Symptomatologie schizophrénique et processus psychopharmacologiques : contribution empirique

Abstract

Objectives The authors discuss the relationship between discontinuities and possible syndromic specificities of schizophrenic pathology. Their strategy leads to a more precise description of the positive, negative and disorganization syndromes in schizophrenia. Then the approach allows speculation about some distinctive properties of the specific cognitive processes which underlie them. Obviously such a model is of a diagnostic interest. Finally, the authors controlled the influence of antipsychotic drugs on the expression of symptoms as expressed in verbal interaction, their mechanisms of action and their repercussions on cognitive processing remain widely debated. This work should enable the authors to take part in this debate. Patients and method The work was based on the cognitivoconversational analysis of 403 verbal transactions extracted from an empirical corpus of investigation composed of one series of 30 interviews carried out by a psychologist-researcher dealing either with a person diagnosed with paranoid schizophrenia ( n = 14) or disorganized schizophrenia ( n = 8) or free of psychiatric disorders ( n = 8) as a control group. Among the 22 schizophrenic participants (fulfilling the Diagnostic and Statistical Manual of Mental Disorders, 4th Ed. [DSM-IV] criteria), 15 had taken an antipsychotic treatment the previous three years (nine patients for paranoid schizophrenia and six patients for disorganized schizophrenia) and seven had not followed any treatment (five patients with paranoid schizophrenia and two patients with disorganised schizophrenia). The latter were experiencing a first episode of schizophrenia. Each of the three groups was paired according to age, sex and level of education. The two sub-groups “paranoid schizophrenia with treatment” and “disorganized schizophrenia with treatment” were paired according to the “antipsychotic treatment” variable. The authors tested the models of verbal discontinuity for each of the 403 transactions. Results The pragmatic and dialogical models of apprehension of discontinuity proposed (models of decisive or non-decisive type) turned out to be particularly discriminating comparing the coherence of the “pathological conversations” with that of the “normal conversations”. The models also proved to be useful in accounting for certain specificities associated with coherence of the discursive and dialogical production among the patients within each of the two diagnostic categories of schizophrenia (paranoid sub-type vs disorganized sub-type). Indeed, the study showed a strong correlation between the paranoid clinical form and a certain type of discontinuous verbal behaviour of the decisive type. This correlation seems to be independent of antipsychotic treatment. However, the authors failed to conclude about the possible thought process disorders that disorganized schizophrenic sub-type patients suffer from insofar as none of these specificities was located in these conversations. In addition, if the authors could not establish a link between the occurrence of non-decisive discontinuous transactions and the clinical form of the schizophrenic pathology independently from the “antipsychotic treatment” variable, it turned out to be different when taking into account the “antipsychotic treatment” variable. Indeed, when the schizophrenic patients were not under any medication more discontinuities of the non-decisive type among patients with disorganized schizophrenia than among those with paranoid schizophrenia were observed. On the contrary, when patients were under medication, there were more discontinuities of non-decisive type among paranoid schizophrenic patients than among disorganized schizophrenic patients. Conclusions From a diagnostic point of view, the development of a model of apprehension of the discontinuity of the decisive type and the consequent formalization of the formal semantic type suggests the possibility of clarifying and even making the concept of “formal thought disorders” operational. Finally, the results underline the interest of taking into account the “antipsychotic treatment” variable and its influence on the dialogical behaviour and on the complex cognitive processes in the studies relative to this pathology. Taking into account such a variable will allow discussing the specificities of the cognitive processes connected to the disorders. These results can lead to discussions with researchers who use the neuropathogenic model of schizophrenic pathology and who may tend to exclude the question in their theoretical concerns.