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Early Detection of Psychotic Disorders: Issues in Implementing a Care Network

Par : Contributeur(s) : Type de matériel : TexteTexteLangue : français Détails de publication : 2004. Ressources en ligne : Abrégé : The emergence of psychotic disorders in adolescents or young adults is invariably associated with considerable suffering for the patient, family and friends. It is imperative to provide help to psychotic patients at the earliest possible stage in order to alleviate the risks of suicide, drug dependency and social or educational exclusion. Nonetheless, support is typically delayed, by one or two years on average. Experimental programmes have been implemented in several countries, mainly in English-speaking ones, to reduce this delay. It is appropriate to assess the feasibility of the transposition to the French context and its acceptability to health professionals, potential patients and their families, as well as to the community. Initiating such programmes inevitably raises questions about the perceptions of mental illness in our society and points to the need to study the practical and (primarily?) ideological and cultural obstacles that delay access to specialized care. Such an approach also opens up a space to consider the actual value of each individual symptoms and the estimation of “risk”, not deterministically, but rather a diachronic understanding of the dynamics of psychiatric disorders over time. This conceptual approach underlines the importance of the long term positive or negative impact of the “environment” on either the emergence of psychotic disorders or, on the contrary, stabilisation at a “sub-clinical” level. As a consequence, it is necessary to rethink forms of care, among which educational and “case management” approaches could have an important role to play.
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The emergence of psychotic disorders in adolescents or young adults is invariably associated with considerable suffering for the patient, family and friends. It is imperative to provide help to psychotic patients at the earliest possible stage in order to alleviate the risks of suicide, drug dependency and social or educational exclusion. Nonetheless, support is typically delayed, by one or two years on average. Experimental programmes have been implemented in several countries, mainly in English-speaking ones, to reduce this delay. It is appropriate to assess the feasibility of the transposition to the French context and its acceptability to health professionals, potential patients and their families, as well as to the community. Initiating such programmes inevitably raises questions about the perceptions of mental illness in our society and points to the need to study the practical and (primarily?) ideological and cultural obstacles that delay access to specialized care. Such an approach also opens up a space to consider the actual value of each individual symptoms and the estimation of “risk”, not deterministically, but rather a diachronic understanding of the dynamics of psychiatric disorders over time. This conceptual approach underlines the importance of the long term positive or negative impact of the “environment” on either the emergence of psychotic disorders or, on the contrary, stabilisation at a “sub-clinical” level. As a consequence, it is necessary to rethink forms of care, among which educational and “case management” approaches could have an important role to play.

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