La prévention des rechutes est devenue l’un des enjeux majeurs de toute prise en charge à long terme des patients schizophrènes. Les stratégies psychosociales de détection des signes avant-coureurs de rechute s’avèrent pertinentes car elles permettent d’intervenir précocement sur le processus de rechute afin de le stopper ou d’en limiter les conséquences. L’objectif de cette recherche était d’étudier les contributions apportées par chacun des acteurs inclus dans ce type de stratégie. Nous avons ainsi réalisé une étude qualitative et exploratoire auprès de dix parents de sujets schizophrènes, dix patients schizophrènes et dix soignants dans l’objectif de mieux comprendre la manière dont ces trois groupes définissent les éléments de la rechute. L’analyse de contenu réalisée par le logiciel Alceste a dégagé différentes classes de discours mettant en exergue les conceptions variées d’une rechute, notamment la nature des signes précoces identifiés. Nos résultats étayent l’importance d’une alliance thérapeutique entre la triade patients/parents/soignants, en mettant en avant la complémentarité de leur rôle et de leur expertise dans l’identification de la « signature de rechute » des patients. L’application de notre étude concerne la mise en place d’un dispositif de prévention des rechutes respectant les spécificités de chacun.

The question of the course of schizophrenia relapses, is of considerable interest in different clinical and social areas such as prognosis, quality of life, therapeutic relationship, psychoeducation, rehabilitation and so on. The more the schizophrenic relapses, the higher the level of handicap. Although there is a widespread agreement that it is essential to detect early signs of relapses in order to prevent them, there still remain theoretical and methodological difficulties in identifying these signs because they are personal, heterogeneous and not always specific to psychosis. That is why the notion of “relapse signature” seems relevant by taking into account differentiated and personal assessment of early signs of relapse. This implies the consideration of the different visions of relapse given by patients, parents and caregivers.

We propose a qualitative study of the joint appraisal of patients, patients’ parents and medical staff. The aim of this study is to regroup the expertises in order to further our understanding of the early signs of relapse. We assume that patients and parents are able to describe signs that are not considered as pathological symptoms, but refer to a personal manner of initiating the relapse process. This should then help in designing early intervention and provide reinforced therapeutic alliance and more positive responses to psychoeducation programs.

We have interviewed 30 subjects divided in three groups: 10 schizophrenic patients, 10 caregivers (including physicians, psychologists and nurses) and 10 parents of schizophrenics. The patients met the following criteria: patients with a diagnosis of schizophrenia (DSM IV criteria), under neuroleptic treatment, and stabilized. The mean duration of illness was 15 years. The patients as well as caregivers were recruited in two external hospital structures. All the subjects gave their written consent for this study and its methods. We did not recruit parents who were not living with their schizophrenic child or who did not see or have frequent contact with him or her for this study. We conducted a semistructured interview and analysed the transcripts of the narratives provided by our three groups on the definition of relapse and early signs of relapse. Recorded interviews were processed using the Alceste Method, a computer program of textual analysis that identifies the word patterns most frequently used by the subjects. Alceste creates classes of words using a hierarchical descending classification. The description of each class is presented in the form of a word list (with the value of the word’s Chi² association in this class). We assessed the awareness of problems using the 8-Q.

The three groups described relapses as a distressed, even traumatic experience. This experience is shared by the patients’ siblings who sometimes mention violent situations and difficulties at home. The analysis showed that each group uses a compartmentalized universe of speech. This raises the question of the communication and the sharing of information between the different groups. Parents who didn’t live the relapse of their children and the caregivers gave prepsychotic or psychotic symptoms of relapse. Conversely, parents who had lived relapse(s) of their children gave nonspecific and very personalized signs of relapse (e.g., “When she relapses, our daughter eats much more cheese than usually”). The patients with a low level of awareness of his/her problem were able to describe early signs of relapse. They described mood and sleep disturbances. This is an unexpected result and calls for a debate on the need or not to have good insight in order to follow a psychoeducation program.

This study insists on the complementarity of different conceptions of all persons involved in schizophrenic relapse in order to identify as accurately as possible the “relapse signature” of patients. According to us, and in order to promote suitable subjective data to increase insight, compliance and therapeutic alliance, psychoeducation programs should rely on these personal criteria rather than propose systematic programs. Then the relapse signature could be the first step to the appropriation of the course of illness and control of psychotic symptoms by schizophrenic patients.