Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder
La détection des prodromes des rechutes schizophréniques a un intérêt préventif, toutefois les études consacrées à ce sujet restent rares.
But du travail
Décrire la fréquence et les délais d’apparition des symptômes prodromaux des rechutes schizophréniques qui sont comparativement plus fréquents que les symptômes présentés par des patients en rémission.
L’étude a porté sur 30 sujets atteints de schizophrénie en rechute et 30 en rémission, chez qui les prodromes ont été recherchés rétrospectivement à partir d’une liste composée de 93 symptômes.
La durée moyenne de la phase prodromale était de 160,5jours. Les prodromes significativement plus fréquents dans le groupe « rechute » que dans le groupe « rémission » étaient les idées surinvesties/délire (93,3 % des sujets en rechute), les troubles du sommeil (80 %), les symptômes de désorganisation (80 %) et les symptômes d’excitation/labilité thymique (73,3 %). Les symptômes non spécifiques précédaient les symptômes spécifiques (149,4jours versus 94,8jours). Les prodromes les plus précoces étaient le syndrome d’influence (113,4jours avant la rechute), l’hétéroagressivité non physique (108,1jours) et les idées suicidaires (94,8jours).
Un dépistage plus précoce des prodromes par le médecin, la famille ou le patient lui-même est nécessaire.
Schizophrenia is a severe, chronic psychiatric disorder. After recovery from a first psychotic episode, 70% of patients have exacerbations. These exacerbations are preceded in 66 to 100% of cases by early signs. Prevention of relapses is the main object of dealing with schizophrenia. In fact, after a psychotic relapse, 17% of patients develop residual symptoms which did not exist before the relapse. Moreover, symptoms resistant to antipsychotics appear in 35% of patients after a relapse. Each relapse increases the risk of future relapses. Finally, the cost of treating patients with relapses is four times higher than in patients without relapses. Prevention of relapses is possible if we detect early signs. In fact, when specific interventions are applied in time, relapses can be avoided. Surprisingly, there is a scarcity of data on prodromal symptoms of schizophrenic relapses in the literature.
In this study, we aimed to describe early signs of schizophrenic relapses, which are comparatively more frequent than those in stabilized outpatients.
We conducted a retrospective, descriptive and comparative trial. We included 30 patients with schizophrenia who had recently experienced a psychotic relapse and a member of their families. We also included a control group of 30 stabilized outpatients with schizophrenia. All of the patients were diagnosed schizophrenic according to the DSM IV and had no secondary diagnosis. Only patients aged from 18 to 55 years and having an illness with an episodic evolution were included. The relapse group must have had a period off illness of more than one year and duration of the last remission greater than 3months. We built a structured interview based on the data of the literature on early symptoms of relapses and on our clinical experience. It contained 93 items describing symptoms and feelings relevant to the period of relapse. The interview lasted about 1h. We collected demographic information from both groups. The relapse group was composed of 21 men and nine women. Their average age was 34 years and their level of education was 9.3 years. The mean number of hospitalizations was 3.8 and 73.3% of patients had interrupted their medication. The stabilized outpatients group included 25 men and five women with an average age of 40.3 years. The mean level of education was 8.3 years, the number of hospitalizations was 2.7 and 16.7% of patients had interrupted their medication.
The mean time interval between the beginning of symptoms and the need for hospitalization was 160.5 days. The more frequent symptoms in the relapse group than in stabilized patients were: overinvested ideas/delusions (93.3% of relapsing patients), trouble sleeping (80%), symptoms of disorganization (80%), and excitement/mood changes (73.3%). Globally, non-specific symptoms precede specific symptoms (149.4 days vs. 94.8 days). The earlier signs were influence syndrome (113.4 days before relapse), verbal aggressions against others (108.1 days) and suicidal thoughts (94.8 days). The latest signs were physical aggression against others (37.3 days), unmotivated smiles (35.4 days), aggression against self (35 days), strange thoughts (30.7 days) and breaking things (25.3 days).
The time between perception of symptoms and hospitalization in schizophrenic patients in this study was very long (approximately 6months). Non-psychotic prodromal symptoms precede psychotic symptoms. We recommend a major focus on teaching the patient and his/her family how to recognize early signs of decompensation and what steps to take to ensure effective treatment. We also recommend further research to determine the predictive positive value of early signs of relapse.
Mots clés : Schizophrénie, Récidive, Prévision, Évolution
Keywords : Schizophrenia, Relapse, Early sign, Prodroma