I would like to present to you the 27-year-old patient Daniel Weber.
| Age | Weight | Height |
|---|---|---|
| 27 years | approx. 70 kg | 178 cm |
No allergies or drug intolerances known.
- Single, not in a relationship.
- Lives with his parents in Nuremberg.
- Left school before completing upper secondary education.
- Training in the warehousing sector discontinued; currently unemployed.
- Marked social withdrawal, no close friendships.
- Support from his mother with personal hygiene, household management, medication intake and appointment organization.
- Nicotine: approx. 20 cigarettes daily since age 17, corresponding to approx. 10 pack-years.
- Alcohol: weekly, mainly on weekends about three to four bottles of beer.
- Cannabis: daily use since age 18, predominantly one to two joints; no longer periods of abstinence.
- Denies use of other drugs.
- No comparable psychiatric illnesses known in the family.
- An older sister, living outside the parental home.
- Hyperthyroidism, on Propylthiouracil well controlled according to history.
- Psychotic symptoms persisting since early adulthood, untreated until now.
- Delayed development of head control in infancy, according to history.
- No surgeries reported.
- Propylthiouracil for hyperthyroidism; exact dosage to be supplemented based on the medication plan brought in.
- No psychopharmacological treatment to date.
- No other regular medications reported.
The patient presented at the request of and accompanied by his mother because of increasing social withdrawal, pronounced mistrust of his surroundings, and recurrent auditory hallucinations.
He reported that since about the age of 19 to 20 he has been convinced that certain people are watching and possibly threatening him. He interpreted, among other things, the gazes of strangers and repeatedly parked vehicles on his street as evidence of this. Because of his fears he rarely leaves his parents’ apartment. These convictions persist even during periods without hearing voices.
Additionally, he repeatedly hears mostly two unknown voices that he perceives as coming from outside. These predominantly address him directly and try to convince him that the outside world is dangerous and that he must stay at home. Occasionally the voices talk about him among themselves. Currently the hallucinations occur almost daily and sometimes for several hours. There have been multi-week periods without hearing voices in between. Requests to self-harm or to harm others were denied. Visual and olfactory hallucinations as well as thought withdrawal, thought insertion and thought dissemination were also denied.
During pronounced hallucinations there are intermittent sudden-onset panic attacks with palpitations, dyspnea, hyperhidrosis and the feeling of an imminent danger. The attacks lasted about ten to fifteen minutes. Comparable complaints independent of the psychotic symptomatology were not reported.
In addition, for years there has been reduced drive, limited daily activity, and neglect of self-care. The patient spends the majority of the day in his room. Personal hygiene, changing clothes and regular meals often occurred only after prompting by his mother. He also reports concentration difficulties, inner tension and difficulty falling asleep with a nightly sleep duration of about four to five hours. Appetite is variable; a marked weight loss is denied.
More pronounced affective changes, according to the patient and his mother, occur before or after a worsening of the psychotic symptoms. Independent depressive or manic episodes without psychotic symptomatology could not be delineated from the history.
Current suicidal thoughts, previous suicide attempts and self-injurious behavior were denied. The patient also denied current aggressive intentions toward others and keeping objects for defense. In family arguments he is occasionally loud, but otherwise he predominantly withdraws.
According to collateral history from his mother, her son already showed little interest in social activities during adolescence and did not maintain close friendships. She describes his intellectual abilities as average. A delayed development of head control was noticed in infancy.
No psychiatric or psychotherapeutic treatment has taken place to date. Somatically, there has been hyperthyroidism known for about two years, which under Propylthiouracil is reported by the patient to have been well controlled recently. The psychotic complaints began several years before the thyroid disease was diagnosed. According to history there are no seizures, severe traumatic brain injuries or inflammatory diseases of the central nervous system.
Sowohl positive als auch negative Punkte werden berücksichtigt. Positive Punkte werden mit der Anzahl der Sterne multipliziert. Negative Punkte werden mit einem Drittel der Sterne gewichtet: Punkte × Sterne ÷ 3. Null Punkte bleiben unverändert. Das Gesamtergebnis wird auf 100 Punkte umgerechnet.
Scenarios
- 1. Improvement on Olanzapin
- 2. Insufficient improvement
- 3. Combination of two antipsychotics
- 4. Additional treatment
- 5. Clozapine
- 6. Electroconvulsive therapy
The pharmacological treatment is started with 5 mg Olanzapin started.
In the first week sleep and appetite improve; internal tension decreases significantly. In the second week the hallucinations decrease markedly. At the same time the patient shows less resistance to critically questioning his delusional convictions.
The dose is increased to 10 mg Olanzapin increased. In the third and fourth weeks the depressive symptoms and anxiety symptoms also improve. In addition there is a slight improvement in self-care.
A maintenance therapy with 10 mg Olanzapin for at least one year, accompanied by regular monitoring of metabolic parameters and the required laboratory tests. In addition, psychotherapy is recommended, especially with supportive and behavioral therapeutic approaches.
Insufficient improvement under the initial dose
At the end of the second week under the initial dose the patient remains restless and highly tense. The delusional convictions remain firmly entrenched; only the frequency of the hallucinations has decreased somewhat. He complains about thinking too much.
Nursing documentation indicates that the patient may not have taken the medication regularly.
In this case a switch to a Olanzapin-depot preparation is considered. After the first injection further injections are given depending on the dose at intervals of one to four weeks. After each gluteal injection a three-hour monitoring is planned. During the first two weeks an orally disintegrating formulation is used.
If regular intake is ensured, treatment with a first-generation antipsychotic will be started, here Tiotixen at an initial dose of 5 mg.
2b1: Partial response and dose escalation
Within the first two weeks the hallucinations partially subside and the delusions lose intensity. The dose is increased to the target dose of 10 mg and treatment is continued until remission. During follow-up checks attention is paid to tardive dyskinesia and extrapyramidal symptoms.
2b2: Persistent positive symptomatology despite higher dosages
Despite several weeks of treatment and higher dosages, the positive symptomatology remains markedly pronounced.
Continue with scenario 3.
Combination of two antipsychotics
With a partial response to Tiotixen a second-generation antipsychotic, for example Risperidon, is added.
As alternative third-line treatment approaches, the following combinations can be used, for example:
An adequate response occurs. The patient then receives both medications as maintenance therapy.
Even after six weeks the response remains absent or is insufficient.
Continue with scenario 4.
Additional treatment for persistent complaints
The additional administration of Propranolol 40 mg daily to Perphenazin leads to a marked improvement. The patient enters the maintenance phase. This approach is particularly effective in cases with accompanying aggressive behavior.
Lithium and Asenapin if ineffective
If this combination (Propranolol + Perphenazin) does not work, treatment is carried out with 600 mg Lithium and 10 mg Asenapin sublingual. This attenuates both the psychotic symptoms and the affective changes as well as the anxiety symptoms. This approach is particularly effective in patients with pronounced cyclical mood swings in addition to psychosis.
If response remains insufficient: continue with scenario 5.
Alternative adjunctive treatment in case of intolerance
If the side effects are not tolerated, another strategy is to add an anticonvulsant or a benzodiazepine to an antipsychotic, for example Valproat, Carbamazepin or a benzodiazepine. This approach is particularly effective for accompanying panic attacks, pronounced anxiety symptoms, or PTSD.
The patient also does not respond to this treatment.
Continue with scenario 5.
Clozapin for treatment-resistant schizophrenia
At this stage, the diagnosis is assumed to be treatment-resistant schizophrenia.
At the next appointment, the patient talks about death and firmly questions the reasons to continue living.
Treatment with Clozapin is initiated. Due to the contraindication mentioned in the original text of concomitant administration with Propylthiouracil internal medicine is consulted to, if possible, establish an alternative treatment (Methimazole) of the hyperthyroidism.
The Clozapin dose is gradually increased to 200 mg over the course of one month. The patient’s thinking becomes more organized, aggressive outbursts cease, and he only hears the voices occasionally late in the evening. He now expresses the conviction: “Life is still worth living.”
Serious complications under Clozapin
1: Acute chest pain and shortness of breath in the third week
In the third week, acute chest pain and shortness of breath occur. Clozapin must be discontinued immediately. To evaluate for myocarditis, an ECG as well as measurement of troponin and creatine kinase are ordered.
2: Sore throat and cervical lymphadenopathy in the second month
In the second month, sore throat and acute cervical lymphadenopathy develop. Clozapin is stopped immediately and a blood count is requested.
Persistent complaints despite adequately dosed Clozapin treatment
If symptoms persist despite a three-month treatment with adequately dosed Clozapin and neither quality of life nor level of functioning improve, a highly treatment-resistant schizophrenia is assumed.
Continue with scenario 6.
Transition to electroconvulsive therapy
Clozapin is gradually discontinued. Subsequently electroconvulsive therapy (ECT) is initiated.
Basics
The schizophrenia is a mental disorder in which perception, thinking, sense of self, emotional expression and behavior can change. Those affected, for example, experience voices, feel persecuted or have difficulty organizing their thoughts. In addition, drive, concentration and social activity can decrease.
The disorder often begins in late adolescence or early adulthood. It can run an episodic course with intermittent improvement or with persistent symptoms. Severity and course vary considerably between affected individuals.
Schizophrenia arises from the interaction of genetic predisposition, altered brain development, and environmental factors. Disturbances in neurotransmission—particularly in the dopamine, glutamate, and GABA systems—affect the processing and appraisal of information. As a result, neutral stimuli can acquire excessive significance and perception and thinking can be altered. Changes in neuronal networks also contribute to cognitive impairments and negative symptoms. Stress and cannabis use can, in susceptible individuals, promote onset or relapse. The precise mechanisms are not yet fully understood.
- Positive symptoms
- Negative symptoms
- Disorganization symptoms
- Cognitive symptoms
- Psychomotor and catatonic symptoms
- Affective and other concomitant symptoms
Positive symptoms are experiences that are added to ordinary experience.
| Symptom | Explanation and examples |
|---|---|
| Delusion | Fixed beliefs that are hardly correctable by contrary evidence. Examples include persecutory delusions, delusions of reference, and grandiose delusions. |
| Hallucinations | Perceptions without a corresponding external stimulus. Acoustic hallucinations are particularly typical, such as commenting voices or voices that speak to each other. |
| Self-disorders | The boundary between one’s own experience and external influences appears altered. For example, affected individuals experience thoughts as being inserted, withdrawn, or accessible to others. |
| Experience of external control | The feeling that one’s own actions, emotions, or bodily processes are being controlled from outside. |
Negative symptoms describe the reduction of abilities and means of expression that are normally present.
| Symptom | Explanation |
|---|---|
| Blunted affect | Emotions are expressed less clearly through facial expression, gestures, and voice. This does not necessarily mean that there are no feelings internally. |
| Alogia | Reduced speech flow with brief, minimally elaborate answers. |
| Avolition | Difficulty initiating and sustaining activities on one’s own initiative. |
| Anhedonia | Reduced experience or expectation of pleasure. |
| Asociality | Reduced interest in social contacts and relationships. |
| Symptom | Explanation and examples |
|---|---|
| Disorganized thinking and speech | Thought processes lose their coherence. Affected individuals jump between topics, answer beside the question, or speak in a way that is difficult to understand. |
| Disorganized behavior | Actions appear poorly goal-directed or unpredictable. Planning and carrying out everyday tasks can be considerably impaired. |
| Domain | Possible impairment |
|---|---|
| Attention | Difficulty sustaining concentration for extended periods or filtering out irrelevant stimuli. |
| Working memory | Information can only be retained and processed in the short term to a limited extent. |
| Processing speed | The acquisition and processing of information take longer. |
| Executive functions | Problems with planning, decision-making, and problem-solving. |
| Social cognition | Difficulty interpreting others’ emotions, intentions, or social cues. |
| Symptom | Explanation |
|---|---|
| Psychomotor agitation | Pronounced motor restlessness with increased motor activity. |
| Stupor | Markedly reduced movement and responsiveness to the environment while consciousness is essentially preserved. |
| Mutism | Absence or almost complete absence of speech. |
| Posturing | Unusual body postures are maintained for extended periods. |
| Negativism | Instructions or attempts to move are opposed without an apparent reason, or there is no response to them. |
| Echo phenomena | Repeating others’ utterances or imitating others’ movements. |
Catatonic symptoms are not limited to schizophrenia and can also occur in other psychiatric or medical conditions.
Additionally, depressed mood, anxiety, panic attacks, irritability, and sleep disturbances may occur. These complaints are not exclusive to schizophrenia but can significantly influence its course.
Suicidal thoughts must also be specifically asked about. Limited insight into the illness can also lead affected individuals to explain their complaints differently and to initially refuse treatment.