Attentes et promesses du risque de psychose

Abstract

ObjectiveThe category of “at-risk” mental states was created during the second half of the 1990s to characterize clinical presentations that were liable to evolve into psychosis within months. At-risk mental states are at the center of a new psychiatry among young adults. This article examines the expectations and promises of this form of psychiatry. MethodsThis article uses an approach based on the sociology of knowledge, highlighting the interests, the institutional contexts and the practices that contribute to shaping psychiatric knowledge and categories, as well as the debates generated by this knowledge and these categories. ResultsOver the last twenty years, debates on at-risk mental states have resulted in a shift in the way clinicians understand this category. The difficulty in stabilizing the risk of transition to psychosis among patients concerned has led proponents of this category to argue for a new interpretation: without being necessarily the sign of a transition towards psychosis, at-risk mental states could point to a pathological outcome that remains open as to its development, and certain as to its endpoint. Two different approaches towards these issues have emerged within the psychiatric community: the first seeks to refine the at-risk category to make it a truly predictive category, the second to use it as the starting-point for a new public health strategy aiming to improve mental health among young adults. DiscussionAt-risk mental states create a paradoxical clinical area of expectation, characterized by the indeterminacy of its perspectives and promises. This indeterminacy could explain its success among a wide array of people with diverse interests from clinical, research and public policy circles. ConclusionA better understanding of the dynamics of innovation and reform in psychiatry could be gained from paying more attention to the social underpinnings of psychiatric promise.