[From Kraepelin to McGorry: Scientific Vision and Experiential Narrative around a Major Paradigmatic Shift].

Publication Type:

Journal Article

Source:

Sante Ment Que, Volume 46, Issue 2, p.23-43 (2021)

Keywords:

Adolescent, Adult, Antipsychotic Agents, Humans, Psychotic Disorders

Abstract:

<p>Objectives Until the early 1990s, a pessimistic view of psychotic disorders, based on the Kraepelinian perspective, prevailed. Early intervention then introduced a new paradigm, approaching psychosis as a more dynamic phenomenon, for which recovery is possible, provided an appropriate approach is used. As this paradigm has not penetrated all fields of psychiatry, professionals starting in early intervention sometimes experience a real culture shock, the objective of this article being to map its contours in order to facilitate this transition. Methods Based on their knowledge of the literature and their clinical experience, the authors will highlight the aspects that distinguish early intervention practice from traditional practice with psychotic disorders. They adopt an experiential approach to these themes, addressing them not only in light of the scientific literature, but also and especially in the first person of the singular. Results The aspects identified and agreed upon by the three authors were grouped into seven themes: 1. the adoption of a recovery-oriented practice and the rejection of the pessimistic view of psychotic disorders, which refocuses practice on the person's life goals; this is accompanied by a different style of approach; 2. Transdisciplinarity and cross-fertilization of expertise with other team members, community organizations and families, which requires humility and openness; 3. Changes in the pharmacotherapeutic approach, characterized by increased attention to adverse effects (e.g., treatment-induced negative symptoms), the use of lower doses, and the proactive use of clozapine and long-acting injectable antipsychotics; 4. The need to tolerate some diagnostic uncertainty given the difficulties in making an accurate diagnosis, and the presence of complex co-morbidities that blur the picture; 5. The high stakes of the critical period, characterized by high stakes, such as the risk of suicide or social disinsertion, which put pressure on the clinician; 6. The importance of relays in the care trajectory, particularly between adolescent and adult psychiatry, and then between early intervention and other services; 7. The resistance to change that early intervention sometimes faces, as its importance is not always recognized, and its implementation can challenge existing services. Conclusion The differences between the traditional mode of practice with persons with a psychotic disorder and that of early intervention are numerous; while they represent challenges, they are also sources of considerable stimulation and satisfaction.</p>

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