Visual broadcast in schizophrenia.

Although doctors are trained to classify psychiatric symptoms (for example, as ‘delusions’ or ‘hallucinations’) within a standardised mental state examination, it is likely that some symptoms will defy such classification. Hence, if the mental state examination is not supplemented by patients’ verbatim descriptions of their experiences, then novel symptoms may go unrecognised and potentially untreated. We have recently cared for a patient whose case reinforces the importance of this point. A 38 year old man with long-standing paranoid schizophrenia suffered a relapse characterised by prominent auditory hallucinations, persecutory delusions and thought broadcast (the experience that one’s own thoughts have become accessible to others). Following admission to psychiatric hospital, he described a previously unrecorded symptom. He explained that he preferred not to bathe because, during bathing, images of his naked body were being transmitted to and seen by others. The basis for this belief was an experience during which he became aware of his own visual perceptions diffusing out of his head, so that whatever he saw was simultaneously seen by millions of other people. The experience was not confined to occur during bathing, but the patient was most embarrassed in that situation, hence the symptom became apparent. Examination by an ophthalmologist revealed only mild short-sightedness. No abnormalities were found on clinical examination. Standard blood tests were normal. The symptom that we describe demonstrates clear similarities with thought broadcast in that the visual images escape passively and are broadcast and shared with others. Hence, our preferred name for this symptom is ‘visual broadcast’. We searched Medline for earlier reports of ‘visual broadcast’ (1966–2004; terms: ‘visual’, ‘vision’, ‘perception’, ‘broadcast’ and ‘schizophrenia’), but found no related citations. Multiple sources describe thought broadcast, but these do not provide a link with visual perception. The symptom of ‘visual broadcast’ is not included in standard forms of structured questioning (for example, Present State Examination). Although ‘visual broadcast’ is previously unrecorded (as far as we are aware), it is not our intention to report a ‘rare’ or ‘obscure’ symptom. Rather, we want to emphasise the importance of listening to patients’ verbatim accounts of their psychiatric symptoms. We argue that disorders of the mind can produce diverse and, perhaps, patient-specific symptoms whose essence can only be captured by patients’ own descriptions of their experiences. The identification of ‘visual broadcast’ in our patient enabled the clinical team to incorporate this knowledge in his management plan. With reassurance, he was able to resume bathing whilst receiving inpatient treatment for acute schizophrenia; his willingness to bathe was also a helpful marker of overall improvement in his mental state.