PSN

, 3:S16 | Cite as

Troubles de la conscience de soi: importance pathogénique et clinique dans la schizophrénie débutante

Psychopathologie De La Psychose Débutante

Résumé

Les perturbations du soi ont été considérées par la littérature psychiatrique classique et la psychopathologie phénoménologique comme des traits fondamentaux du spectre des troubles schizophréniques. Ces anomalies de l’expérience sont ignorées par la psychiatrie contemporaine car son orientation comportementaliste entraîne une méfiance vis-à-vis de l’étude de la subjectivité. Nous présentons ici, sur la base de nos travaux empiriques et de ceux d’autres équipes, une tentative d’explication phénoménologique des troubles de la conscience de soi détectables dans la phase prodromique de la schizophrénie, ainsi que dans les états schizotypiques. Nous proposons une étude conjointe des troubles du soi à un niveau psychopathologique et empirique qui pourrait faciliter l’intégration des recherches étiologiques sur les facteurs de risques neuro-développementaux avec l’approche de la psychologie du développement sur l’ontogenèse du soi. La familiarité clinique avec ces aspects symptomatiques discrets, mais cruciaux, de la vulnérabilité à la schizophrénie pourrait aider à la détection des prodromes pré-schizophréniques dans la population cliniquement non-psychotique, et ainsi permettre une intervention thérapeutique précoce.

Mots-Clés

Soi Schizophrénie Prodrome Neurodéveloppement Anomalies de la connectivité Diagnostic précoce 

Disorders of self-awareness: Pathogenetic and clinical relevance in early schizophrenia

Abstract

Disorders of the self had already been considered in classic psychiatric literature and in phenomenological psychopathology as fundamental features of the spectrum of schizophrenic disorders. These experiential anomalies have been ignored by the contemporary psychiatry, because its behaviouristic orientation entails a mistrust of studying subjectivity. In this article, based on our own and other empirical studies, we present a phenomenologically-informed account of disorders of self-awareness that are detectable in the prodromal phases of schizophrenia as well as in the schizotypal conditions. We propose that a joint psychopathological and empirical emphasis on the disorders of self may facilitate an integration of the etiological search for neuro-developmental risk factors with the developmental-psychological approach to the ontogenesis of the self. Clinical familiarity with these subtle, yet crucial, symptomatic aspects of the vulnerability to schizophrenia may assist in the detection of pre-schizophrenic prodromal conditions in the non-psychotic clinical populations and thus enable early therapeutic interventions.

Keywords

Self Schizophrenia Prodrome Neurodevelopment Misconnectivity Early diagnosis 

Références

  1. 1.
    Aitken K.J., Trevarthen C. 1997. Self/other organization in human psychological development.Develop Psychopathol 9: 653–77.CrossRefGoogle Scholar
  2. 2.
    Arnold S.E. 1999. Neurodevelopmental abnormalities in schizophrenia: insights from neuropathology.Develop Psychopathol 11: 439–56.CrossRefGoogle Scholar
  3. 3.
    Benes F.M. 2000. Emerging principles of altered neural circuitry in schizophrenia.Brain Res Rev 31: 251–69.PubMedCrossRefGoogle Scholar
  4. 4.
    Berze J. 1914.Die primäre Insuffizienz der psychischen Aktivität. Ihr Wesen, ihre Erscheinungen und ihre Bedeutung als Grundstörungen der Dementia Praecox und der Hypophrenien überhaupt. Leipzig: Franz Deuticke.Google Scholar
  5. 5.
    Berze J., Gruhle H. 1929.Psychologie der Schizophrenie. Berlin: Springer.Google Scholar
  6. 6.
    Blankenburg W. 1971.Der Verlust der natürlichen Selbstverständlichkeit. Ein Beitrag zur Psychopathologie symptomarmer Schizophrenien. Stuttgart: Enke. (Trad. française par J.-M. Azorin et Y. Totoyan, revue par A. Tatossian. 1991.La perte de l’évidence naturelle. Paris: PUF).Google Scholar
  7. 7.
    Blankenburg W. 1988. Zur Psychopathologie des Ich-Erlebens Schizophrener.In Spitzer M., Uehlein F.A., Oepen G. (eds)Psychopathology and Philosophy. Berlin: Springer, p. 184–97.Google Scholar
  8. 8.
    Bleuler E. 1911. Dementia Praecox oder Gruppe der Schizophrenien. In Aschaffenburg G. (ed)Handbuch der Psychiatrie. Leipzig-Wien: Franz Deuticke (Trad. française par A. Viallard, 1993.Dementia praecox ou groupe des schizophrénies. Paris-Clichy: EPEL-GREC).Google Scholar
  9. 9.
    Bourdieux P. 1980.Les sens pratique. Paris: Minuit.Google Scholar
  10. 10.
    Bovet P., Parnas J. 1993. Schizophrenic delusions: A phenomenological approach.Schizophr Bull 19: 579–97.PubMedGoogle Scholar
  11. 11.
    Cannon T.D., Mednick S.A., Parnas J., Schulsinger F., Praestholm J., Vestergaard A. 1993. Developmental brain abnormalities in the offspring of schizophrenic mothers: 1. Contributions of genetic and perinatal factors.Arch Gen Psychiatry 50: 551–64.PubMedGoogle Scholar
  12. 12.
    Cannon T.D., Mednick S.A., Parnas J., Schulsinger F., Praestholm J., Vestergaard A. 1994. Developmental brain abnormalities in the offspring of schizophrenic mothers: 2. Structural characteristics of schizophrenia and schizotypal personality disorder.Arch Gen Psychiatry 51: 955–62.PubMedGoogle Scholar
  13. 13.
    Carter J.W., Schulsinger F., Parnas J., Cannon T., Mednick S.A. 2003 A multivariate prediction model of schizophrenia.Schizophr Bull 28: 649–82.Google Scholar
  14. 14.
    Cattell J.P., Cattell J.S. 1974. Depersonalization: Psychological and social perspectives.In Arieti S., Brody E.B. (eds)American Handbook of Psychiatry. Second Edition, Vol. III: Adult Clinical Psychiatry. New York: Basic Books, p. 766–99.Google Scholar
  15. 15.
    Churchland P.S. 1986.Neurophilosophy: Toward a unified science of the mind/brain. Cambridge, MA: MIT Press.Google Scholar
  16. 16.
    Corin E., Lauzon G. 1992. Positive withdrawal and the quest for meaning: the reconstruction of experience among schizophrenics.Psychiatry 55: 266–78.PubMedGoogle Scholar
  17. 17.
    Crow T.J. 1980. Molecular pathology of schizophrenia: More than one disease process?Br Med J (Clin Res) 280: 66–8.CrossRefGoogle Scholar
  18. 18.
    Curtis V.A., van Os J., Murray R.M. 2000. The Kraepelinian dichotomy: Evidence from developmental and neuroimaging studies.J Neuropsychiatry Clin Neurosc 12: 398–405.Google Scholar
  19. 19.
    Cutting J. 1997.Principles of psychopathology. Two worlds-two minds-two hemispheres. Oxford: Oxford University Press.Google Scholar
  20. 20.
    Davies N., Russell A., Jones P., Murray R.M. 1998. Which characteristics of schizophrenia predate psychosis?J Psychiatr Res 32: 121–31.PubMedCrossRefGoogle Scholar
  21. 21.
    De Clérambault G. 1942.Oeuvre psychiatrique. Paris: PUF.Google Scholar
  22. 22.
    Dennett D.C. 1991.Consciousness Explained. New York: Little Brown.Google Scholar
  23. 23.
    Depraz N. 2001.Lucidité du corps. De l’empirisme transcendental en phénoménologie. Dodrecht: Kluwer Academic Publishers.Google Scholar
  24. 24.
    Engel A.K., König P., Kreiter A.K., Singer W. 1991. Interhemispheric synchronisation of oscillatory neuronal responsesin cat visual cortex.Science 252: 1177–9.CrossRefGoogle Scholar
  25. 25.
    Erlenmeyer-Kimling L. 2001. Neurobehavioral deficits in offspring of schizophrenic parents: Liability indicators and predictors of illness.Am J Med Genet; 97: 65–71.CrossRefGoogle Scholar
  26. 26.
    Freedman B.J. 1974. The subjective experience of perceptual and cognitive disturbances in schizophrenia. A review of autobiographical accounts.Arch Gen Psychiatry 30: 333–40.PubMedGoogle Scholar
  27. 27.
    Grivois H. 1995.Le Fou et le mouvement du monde. Paris: Éditions Grasset.Google Scholar
  28. 28.
    Gross G., Huber G., Klosterkötter J., Linz M. 1987.Bonner Skala für die Beurteilung von Basissymptomen. Berlin: Springer (Trad. danoise par P. Handest et M. Handest. J. Parnas, P. Handest, eds. 1995. Copenhagen: Synthélabo).Google Scholar
  29. 29.
    Handest P. 2004.The expressive and experienced psychopathology in schizophrenia spectrum. Doctoral thesis. Copenhagen: University of Copenhagen.Google Scholar
  30. 30.
    Harrison P.J. 1999. The neuropathology of schizophrenia. A critical review of the data and their interpretation.Brain 122: 593–624.PubMedCrossRefGoogle Scholar
  31. 31.
    Hartmann E., Milofsky E., Vaillant G., Oldfield M., Falke R., Ducey C. 1984. Vulnerability to schizophrenia. Prediction of adult schizophrenia using childhood information.Arch Gen Psychiatry 41: 1050–6.PubMedGoogle Scholar
  32. 32.
    Henry M. 1963.L’essence de la manifestation. Paris: PUF.Google Scholar
  33. 33.
    Henry M. 1965.Philosophie et phénoménologie du corps. Paris: PUF.Google Scholar
  34. 34.
    Hesnard A.L.M. 1909.Les troubles de la personalité dans les états d’asthénie psychique. Étude de psychologie clinique. Thèse de médecine. Bordeaux: Université de Bordeaux.Google Scholar
  35. 35.
    Huber G., Gross G., Schüttler R. 1979.Schizophrenie. Eine Verlaufs- und socialpsychiatrische Langzeitstudie. Berlin: Springer.Google Scholar
  36. 36.
    Husserl E. 1966.Zur Phänomenologie des inneren Zeitbewusstseins. The Hague: Martinus Nijhoff.Google Scholar
  37. 37.
    Husserl E. 1972.Ideas Pertaining to a Pure Phenomenology and to a Phenomenological Philosophy. Second Book. Transl. By Rojcewicz R. and Schuwer A. Dodrecht: Kluwer Academic Publishers.Google Scholar
  38. 38.
    Innocenti G., Ansermet F., Parnas J. Schizophrenia, neurodevelopment and corpus callosum.Molecular Psychiatry, in press.Google Scholar
  39. 39.
    Janet P. 1903.Les obsessions et la psychasthénie. Paris: Alcan.Google Scholar
  40. 40.
    Jaspers K. 1923.Allgemeine Psychopathologie. 3ème ed. Berlin: Springer (Trad. française par A. Kastler et J. Mendousse, 1928.Psychopathologie générale. Réédition Paris: Tchou, 2000).Google Scholar
  41. 41.
    Kay S., Fishbein A., Opier L. 1987. The positive and negative syndrome scale (PANSS) for schizophrenia.Schizophr Bull 13: 261–75.PubMedGoogle Scholar
  42. 42.
    Kenny A. 1988.The Self. Milwaukee, WI: Marquette University Press.Google Scholar
  43. 43.
    Kimura B. 1997. Cogito et le Je.Évol Psychiatr 62: 335–48.Google Scholar
  44. 44.
    Klosterkötter J., Hellmich M., Steinmeyer E.M., Schultze-Lutter F. 2001. Diagnosing schizophrenia in the initial prodromal phase.Arch Gen Psychiatry 58: 158–64.PubMedCrossRefGoogle Scholar
  45. 45.
    Klosterkötter J. 1988.Basissymptome und Endphänomene der Schizophrenie. Eine empirische Untersuchung der psychopathologischen Übergangsreihen zwischen defizitären und produktiven Schizophreniesymptomen. Berlin: Springer.Google Scholar
  46. 46.
    König P.et al. 1993. Squint affects synchronization of oscillatory responses in cat visual cortex.Eur J Neurosci 5: 501–8.PubMedCrossRefGoogle Scholar
  47. 47.
    Kraepelin E. 1913.Psychiatrie. III Band. Klinische Psychiatrie. 2. Teil. Leipzig: J. A. Barth.Google Scholar
  48. 48.
    Laing R.D. 1959.The divided Self. London: Tavistock.Google Scholar
  49. 49.
    Larsen T.K.et al. 2001. Early detection and intervention in first-episode schizophrenia: a critical review.Acta Psychiatr Scand 103: 323–34.PubMedCrossRefGoogle Scholar
  50. 50.
    Matthysse S., Levy D.L., Wu Y., Rubin D.B., Holzman P. 1999. Modelling intermittent degradation in schizophrenic performance.Schizophr Res 40: 131–46.PubMedCrossRefGoogle Scholar
  51. 51.
    McGhie A., Chapman J. 1961. Disorders of attention and perception in early schizophrenia.Brit J Med Psychol 34: 103–16.PubMedGoogle Scholar
  52. 52.
    McGorry P.D.et al. 1995. The prevalence of prodromal features of schizophrenia in adolescence: a preliminary study.Acta Psychiatr Scand 92: 241–9.PubMedCrossRefGoogle Scholar
  53. 53.
    Meehl P. 2001. Primary and secondary hypohedonia.J Abnorm Psychol 110: 188–93.PubMedCrossRefGoogle Scholar
  54. 54.
    Meltzoff A.N., Prinz W. (eds). 2002.The imitative mind: development, evolution, and brain bases. Cambridge: Cambridge University Press.Google Scholar
  55. 55.
    Merleau-Ponty M. 1945.Phénoménologie de la perception. Paris: Gallimard.Google Scholar
  56. 56.
    Minkowski E. 1997.Au-delà du rationalisme morbide. Paris: L’Harmattan.Google Scholar
  57. 57.
    Minkowski E. 1927.La schizophrènie. Psychopathologie des schizoïdes et des schizophrènes. Paris: Payot.Google Scholar
  58. 58.
    Mohamed S., Paulsen J. S., O’Leary D., Arndt S., Andreasen N. 1999. Generalized cognitive deficits in schizophrenia. A study of first-episode patients.Arch Gen Psychiatry 56: 749–54.PubMedCrossRefGoogle Scholar
  59. 59.
    Møller P., Husby R. 2000. The initial prodrome in schizophrenia: searching for naturalistic core dimensions of experience and behavior.Schizophr Bull 26: 217–32.PubMedGoogle Scholar
  60. 60.
    Møller P. 2001. Duration of untreated psychosis: are we ignoring the mode of initial development?Psychopathology 34: 8–14.PubMedCrossRefGoogle Scholar
  61. 61.
    Murray R.M., Lewis S.W., Reveley A.M. 1985. Towards an etiological classification of schizophrenia.Lancet 1: 1023–6.PubMedCrossRefGoogle Scholar
  62. 62.
    Murray R.M., O’Callaghan E., Castle D.J., Lewis S.W. 1992. A neurodevelopmental approach to the classification of schizophrenia.Schizophr Bull 18: 329–32.Google Scholar
  63. 63.
    O’Connell P., Woodruff P.W., Wright I., Jones P., Murray R.M. 1997. Developmental insanity or dementia praecox: was the wrong concept adopted?Schizophr Res 23: 97–106.PubMedCrossRefGoogle Scholar
  64. 64.
    Palmer B.W., Heaton R.K., Paulsen J.S., Kuck J., Braff D., Harris M.J., Zisook S., Jeste D.V. 1997. Is it possible to be schizophrenic yet neuropsychologically normal?Neuropsychology 11: 437–46.PubMedCrossRefGoogle Scholar
  65. 65.
    Parnas J., Bovet P., Innocenti G.M. 1996. Schizophrenic trait features, binding, and cortico-cortical connectivity: a neurodevelopmental pathogenetic hypothesis.Neurol Psychiat Brain Res 4: 185–96.Google Scholar
  66. 66.
    Parnas J., Bovet P. 1991. Autism in schizophrenia revisited.Compr Psychiatry 32: 7–21.PubMedCrossRefGoogle Scholar
  67. 67.
    Parnas J., Carter J.W. 2002. High-risk studies and developmental hypothesis.In Häfner H. (ed)Risk and protective factors in schizophrenia: towards a conceptual disease model. Darmstadt: Steinkopff, p. 71–82.Google Scholar
  68. 68.
    Parnas J., Handest P., Jansson L., Sæbye D. 2003. Anomalies of subjective experience in schizophrenia and psychotic bipolar illness.Acta Psychiatr Scand 108: 126–33.PubMedCrossRefGoogle Scholar
  69. 69.
    Parnas J., Handest P. 2003 Phenomenology of anomalous self-experience in early schizophrenia.Compr Psychiatry 44: 121–34.PubMedCrossRefGoogle Scholar
  70. 70.
    Parnas J., Jansson L., Sass L.A., Handest P. 1998. Self-experience in the prodromal phases of schizophrenia.Neurol Psychiatry Brain Res 6: 97–106.Google Scholar
  71. 71.
    Parnas J., Handest P. Anomalies of subjective experience in first-admitted schizophrenia spectrum: empirical investigation.Psychopathology, sous presse.Google Scholar
  72. 72.
    Parnas J., Vianin P., Saebye D. 2001. Visual binding abilities in the initial and advanced stages of schizophrenia.Acta Psychiatr Scand 103: 171–80.PubMedCrossRefGoogle Scholar
  73. 73.
    Parnas J., Zahavi D. 2002. The role of phenomenology in psychiatric classification and diagnosis.In Maj M., Gaebel W., Lopez-Ibor J.J., Sartorius N. (eds)Psychiatric Diagnosis and Classification. Chichester: John Wiley & Sons, p. 137–62.CrossRefGoogle Scholar
  74. 74.
    Parnas J. 2000. The self and intentionality in the pre-psychotic stages of schizophrenia: a phenomenological study.In Zahavi D. (ed):Exploring the Self. Philosophical and Psychopathological Perspectives on Self-Experience. Philadelphia: John Benjamins Publishing Company, p. 115–48.Google Scholar
  75. 75.
    Penn A.A. 2001. Early brain wiring: activity-dependent processes.Schizophr Bull 27: 337–47.PubMedGoogle Scholar
  76. 76.
    Rochat P. 2001.The Infant’s World. Cambridge, MA: Harvard University Press.Google Scholar
  77. 77.
    Sass L. 1992.Madness and modernism: insanity in the light of modern art, literature, and thought. Cambridge, MA: Harvard University Press.Google Scholar
  78. 78.
    Sass L., Parnas J. 2003. Self, consciousness, and schizophrenia.Schizophr Bull 29: 427–44.PubMedGoogle Scholar
  79. 79.
    Scharfetter C. 1980.General psychopathology. An introduction. Trad. anglaise par H. Marshall deAllgemeine Psychopathologie, 1976, G. Thieme Verlag, Stuttgart. Cambridge: Cambridge University Press.Google Scholar
  80. 80.
    Schneider K. 1959.Clinical psychopathology. Trad. anglaise de M.W. Hamilton. New York: Grune and Stratton.Google Scholar
  81. 81.
    Searle J.R. 1992. The rediscovery of the mind. Cambridge: MIT Press.Google Scholar
  82. 82.
    Selemon L.D., Goldman-Rakic P.S. 1999. The reduced neuropil hypothesis: a circuit based model of schizophrenia.Biol Psychiatry 45: 17–25.PubMedCrossRefGoogle Scholar
  83. 83.
    Singer W. 1994. Putative functions of temporal correlations in neocortical processing.In Koch C., Davis J.L. (eds)Large-Scale Neuronal Theories of the Brain. Cambridge: MIT Press, p. 201–37.Google Scholar
  84. 84.
    Spitzer M. 1988. Ichstörungen: in search of a theory.In Spitzer M., Uehlein F.A., Oepen G. (eds)Psychopathology and Philosophy. Berlin: Springer, p. 167–83.Google Scholar
  85. 85.
    Strawson G. 1997. The Self.J Consciousness Studies. 4: 405–28.Google Scholar
  86. 86.
    Tatossian A. 1979.Phénoménologie des psychoses. Paris: Masson.Google Scholar
  87. 87.
    Thelen E., Smith L.B. 1994.A dynamic systems approach to the development of cognition and action. Cambridge: MIT Press.Google Scholar
  88. 88.
    Varsamanis J., Adamson J.D. 1971. Early Schizophrenia.Canad Psychiat Ass J 16: 487–97.Google Scholar
  89. 89.
    Vianin P.et al. 2002. Reduced P300 amplitude in a visual recognition task in patients with schizophrenia.Neuro-Image 17: 911–21.PubMedGoogle Scholar
  90. 90.
    Weiser M.et al. 2001. Association between nonpsychotic psychiatric diagnoses in adolescent males and subsequent onset of schizophrenia.Arch Gen Psychiatry 58: 959–64.PubMedCrossRefGoogle Scholar
  91. 91.
    Zahavi D., Parnas J. 1998. Phenomenal consciousness and self-awareness: A phenomenological critique of representational theory.J Consciousness Studies 5: 687–705.Google Scholar
  92. 92.
    Zahavi D. 1999.Self-awareness and alterity. A phenomenological investigation. Evanston: Northwestern University Press.Google Scholar

Copyright information

© Springer 2003

Authors and Affiliations

  1. 1.The Danish National Research Foundation, Center for Subjectivity ResearchUniversité de CopenhagueDanmark
  2. 2.Département Universitaire de PsychiatrieHvidovre HospitalDanmark

Personalised recommendations