Penser le risque de schizophrénie : Enjeux pronostiques lors du travail clinique auprès de jeunes patients.

Abstract : Background: Over the last twenty years, predicting psychosis has become a priority of both research and policies in the mental health field. While psychiatrists promoting those approaches defend the use of “at risk mental states” categories, cases of patients presenting unclear symptoms that might be the signs of a beginning psychotic process or might as well reflect some adolescent unease are commonplace in youth psychiatry. Yet little is known about the routine practices of youth psychiatrists regarding prognosis. What kinds of expectations do psychiatrists have when treating young patients? Do they anticipate future mental disorders? Do they communicate their expectations to patients and their families? Method: we asked a sample of French youth psychiatrists how they used prognosis in their daily work. Interviews were analyzed using qualitative methodology. Results: While most of them did not spontaneously mention the fact that they made prognostications when treating young patients, psychiatrists described situations where their expectations regarding the future of their patients were problematic and called for specific action. They stressed the impossibility of making a reliable prognosis and feared to induce mental troubles if announcing them, as would do a self-fulfilling prophecy. These contradicting expectations towards prognosis were only managed at the cost of ambivalent attitudes and a deep emotional involvement. Conclusion: Inconspicuous risk management is part of youth psychiatrists’ daily work, and indetermination of prognosis reflects the many uncertainties concerning the boundaries between symptoms and existence in the realm of severe mental disorders.
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Laelia Benoit. Penser le risque de schizophrénie : Enjeux pronostiques lors du travail clinique auprès de jeunes patients. . Sciences de l'Homme et Société. Université Pierre et Marie Curie, Paris VI, 2016. Français. ⟨NNT : 2016PA06S011⟩. ⟨tel-01340796⟩

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