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 …