There is little understanding of marijuana use by psychiatric patients, specifically regarding the issue why they continue smoking marijuana in spite of the negative consequences, such as being readmitted to psychiatric hospitals due to a diagnosis called marijuana–induced psychosis. Therefore, it is important to understand why psychiatric patients continue to use marijuana, despite experiencing its negative effects on their condition. From the above background, the researcher identified the need to explore and describe the perceptions of psychiatric patients regarding marijuana use in Potchefstroom, North–West Province. The exploration and description of these psychiatric patients' perceptions regarding marijuana use will provide insight into more appropriate care and treatment in order to reduce the readmissions of psychiatric patients due to marijuana–induced psychosis. A qualitative, exploratory, descriptive and contextual research design was followed in order to give 'voice' to the perceptions of psychiatric patients regarding marijuana use. Purposive sampling was utilised to identify participants who complied with the set selection criteria. The sample size was determined by data saturation, which was reached after ten individual interviews with psychiatric patients. Unstructured individual interviews were utilised to gather data after written approval from the research ethics committee of the North–West University (Potchefstroom campus), North–West Provincial Department of Health, the clinical manager of the psychiatric hospital where data were collected, as well as from the psychiatric patients. After the co–coder and the researcher of the study analysed the data independently, a meeting was scheduled to reach consensus on the categories and subcategories that emerged from the data. The findings of this study indicated perceptions that psychiatric patients have on: the use of marijuana, the negative effects of marijuana use, marijuana use and mental illness, and stopping the use of marijuana. From this results it seems that although some patients realise that stopping the use of marijuana might be difficult, some patients want to walk the extra mile by helping other people to stop smoking marijuana. It is of specific interest that psychiatric patients seem to expect external groups to take responsibility on their behalf to terminate the use of marijuana, namely: foreigners, the police and the Rastafarians. From the findings, literature and the conclusions of this study, recommendations in the fields of nursing education, nursing research as well as nursing practice were made. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2011.

Background: While literature indicates a positive impact of family interventions (FIs) on people with experience of psychosis, less is known about outcomes for other family members involved with these interventions. Furthermore, there is a paucity of literature offering an understanding of how young people with a parent with experience of psychosis view themselves in relation to their parent’s care. In the context of community care for psychosis, consideration of family views and outcomes is important in establishing how their needs may best be met. Aim: The thesis aims were twofold: (a) to systematically review the literature to explore the impact of single FIs for psychosis on family members, establish whom outcomes are being gathered for, and to what extent children and young people are involved; and (b) to develop an understanding of how young people with a parent with experience of psychosis conceptualise themselves in the context of their parent’s care. Method: A systematic search of the literature was conducted in October, 2016. Additionally, 12 interviews were carried out with 11 young people (aged 14-18 years) with a parent with experience of psychosis. A grounded theory approach was employed. Results: 21 studies were included in the systematic review. 86% revealed at least one positive outcome for family members engaging with FIs. None of the studies included children or young people. In the empirical study, a provisional theory was generated and at the core of this is how young people establish and negotiate their role in relation to their parent’s care in the context of adolescence; balancing caring for and/or living with a parent with experience of psychosis with “being a teenager”. This process appears dependent on young people’s perception of parental needs and supports and among other factors, seems to be facilitated by having appropriate information (that is specific and formulation based). Young people perceiving adults to view them as “too young” appears to be a significant barrier to this. Conclusion: The systematic review points towards a generally positive impact of FIs on family members but involvement of children and young people is lacking. The empirical study highlights that parental psychosis appears to pose additional and unique challenges to young people, particularly in the context of adolescent development; emphasising the need for better support, appropriate information sharing and adults recognising and validating young people’s experiences. Future research would benefit from the exploration of inclusion of children and young people in FIs.

Background: Considering recent advances in the field of early detection and intervention in young people with increased levels of psychotic symptoms seeking help, this thesis proposes that early attachment insecurity triggers an inability to regulate emotional distress, to engage in positive interpersonal interactions with others, to use adaptive coping mechanisms and to manage social support appropriately. These constructs appear to be linked to psychosis; however, considering continuity between subthreshold psychotic symptoms and the later development of psychosis, it is vital to understand if these underlying affective and interpersonal mechanisms increase the risk of psychosis in help-seeking young people. Objectives: This study was cross-sectional and investigated the following research questions: 1) Does attachment insecurity signpost the risk of developing psychosis? 2) Do coping strategies, interpersonal difficulties, social support and emotional distress have an indirect effect on the relationship between attachment insecurity and the risk of developing psychosis? Methods: A total of 76 help-seeking young people were recruited from Community Mental Health Services in Edinburgh. All participants completed a number of questionnaires exploring their coping strategies, interpersonal problems, perceived social support and emotional distress. A semi-structured interview was undertaken, to assess their socio-demographic background. The Comprehensive Assessment of At-Risk Mental States was administered and coded to assess their risk of psychosis and associated psychopathology, while path analysis was used to analyse the data and to address the research questions. Results: The profile of help-seeking young people in this sample (n=76) was made up of individuals with a moderate degree of difficulties in relation to coping strategies employed to manage stress and interpersonal problems dealing with others, moderate levels of emotional distress and discrepancies between their ideal and received social support. From the total help-seeking sample, the attachment dimensions anxiety and avoidance were relatively high. These young people were found to have had mild, psychotic-like experiences, especially in the domains associated with unusual thought content and perceptual abnormalities. When considering the subgroup of help-seeking young people with an at-risk mental state (ARMS) (n=46), the results revealed that this group had high levels of difficulties in interpersonal relationships, relied on non-productive coping strategies, presented emotional distress levels of clinical importance and also had discrepancies in their ideal and received social support. From the subsample of help-seeking young people with an ARMS the attachment dimensions anxiety and avoidance were reasonably high. These young people were found to have had moderately severe psychotic experiences, especially in the domains associated with unusual thought content and perceptual abnormalities. Path analysis revealed that attachment insecurity directly predicted psychotic symptoms in the total sample but not in the subgroup of young people with an ARMS. Emotional distress played a partially moderating role between attachment insecurity and the severity and distress associated with disorganised speech and perceptual abnormalities in the total sample but not when considering only those with an ARMS, while interpersonal problems did not mediate the relationship between attachment insecurity and the risk of psychosis in either group. Discrepancies between ideal and received social support fully mediated the relationship between attachment insecurity and the distress associated with disorganised speech in the total sample but not when considering those with an ARMS. The tendency to use less adaptive coping strategies was found to mediate directly the relationship between attachment anxiety and the distress associated with perceptual abnormalities in young people with an ARMS, albeit not in the total sample. Discussion: The clinical and theoretical implications of these results are discussed within the clinical staging model for intervention in psychosis. The findings strongly indicate that clinicians should take into consideration the mechanisms of attachment, coping strategies and social support, as well as the deleterious effects of associated emotional distress, when working with young people with increased levels of psychotic symptoms.

Cette étude démontre que l’alexithymie primaire nous oriente vers la présence de troubles schizophréniques. Comme hypothèse, nous formulons que : «l’alexithymie est un trait de personnalité dans la schizophrénie responsable de la toxicomanie et du recours aux traitements méthadone. La méthadone est une suppléance dans la psychose». L’intérêt de cette recherche est double : sur le plan clinique, elle souligne l’importance du repérage des troubles émotionnels et de la personnalité en addictologie. Elle précise que la TAS-20 et MMPI-2 sont des outils d’aide au diagnostic de la schizophrénie ; sur le plan thérapeutique, le repérage de ces affections permettra de traiter simultanément les comorbidités associées et de guider la prise en charge. L’approche de la schizophrénie à partir du concept d’alexithymie nous inscrits dans une approche intégrative(neuropsychatrique et psychodynamique). Dans un premier volet, nous avons réalisé une étude longitudinale avec suivi de 6 mois chez des toxicomanes sous TSO, admis au CSAPA de Montpellier. Le groupe contrôle est composé 28 toxicomanes sans trouble avéré. Six mois après, 15 usagers ont mené l’étude à son terme (âge=35ans ; ET=6,43). 11 toxicomanes atteints de troubles(âge= 39 ans ; ET= 6,9) constituent le groupe expérimental. La procédure consistait à diagnostiquer les troubles de la personnalité dans le groupe contrôle ; à évaluer la dépendance aux drogues et le niveau d’alexithymie au sein des groupes. Nous avons eu recours à : le MMPI-2 pour le diagnostic des troubles ; la DAST-20 pour le repérage de la dépendance (DSM-IV) et la TAS-20 pour la mesure de l’alexithymie. La TAS-20 a été administrée pendant le traitement et six mois après. Les résultats au MMPI-2 décrivent une prévalence de troubles schizophréniques 33% et de protocoles invalides 20%. La DAST-20 présente un faible niveau de dépendance dans le groupe contrôle 1.93 et expérimental 1.49. Dans le groupe contrôle, les scores d’alexithymie et ses sous-dimensions augmentent six mois après le traitement. L’alexithymie est un trait (z=.21 ; p=.834) et un état de la personnalité (r=.621*; p=.013). Dans le groupe expérimental, la TAS-TOT confirme une diminution des scores, mais l’analyse des sous-dimensions admet que cette baisse est non significative. L’alexithymie est un trait de la personnalité (z=.4 ; p=.689).Des hauts scores d’alexithymie sont observés chez les toxicomanes diagnostiqués schizophrènes des deux groupes. L’alexithymie est un trait (z=1.21 ; p=.225) et un état (r=.90* ; p=.015) de la personnalité chez les schizophrènes du groupe contrôle. En ce qui concerne les schizophrènes du groupe expérimental, la diminution des scores TASTOT 63% et 57% invalide sa dimension primaire. Dans le second volet, l’analyse du discours a permis de déceler des unités signifiantes spécifiques à l’alexithymie et à la psychose. La méthodologie est centrée sur des cas cliniques. Des entretiens semi-directifs avec pour support un guide d’entretien ont été réalisés chez des toxicomanes sans trouble de la personnalité (groupe contrôle). Ils ont été retranscrits sur papier selon la méthode analytique. Nous avons recours aux paradigmes psychanalytique, phénoménologique et psychosomatique. La description narrative s’est élaborée sur quatre temps : le contexte anamnestique, l’expression des sentiments, l’entrée dans la toxicomanie et au Programme Méthadone. L’analyse des récits atteste un ensemble de signes cliniques qui résultent de la non extraction de l’objet a, prototype de la psychose. L’alexithymie se traduit sur le plan clinique par relation la blanche. En définitive, les résultats de l’analyse mixte admettent que l’alexithymie est présente dans la toxicomanie et dans la schizophrénie. Chez le toxicomane, le score élevé d’alexithymie est un indice diagnostic de schizophrénie, indépendamment de sa nature primaire ou secondaire.Mots clés: schizophrénie-alexithymie-toxicomanie-méthadone-buprénorphine-suppléance. / As hypothesis, we propose that alexithymie is a personality trait of schizophrenia responsible of the drug addiction and the use of methadone treatment. Methadone is an antipsychotic. Clinically, this study stresses the importance of the diagnosis of emotional disorders and personality. It demonstrates that TAS-20 and MMPI-2 are disposal tools for diagnosis of schizophrenia. Therapeutically, the importance of diagnosis is to treat comorbidities and to orientate the care. The approach of schizophrenia from the concept of alexithymia enrolled us in an integrative approach, which takes into consideration the neuropsychiatric and psychodynamic concepts.In the first part, we conducted a longitudinal study with follow-up 6 months with drug addict on methadone or buprenorphine, admitted to CSAPA-UTTD Montpellier. The control group includes 28 addicts out without disorder. Six months later, 15 users conducted the study to completion (age = 35 years, SD = 6.43). 11 addicts with schizophrenia, depression and anxiety (age = 39 years, SD = 6.9) constitute the experimental group. The procedure was to diagnose personality disorders in the control group; to evaluate drug dependence and the level of alexithymia in the groups. We used : the MMPI-2 for the diagnosis of personality disorders; DAST-20 for evaluate dependence according to DSM-IV and the TAS-20 to measure alexithymia. The TAS-20 was administered during treatment and six months after. The results MMPI-2 describe a prevalence of schizophrenic 33% and 20% invalid protocols. The DAST-20 has a low level of dependence in the control group and 1.93 1.49 experimental. In the control group, the scores of alexithymia and its sub-dimensions increase six months after treatment TAS-TOT 52.88% and 55.2%; DIF 19.54 et19.9; DDF 14.87% and 15.57%; EOT 18.47% and 19.73%. Alexithymia is a trait (z = .21, p = .834) and a state of personality (r = .621 *; p = .013). In the experimental group, the TAS-TOT confirms lower scores, but the analysis of sub-dimensions admits that this decrease is not significant TAS-TOT 56% and 54.36%; DDF 17% and 16.36%; DIF 18.45% and 18.18%; EOT 20.55% and 19.82%. Alexithymia is a personality trait (z = .4, p = .689). High alexithymia scores were observed among addicts diagnosed with schizophrenia in both groups. In the TAS-TOT control group 59% and 65.2%; DIF 19.53% and 19.9%; DDF 14.87% and 15.57%; EOT 18.47% and 19.73%. In the10experimental group TAS-TOT 63% and 57%; DIF 21% and 18%; DDF 24% and 21%; EOT 18% and 18%. Alexithymia is a trait (z = 1.21, p = .225) and a state (r = .90 * P = .015) personality in schizophrenics control group. Regarding schizophrenia in the experimental group, lower TASTOT scores 63% and 57% alexithymia is a state.In the second part, discourse analysis detected specific signifying units of alexithymia and psychosis. The methodology focuses on clinical cases. We use semi-structured interview with addicts without personality disorder. They were transcribed on paper according to the analytical method. We use psychoanalytic paradigms, phenomenological and psychosomatic. The narrative description shall include four stages: the anamnesis, the expression of feelings, entry into drug addiction and Methadone Program. The analysis of stories attests a set of clinical signs resulting from the non-extraction of the object, prototype of psychosis. Alexithymia translates clinically by white relationship.Ultimately, the results of the joint analysis recognize that alexithymia is present in drug addiction and schizophrenia. Among drug users, high alexithymia scores are diagnoses of schizophrenia indications, regardless of primary or secondary in nature. Alexithymia is a polydrug factor.Keywords : schizophrenia-alexithymia-drug addiction-methadone-buprenorphine-

BACKGROUND: Idiopathic psychotic disorders, which include schizophrenia, schizoaffective and bipolar disorder with psychosis, are debilitating disorders affecting about 3% of the world’s population. Neurodevelopmental and neurodegenerative hypotheses have been proposed in psychosis, but the literature is mixed in regards to whether psychosis pathogenesis involves one or both of these processes. Since the visual system matures early in development, studying visual pathway abnormalities stratified by disease onset may further inform our understanding of psychosis pathogenesis. OBJECTIVE: The objective of this thesis is to determine whether disease onset, independent of illness duration, has a differential effect on visual cortical abnormalities in psychosis. We examined visual cortical measures for thickness, surface area, and volume using a pseudo-longitudinal study design of first episode psychosis-schizophrenia (FEP-SZ), FEP-non-schizophrenia (FEP-NSZ), early onset psychosis (EOP, <15 years of age), adult onset psychosis (OP, >15 and <30 years of age), and late onset psychosis (LOP, >30 years of age) groups. Relationships between visual cortical metrics and clinical or functional outcomes were performed. METHODS: The FEP sample (n= 102) included healthy controls (n= 44), FEP-SZ (n= 36), and FEP-NSZ (n= 22). The chronic psychosis data included healthy controls (n= 311) and psychosis probands (n=510). Psychosis probands was stratified by disease onset: EOP (n=213), OP (n=257), and LOP (n=40). Propensity matching was performed to match healthy controls (HC) according to age, sex and race. Linear regression models were performed comparing the means of visual cortical measures between groups. Partial Spearman correlations controlling for confounding factors were performed between visual cortical regions and clinical data. For FEP, clinical outcomes were assessed using Clinical Global Impression scale (CGI), Scale of Positive Symptoms (SAPS), and Scale of Negative Symptoms (SANS). For onset groups, clinical and functional outcomes were assessed using Positive and Negative Syndrome Scale (PANSS), Montgomery–Åsberg Depression Rating Scale (MADRS), Brief Assessment of Cognition (BACS), Wecshler Memory Scale (WMS) spatial span, anti-saccade error rates, dot expectancy pattern test, emotion recognition test, and Birchwood Social Functioning Scale (SFS). Multiple comparisons were performed using the Benjamini-Hochberg procedure. RESULTS: FEP-SZ was associated with smaller V1 and V2 areas, higher MT area and lower MT thickness compared to HCs. Lower MT thickness was associated with worse negative symptoms. Compared to HC, patients with chronic psychosis had lower V1, V2, and MT areas, as well as smaller MT thickness. V1 and V2 area and MT thickness were lower in the EOP group in comparison to matched HC. OP and LOP had a thinner MT region compared to matched HC. Of particular note, it was observed that EOP had greater area differences as compared to thickness reductions in the LOP group. Increased hallucinations and delusions were associated with a thinner MT region in the EOP group. CONCLUSION: When stratified by disease onset, FEP, EOP, OP, and LOP appear to have different pathogenic mechanisms and the severity of visual cortex neuroanatomical abnormalities are dependent on when the disease onset occurs. EOP occurs earlier in neurodevelopment resulting in greater severity in symptom and visual cortical measures as compared to OP. On the contrary, LOP appears to have a neurodegenerative mechanism which is evidenced by accelerated visual cortical thinning. / 2022-06-01T00:00:00Z

Thesis (MA)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Recovery in schizophrenia was regarded, for a very long time, as a somewhat unattainable goal. In addition, the de-emphasis of the subjective experience of the person living with schizophrenia created an environment where studies on the experience of recovery was disregarded. The dawn of the civil rights movement in the 1960s paved the way for the recovery movement in mental health. A new emphasis was placed on the person living with schizophrenia and his or her individual experience. Together with this, the deinstitutionalisation of long-term patients following the introduction of anti-psychotic medication allowed for recovery in schizophrenia to become a more widely accepted concept. Against this background, this study seemed crucial and focused on how seven participants experienced their recovery from first-episode psychosis in schizophrenia. Each participant was interviewed twice, the interviews transcribed and then analysed with the use of Interpretative Phenomenological Analysis. It was found that support and its natural corollary, having to care for another, are possibly the greatest contributors to the recovery of persons faced with mental illness. Participants highlighted the important role of spirituality in their recovery, despite it being generally regarded as a controversial topic. Since spirituality has the ability to build resilience, it cannot and should not be overlooked. Stigma was found to be ingrained and pervasive, as it so often is for persons faced with mental illness. It can be a barrier to recovery. The retention or rediscovery of the abilities of those challenged by mental illness was seen as a determining factor for recovery, since it (re)introduces a sense of agency. In conclusion, and without fail, all the participants agreed that talking about their experiences aided them. This points to the fact that there can be no question as to the value of the narrative in the process of recovery. / AFRIKAANSE OPSOMMING: Herstel (recovery) in skisofrenie is vir 'n lang tyd beskou as 'n ietwat onbereikbare doel. Hiermee saam is die subjektiewe belewenis van die persoon wat met skisofrenie saamleef al minder van waarde geag. Dit het 'n omgewing geskep waar die studie van die belewenis van herstel geminag is. Die opkoms van die burgerregtebeweging in die 1960s het die weg gebaan vir die herstelbeweging in geestesgesondheid. 'n Hernude klem is geplaas op die persoon wat met skisofrenie saamleef en sy of haar indiwiduele belewenis. Tesame hiermee, het die ontslag van langtermynpasiënte uit institusionele sorg as gevolg van die bekendstelling van anti-psigotiese medikasie daartoe gelei dat herstel in skisofrenie meer algemeen aanvaar is. Teen hierdie agtergrond is hierdie studie as noodsaaklik beskou en het dit gefokus op hoe sewe deelnemers hul herstel van „n eerste psigotiese episode beleef. Daar is twee onderhoude met elke deelnemer gevoer. Hierdie onderhoude is getranskribeer en daarna geanaliseer met behulp van Interpretative Phenomenological Analysis. Daar is gevind dat ondersteuning en daarmee saam, om „n ander te versorg, waarskynlik die grootste bydraende faktore is tot die herstel van persone wat deur geestessiektes uitgedaag word. Die deelnemers het die rol van spiritualiteit, wat dikwels as 'n omstrede onderwerp beskou word, beklemtoon. Aangesien dit kan bydra tot veerkragtigheid, kan en moet dit nie oorgesien word nie. Stigma is diepgewortel en deurdringend bevind, soos dit so dikwels is vir dié wat geestessiektes in die gesig staar. Dit kan 'n hindernis tot herstel wees. Die behoud of herontdekking van die vermoëns van dié wat deur geestessiektes uitgedaag word is 'n bepalende faktor, aangesien dit (weer) 'n gevoel van beheer oor die eie aksies (“sense of agency”) inlei, wat so deurslaggewend is tot herstel. Ter afsluiting, en sonder uitsondering, het al die deelnemers saamgestem dat om oor hul belewenisse te praat hulle gehelp het. Derhalwe, kan die waarde van die narratief in die proses van herstel nie betwyfel word nie.

Background: Current psychological theories of persecutory delusions appear limited in being able to explain their interpersonal nature. Unanswered questions include why the content of delusions mostly involves persecution by other people. Research into rejection including rejection sensitivity may provide a rational for delusion personalisation and also may indicate how rejection may be implicated in the maintenance of delusions. The aim of this study was to investigate responses to rejection for individuals with a psychosis that includes persecutory delusions compared with controls. Methodology: Participants (22 with psychosis with persecutory delusions, 18 with an anxiety disorder and 19 healthy individuals) played a computerised game of catch (Cyberball). Half of each group was either included or excluded, inducing a mood change in those rejected. Questionnaires were completed to measure mood change, indicating rejection sensitivity. A second task was completed enabling participants to react either antisocially or neutrally towards the game characters. Measures of psychological and demographic variables were also collected. Results: There was a large effect between the excluded and included participants. There was a null finding for the hypothesis that the psychotic group would have higher levels of rejection sensitivity than the anxious and healthy groups. There was also a null finding for the hypothesis that the psychosis group will be more likely to respond antisocially after rejection and make more negative attributions about the game character’s personalities. However, there was a trend for a the psychotic group to be more antisocial after inclusion. Conclusions: The results obtained in the study were contrary to those expected. Rejection appears to be a similarly negative experience for all participants, but differences may be observed behavioural responses with those with psychosis appearing ambivalent to inclusion or exclusion.

Background. Impaired insight, or unawareness of illness, is a common symptom of schizophrenia. Clinical insight is awareness of having a mental disorder; cognitive insight is ability to self-reflect (self­reflectiveness) and certainty in cognitions (self­certainty). In schizophrenia insight is associated with brain function and improving insight is a potential early intervention point. This study investigated whether insight is impaired in youth at ultra high-risk (UHR) for psychosis, and if it is related to major brain networks. Methods. Data from a larger UHR study was used, including 55 UHR adolescents and 55 controls assessed with the Structured Interview of Prodromal Symptoms, MATRICS Consensus Cognitive Battery, Scale to Assess Unawareness of Mental Disorder, and Beck Cognitive Insight Scale, as well as resting state functional MRI scans. UHR and control groups were tested for differences in self-reflectiveness and self-certainty, and correlations between insight dimensions and clinical and cognitive measures. Functional connectivity was calculated for the default mode, the cingulo-opercular, and central executive networks and regressed on participants’ reported clinical and cognitive insight, while covarying for head motion. Results. Self-reflectiveness was higher in the UHR group (d = 1.28), but the groups did not differ in self-certainty (d = 0.28). Among UHR, poorer clinical insight was related to greater symptom severity. Default mode connectivity was negatively correlated with self-reflectiveness (R2 = .091) and clinical insight (R2 = .399) in UHR, but no such correlations were found in controls. Cerebello-prefrontal cortex connectivity was negatively associated with self-certainty in the UHR group (R2 = .089 - .138). Conclusions. Default mode connectivity appears to be associated with the facets of insight concerning self-awareness, whereas cerebello-prefrontal connectivity appears to be associated specifically with self-certainty. This is the first study to relate major brain networks to insight before the onset of psychosis, and is consistent with models proposing that different facets of insight are related to self-awareness and executive functioning through networks associated with these processes.

Distortions in the perception of time historically have been associated with dissociation and psychosis in clinical populations. However, the relations among dissociation, psychosis, and time perception in sub-clinical populations have not been investigated. In the present study, college undergraduates scoring either normally or deviantly high on the Per-Mag were given a Dissociative Experiences Scale (DES) and a computerized time-estimation/production task. Participants scoring high on the Per-Mag obtained higher scores on the DES than participants scoring low on the Per- Mag. Per-Mag scores also correlated positively with DES scores across 608 total participants screened. The relation between dissociative and psychotic symptomatology is discussed considering dichotomous versus continuous conceptualizations of psychopathology. The effects of intelligence, social desirability, malingering, gender, and post-traumatic stress on the measures used are also discussed.

En nous étayant des théories issues de l’épistémologie psychanalytique, nous concevons la schizophrénie comme résultant d’une expérience traumatique primaire n’ayant pu être intégrée au sein de la subjectivité. Ce traumatisme, nous le rattachons moins à un évènement en tant que tel qu’à la position impensable qu’il désigne pour le sujet. Ainsi, en nous inspirant de la pensée de P. Aulagnier et de R. Roussillon, nous suggérons que le noyau traumatique conditionnant le développement d’une problématique schizophrénique se rapporte à la position d’objet pulsionnel, ou de non-désir, à laquelle se trouve identifié le sujet au sein des premiers échanges avec son environnement. Face à l’impensable de cette position identificatoire, le sujet se voit contraint de s’extraire de la scène relationnelle avec ses objets primaires, se clivant par la même opération du capital représentatif qui lui est associé. Dans ces conditions, nous pensons que le délire, moins d’apparaître comme une production pathologique dépourvue de sens, correspond à un mode de réponse face au retour hallucinatoire de l’impensé traumatique. Aussi, à partir d’une méthodologie qualitative basée sur l’analyse d’une douzaine de cas cliniques, nous mettons en évidence trois principales fonctions du délire dans la schizophrénie. La première, conceptualisée sous le terme de « fonction contenante », procède à la mise en forme et à la transformation signifiante de ce qui ne put être symbolisé de l’expérience traumatique. La seconde, nommée « fonction localisante », tente de situer en dehors du sujet le débordement pulsionnel inhérent au traumatisme primaire. La troisième, appelée « fonction identifiante », permet à la personne délirante de s’attribuer un énoncé identificatoire qui, de manière auto-créée, supplée à l’énigme de son histoire insensée.Enfin, l’analyse de nos données cliniques souligne que ces trois fonctions de l’activité délirante ne se réalisent pas de façon aléatoire mais qu’elles s’articulent selon une logique particulière. Ainsi, nous suggérons qu’à partir de sa triple opération le délire schizophrénique tend à se déployer en un « processus délirant », par lequel le sujet peut rendre pensable et supportable la position traumatique à laquelle il a été identifié au cours de son histoire. / By following theories from the psychoanalytical epistemology, we consider schizophrenia as the result of a primary trauma that has not been assimilated within the subjectivity. We connect less this traumatism with an event than with the unthinkable position the subject is identified to. Therefore, being inspired by the thought of P. Aulagnier and R. Roussillon, we suggest that the traumatic nucleus which conditions the development of schizophrenia is related to the position of instinctual object, or of non-desire, to which the subject is identified within the first exchanges with his environment. In view of this unthinkable position, the subject is forced to remove himself from the relationship with his primary objects, splitting off from the representative capital that is associated with it. In these conditions, we think that the delusion appears less as a meaningless pathological production than as a way of answering to the hallucinatory return of the traumatic unthought. From a qualitative methodology based on the analysis of a dozen clinical cases, we highlight three main functions of the delusion in schizophrenia. The first, conceptualized under the term «containing function», carries out the shaping and the significant transformation of what could have not been symbolized of the traumatic experience. The second, called «localizing function», tries to locate outside of the subject the instinctual overflow inherent to the primary trauma. The third, named «identifying function», enables the delusional person to assume an identificatory principle which, in a self-created way, compensates for the enigma of his senseless history.Finally, the analysis of our clinical data underlines that these three functions of the delusional activity are not randomly accomplished but are organized according to a particular logic. Thus from its triple operation, we suggest that the schizophrenic delusion tends to develop into a «delusional process», by which the subject can make thinkable and bearable the traumatic position to which he was identified during his history.