Research on the reasons for schizophrenic relapses. Though rarely recognized by the patients themselves or by their entourage, the main cause of schizophrenic relapses that require hospitalization is the stoppage of their prescription medical treatment. We thus asked ourselves two key questions: is there some hidden cause for this stoppage of treatment, and does the fact that the patient had stopped taking his prescribed medication necessarily indicate that his overall medical care was a failure? A psychiatric clinic specializing in schizophrenia is made up of patients with a lack of clear symbolization, which is made apparent by the syndrome of dissociation that seems to spread through the clinic itself. Yet, symbolization is pile Of the main tools involved in the social relationships that a given patient maintains with the world around him. These social relations are to be studied on a scale of life events, which is why we carried out the following research: a collective study of the group of schizophrenic patients at the Valvert psychiatric hospital who had already been hospitalized on a previous occasion and who had been diagnosed with schizophrenia before their release. This study included all hospital wards and was conducted over a one-year period (from February 2, 2011, to January 31, 2012). The study involved setting up a clinical interview with each patient in order to find out exactly what had transpired since his or her previous hospital stay and to then rate reported actions or incidents when compiling a list of what we would consider life events. We used the PERI Life Event Scale as our initial template, though we removed certain events that did not apply to the group of patients under study. Significantly, this list allows for both qualitative and quantitative evaluations. In order to ensure uniformity between different psychiatric units, as well as the easy and efficient transfer of data and findings, we set up one team of evaluators in each hospital ward. The accuracy of testing was ensured by applying the parameters of the test at two different times on the same test subjects (the test phase and the retest phase, which took place eight days apart). Our list included 102 life events, which were categorized according to the setting in which they occur (Work, Personal Relationships, Home Life, Housing Issues, Social Activities, Health Issues, Child Care, Legal Matters). Each event was then given a rating in line with its qualitative impact. The results of the study showed the following: in all cases under study, there was at least one key life event that occurred before the patient's relapse. We can hypothesize that in cases in which only one life event with a score below 500 was involved, it was indeed the stoppage of prescription treatment that brought about hospitalization, not because the patient had taken specific action under the influence of his schizophrenia but because he had "acted out". In the other cases, however, we could suppose that the succession of several life events brought about the patient's re-admittance to hospital care, the first events having been discussed by the patient with his therapist. The life event category that was far more frequently cited in patient profiles was the one concerning Home Life, or more accurately changes in the home or family unit surrounding the patient or in the means of communication between those within that unit. This clearly indicates a need for greater vigilance regarding such matters on the part of mental health care professionals once the schizophrenic patient has completed his initial hospital stay. In terms of qualitative analysis, even if 73 % of patients under study had a score of 500 or higher, the referential life event score assigned to marriage, the overall allocation of scores and the typical discrepancy between them demonstrate a key dispersion feature. The hypothesis that we have put forth to account for this dispersion is that delaying the onset of a relapse or the need to again be hospitalized greatly depends on the reciprocal relationship between the patient and his assigned health care professional, and on how reactive the latter is as regards changes to the patient's treatment and life events after initial release. Without getting into the heated debate concerning the etiologic ties to life events in schizophrenia, our research has indicated that the true origin of schizophrenic relapse is tied to a breakdown of the patient's symbolic system of referencing, as the patient is no longer able to "think out" what is happening to him, even when dealing life events that are small in number or of little importance. We have concluded, through our interpretation of data concerning the stoppage of prescription treatment and the re-admittance to hospital care, that continued and accurate prescription medical treatment was a necessary part of avoiding relapse but was not enough on its own. Mental health care professionals treating schizophrenic patients must pay particularly close attention to the way that the patient interacts with life events belonging to the key categories that we studied and must help the patient to verbalize and think out those life events. Even if relapses by schizophrenic patients are something to be avoided, and something that will be overcome through our ever-increasing understanding of the disease, it is still interesting to consider the relapse, not necessarily as a failure of the patient's overall care, but rather as a call for help on the part of the patient, a need for better or renewed exchange with his mental health care professionals. This in turn brings up the issue of late prescription treatment, whereby a patient who takes this new medication properly may then avoid re-admittance to hospital care that he nevertheless needs. (C) 2015 Elsevier Masson SAS. All rights reserved.
