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Pearls


Think PLANT to recall vegetative symptoms

Vol. 5, No. 1 / January 2006

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).

Table

Use PLANT pseudo-acronym to recall vegetative symptoms

Symptom

Meaning

Examples

aPathy/avolition

Lack of drive

Poor grooming

Anergia

Impersistence

aLogia

Marked impairment in thought processing and/or content

Poverty of speech

Poverty of content

Thought blocking

Latency of response

Poor abstracting

Affective disturbances

Altered expressiveness

Poor eye contact

Aprosodic speech

Lack of expression

Poverty of gestures

aNhedonia/
asociality

Loss of interests and pleasures

Little interest in sex

Lack of closeness

Few friends

Poor capacity for rapport

aTtentional impairment

Inattentiveness

Poor concentration

Stereotyped thought

References

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.

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