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PSN

, Volume 2, Issue 3, pp 29–38 | Cite as

L’insight et les schizophrénies: un paradoxe?

  • Frédéric Advenier
  • Vassilis Kapsambelis
  • Christophe Recasens
Psychopathologie Clinique
  • 34 Downloads

Résumé

Le but de cet article est de présenter une réflexion sur le concept d’insight dans la schizophrénie. L’insight correspond à un regard posé sur soi et sur ses rapports au monde, dirigé vers l’intérieur mais qui part de l’extérieur. Ce regard s’associe aux notions de vérité, de découverte et de clarté. L’étude de ce concept est paradoxale dans le cadre de la schizophrénie. Les modèles psychanalytique, phénoménologique et empirique montrent qu’il existe différents niveaux d’analyses: (a) le patient, son psychisme troublé et des facteurs individuels dans son expression, (b) le clinicien, avec ses croyances et connaissances sur la maladie mentale, ses affects, son expérience, ses attitudes et (c) l’interaction entre le patient et le médecin. Dans la plupart des études psychométriques récentes, l’insight se réduit à l’évaluation du degré d’acceptation, de la part du patient, du caractère morbide des symptômes. Cette réduction le fait apparaître un phénomène multidimensionnel et variable dans le temps, perturbé dans la schizophrénie et corrélé significativement, modérément et positivement au QI et à la compliance, et négativement avec la symptomatologie, les phases aiguës de la maladie, les passages à l’acte hétéroagressifs et la fréquence des hospitalisations, notamment sous contrainte. Les études sont par contre divergentes quant aux rapports entre l’insight et le suicide, les fonctions cognitives, l’anatomie cérébrale. Sur le plan de la pratique clinique, c’est l’insight du clinicien qui occupe une place importante dans l’émergence d’uninsight chez le patient. Étudier ce processus de manière objectivable nécessite des modèles plus complexes, nécessitant le développement d’une théorie de la pratique psychiatrique.

Mots Clés

Insight Schizophrénie Symptômes Conscience de soi Conscience des troubles Compliance 

Insight and schizophrenia, a paradox?

Abstract

The aim of this paper is to focus on the concept of “insight” in schizophrenia. Insight corresponds to an interior view of oneself and its relationships to the world, and is directed from the exterior to the interior world. This view is linked with the concepts of truth, discovery and clarity. The study of the insight concept in regards to schizophrenia is paradoxical. Psychoanalytical, phenomenological and empirical models show that there are three different levels of analysis: (a) the patient, with his or her troubled mind and the individual factors of expression, (b) the physician, with his or her own beliefs, knowledge about the disease, personal emotions, experience and attitudes, (c) the interaction between physician and patient. In most recent psychometric studies, insight is restricted to the evaluation of the degree of the patient’s acceptance of his or her disease. This restriction shows a multidimensional phenomenon, which varies according to time and is disturbed by schizophrenia. Insight is correlated with the symptoms of the disease, with IQ, with the acute stages of the schizophrenia disease, with acting out, and with the frequency of hospitalisation, especially when nonvoluntary. However, results differ concerning the correlation of insight with suicide, cognitive functions and cerebral anatomy. From the point of view of clinical practice, it is the psychiatrist’s insight which plays an important role in the process of the emergence of the patient’s insight. To objectively study this process, more complex models are necessary, which would imply further developments in the theory of psychiatric practice.

Key Words

Insight Schizophrenia Symptoms Self-consciousness Awareness of illness Compliance 

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Copyright information

© Springer 2004

Authors and Affiliations

  • Frédéric Advenier
    • 1
  • Vassilis Kapsambelis
    • 2
  • Christophe Recasens
    • 3
  1. 1.Centre Médico-PsychologiqueEPS Ville-EvrardSaint-Ouen
  2. 2.ASM 13Paris
  3. 3.Hôpital Albert ChenevierCréteil

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