The evolution of early psychosis with variable expression. Study of a clinical case
Feriane, Aizel
The evolution of early psychosis with variable expression. Study of a clinical case - 2020.
64
It is the study of a clinical observation, over a period of two years, of a 21-year-old man who often presented himself at the emergency room for severe anxiety and behavioral disorders characterized by repeated self-mutilation, psychomotor agitation, homicidal behavior toward his father, aggressive impulsivity, and sometimes antisocial behavior (running away and dangerousness). Ideas of persecution and reference often underlay his disordered behaviors. The patient also made frequent suicide attempts related to brief depressive periods, in which he verbalized great suffering that he explained by family relational difficulties and traumatic events (parental abuse, accidents). After two years, the clinical picture was aggravated by the appearance of symptoms of schizophrenia comprising paranoid delusion, hallucinations with mental automatism, social withdrawal, and affective and behavioral disorganization that had completely replaced his self-aggressive acting-out. These polymorphic symptoms initially posed a diagnostic and therapeutic problem for psychiatrists due to their persistence and repetition; these were made more complex by the sexual and identity problems that were later revealed through psychotherapeutic observation.The observation consisted of attentive listening during regular psychotherapeutic interviews that allowed to retrace the evolution of this pathology and his stabilization. The goal was to construct a clinical and evolutionary perspective taking into account the progression of symptoms over time until the onset of psychosis. Despite us being limited by a neurobiological exploration that yielded no apparent results, the semiotic analysis of the patient’s symptoms, writings, and symbols allowed us to research the different precocious phases of the disease, as well as the psychopathological analysis of his symptoms. Results: This method allowed us to determine the first symptom, to identify the initial period of disorders and their relationships with vulnerability factors (parental trauma, genetics), to describe their evolution according to age, and to trace the symptoms of psychotic transition. Our aim was to emphasize the preventive role of early treatment of prepsychotic disorders. We consider the impact of anxiety on the patient's neuropsychic development and on the genetic origins of the disease. Conclusion: We emphasize the preventive approach, which consists in detecting the subjects at risk of psychotic transition and determining an appropriate psychotherapy to avoid any recurrence or aggravation of the disorders.
The evolution of early psychosis with variable expression. Study of a clinical case - 2020.
64
It is the study of a clinical observation, over a period of two years, of a 21-year-old man who often presented himself at the emergency room for severe anxiety and behavioral disorders characterized by repeated self-mutilation, psychomotor agitation, homicidal behavior toward his father, aggressive impulsivity, and sometimes antisocial behavior (running away and dangerousness). Ideas of persecution and reference often underlay his disordered behaviors. The patient also made frequent suicide attempts related to brief depressive periods, in which he verbalized great suffering that he explained by family relational difficulties and traumatic events (parental abuse, accidents). After two years, the clinical picture was aggravated by the appearance of symptoms of schizophrenia comprising paranoid delusion, hallucinations with mental automatism, social withdrawal, and affective and behavioral disorganization that had completely replaced his self-aggressive acting-out. These polymorphic symptoms initially posed a diagnostic and therapeutic problem for psychiatrists due to their persistence and repetition; these were made more complex by the sexual and identity problems that were later revealed through psychotherapeutic observation.The observation consisted of attentive listening during regular psychotherapeutic interviews that allowed to retrace the evolution of this pathology and his stabilization. The goal was to construct a clinical and evolutionary perspective taking into account the progression of symptoms over time until the onset of psychosis. Despite us being limited by a neurobiological exploration that yielded no apparent results, the semiotic analysis of the patient’s symptoms, writings, and symbols allowed us to research the different precocious phases of the disease, as well as the psychopathological analysis of his symptoms. Results: This method allowed us to determine the first symptom, to identify the initial period of disorders and their relationships with vulnerability factors (parental trauma, genetics), to describe their evolution according to age, and to trace the symptoms of psychotic transition. Our aim was to emphasize the preventive role of early treatment of prepsychotic disorders. We consider the impact of anxiety on the patient's neuropsychic development and on the genetic origins of the disease. Conclusion: We emphasize the preventive approach, which consists in detecting the subjects at risk of psychotic transition and determining an appropriate psychotherapy to avoid any recurrence or aggravation of the disorders.
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