Think PLANT to recall vegetative symptoms
Obvious positive symptoms of schizophrenia—such as hallucinations and delusions—typically prompt treatment, but positive symptoms may be absent or clouded by the rationalizations and minimization often seen in paranoia. Negative symptoms can also escape detection because of their subtlety.
Andreasen and Olson’s criteria for negative symptoms1 provide the basis for the Schedule for the Assessment of Negative Symptoms (SANS) that includes the five As: avolition/apathy, alogia, affective flattening, anhedonia/asociality, and attentional impairment.
Many remember Bleuler’s four As of schizophrenia—autism, loosening of associations, affective disturbances, and ambivalence—but may have a harder time remembering the SANS’ five As. I find the pseudo-acronym PLANT (for the vegetative changes manifested with negative symptoms) helpful for recalling all five As (Table).
Use PLANT pseudo-acronym to recall vegetative symptoms
Lack of drive
Marked impairment in thought processing and/or content
Poverty of speech
Poverty of content
Latency of response
Poor eye contact
Lack of expression
Poverty of gestures
Loss of interests and pleasures
Little interest in sex
Lack of closeness
Poor capacity for rapport
1. Andreasen N, Olson SC. Negative versus positive schizophrenia: definition and validation. Arch Gen Psych 1982;39:789-94.
Dr. Wagner is assistant clinical professor, Indiana University School of Medicine, and staff psychiatrist, Richard L Roudebush VA Medical Center, Indianapolis.