La aparición de los antipsicóticos atípicos o de segunda generación ha supuesto un gran cambio en el manejo de los pacientes con trastorno bipolar. Los ensayos controlados han demostrado la eficacia de prácticamente todos los antipsicóticos atípicos en la manía aguda. Además, la mayor parte de ellos disponen de datos positivos para el tratamiento de mantenimiento del trastorno bipolar, lo que sugiere propiedades normotímicas. E incluso algunos de ellos han mostrado datos positivos en la depresión bipolar. Sin embargo, apenas existen estudios independientes comparando la acción de los atípicos con la de los clásicos, mas allá del uso de haloperidol como comparador activo en algunos estudios de manía aguda. En este contexto, esta tesis tiene como objetivo evaluar el comportamiento de los antipsicóticos atípicos en las fases de manía aguda y depresión, en comparación con el de los antipsicóticos clásicos (haloperidol) y placebo respectivamente, para testar las posibles propiedades normoreguladoras en los episodios agudos. Se utilizaron para ello las técnicas de metanálisis, estructurándose la tesis en dos metanálisis separados. El primero en manía aguda, comparando antipsicóticos atípicos con antipsicóticos clásicos. Dentro de este metanálisis se escogieron dos variables principales: la velocidad de inicio de acción, operativizada como la disminución en la puntuación en la escala de manía a la primera semana, y el viraje depresivo. En los dos casos, se trata de variables de interés clínico, escasamente estudiadas hasta la actualidad, y que señalan el perfil de acción de los fármacos. En segundo lugar, se llevó a cabo un segundo metanálisis comparando la acción de los antipsicóticos atípicos con la del placebo (no existían estudios comparativos con antipsicóticos clásicos) en depresión bipolar. Los resultados de la primera variable del metanálisis en manía aguda, que dan lugar al primer artículo de esta tesis, confirman que el haloperidol muestra un inicio de acción más rápido que los antipsicóticos atípicos. El tamaño del efecto fue pequeño (SMD = 0,17 [0,01 - 0,32] tal como cabria esperar entre dos grupos de eficacia demostrada. Sin embargo, este resultado sugiere que el haloperidol puede seguir siendo un tratamiento de primera línea en la manía aguda en casos graves en los que se requiere una mejoría sintomática urgente, siempre y cuando el riesgo de efectos adversos extrapiramidales y de viraje depresivo sea bajo. El segundo artículo de la tesis analiza las diferencias en el riesgo de viraje depresivo tras el tratamiento de la manía aguda con antipsicóticos atípicos en comparación con haloperidol. El resultado del metanálisis es que los atípicos conllevan un 42% menos de riesgo de viraje que el haloperidol. No obstante, se observa heterogeneidad en este análisis y las diferencias entre grupos son atribuibles especialmente a la acción de tres de los atípicos: olanzapina, quetiapina, y ziprasidona. El segundo metanalisis, que da lugar al tercer lugar de la tesis, observa que existe un efecto positivo en la depresión bipolar, en comparacion con placebo, pero que solo es atribuible a algunos de los antipsicóticos atípicos, concretamente, a la olanzapina y la quetiapina. De modo que se concluye que no se trata de un efecto de clase de la familia. Analizando los resultados de los dos metanálisis en conjunto se observa que se puede establecerse un gradiente en función de la afinidad por el receptor dopaminergico D2, modulado por la acción sobre otros receptores, en el que la mayor afinidad y selectividad antiD2 supondría mayor potencia antimaníaca, inicio de acción antimaníaca más rápido, mayor riesgo de viraje depresivo, e ineficacia y/o agravamiento de la depresión bipolar. Haloperidol se situaría en el extremo izquierdo del gradiente y se propone la siguiente ubicación para los antipsicóticos atípicos: Risperidona – Aripiprazol – Ziprasidona – Olanzapina – Quetiapina. Además, este gradiente coincide con el de los valores del Índice de Polaridad obtenidos en los estudios de prevención de recurrencias con los antipsicóticos atípicos, de lo que se desprende que los efectos en los episodios agudos tiende a perdurar durante el tratamiento de mantenimiento. / Introduction of atypical antipsychotics has involved a great change in the management of bipolar disorder during last decade. Not only they show efficacy in mania, but also for recurrence prevention, and some of them have also been shown to work in bipolar depression. However, comparisons with classical neuroleptics to assess advantages and disadvantages are scarce. In this context, the goal of this thesis was to assess the behavior of atypical antipsichotics in the acute phases of mania and depression, compared to classical antipsychotics in the former and with placebo in the latter, and study their possible normothymic properties. Metanalysis techniques were used. The thesis was structured in two different metanalysis. The first one in acute mania, comparing atypical and classical antipyschotics. Two different outcomes were assessed: speed of onset of action and switch to depression. The second metanalysis studied the efficacy of atypical antipsychotics in bipolar depression versus placebo. The first article of the thesis shows that haloperidol has a faster onset of action than atypical antipsychotics in acute mania. The size of the effect was small (SMD = 0,17 [0,01 - 0,32] but could still be clinically significant in the subset of severe manic patients who require an urgent relief of symtpoms. On the other hand, as it is shown in the second paper of the thesis, treatment with atypicals involves a 42% reduction in the risk of switch to depression compared to haloperidol. However, heterogeneity was present which could be due to differences in the group of atypicals, as three of them (olanzapine, quetiapine, and ziprasidone) could explain the effect. The third article, corresponding to the second metanálisis, shows only some atypicals, namely olanzapine and quetiapine, are efficacious in bipolar depression. Therefore, there is no class effect. A global view of both metanalysis shows that dopaminergic D2 affinity is likely to be the most important factor over the different profile of antipsychotics, with lower affinity involving more clear normothymic actions.

Objective: To investigate whether there is an association between use of cocaine, amphetamines, or psychedelics and psychotic symptoms. Method: Cumulated data from a prospective, longitudinal community study of 2588 adolescents and young adults in Munich, Germany were used. Substance use was assessed at baseline, 4-year and 10-year follow-up using the Munich Composite International Diagnostic Interview; psychotic symptoms were assessed at 4-year and 10-year follow-up. Multinomial logistic regression analyses, adjusted for sociodemographic factors, common mental disorders, other substance use, and childhood adversity (adjusted odds ratios, AOR), revealed associations between cocaine, amphetamine or psychedelic use and psychotic symptoms. Results: Lifetime experience of psychotic symptoms was associated with lifetime use of cocaine (AOR 1.94; 95%CI 1.10-3.45), amphetamines (AOR 1.69; 95%CI 0.98-2.93), psychedelics (AOR 2.37; 95%CI 1.20-4.66) and all three substances (AOR 1.95; 95%CI 1.19-3.18). Conclusion: Associations between psychotic symptoms and use of cocaine, amphetamines, and/or psychedelics in adolescents and young adults call for further studies to elucidate risk factors and developmental pathways.

Objective: The aim of the current study was to investigate the differences in baseline characteristics and three-year outcomes between two diagnostic categories with presentation of first-episode psychosis: bipolar affective disorder (mania with psychotic features) and schizophrenia. The comparison was based on pre-treatment characteristics, clinical presentation, symptomatic and functional outcomes, and engagement in risk behaviours. Methods:461 schizophrenic patients and 54 bipolar affective disorder (BAD) patients between the ages of 15 to 25 years from a local first-episode psychosis treatment program within the years2001 to 2003 were studied. Researchers collected detailed data on baseline and three-year follow up variables from systematic medical file review for statistical analyses. Results: At service entry, compared to schizophrenic patients, bipolar affective disorder(BAD)patients exhibited more prominent positive symptoms (p = 0.01), were younger at first presentation and had a higher unemployment rate (p < 0.01), were more likely to have acute onset of psychosis, shorter duration of untreated psychosis (DUP), a higher rate of hospital admission within first month after initial contact, and lower pre-treatment functioning (Social and Occupational Functioning Assessment Scale (SOFAS), p < 0.001). There was no significant difference in gender, education level, age of onset and pre-treatment risk taking behaviours. After applying univariate analysis of variance (ANCOVA)by controlling baseline variables that showed significant differences, the three year follow up reveals that schizophrenic patients displayed fewer numbers of hospitalization (p <0.01)with no difference in the total length (days) of hospitalization, more prominent positive symptoms(p < 0.01), poorer functioning at year 3 (p <0.05), and consistently significant lower employment rate at 12 month (p < 0.001), 24 month (p < 0.001) and 36 month (p < 0.01). Finally, more schizophrenic patients received social benefits (p < 0.05). Conclusion: The outstanding baseline poorer functioning level of bipolar affective disorder patients have progressively made a modest improvement in functional outcomes at the end of three-year follow up. BAD patients also displayed a marked improvement with fewer positive symptoms in the follow up. The results suggest a differentiation in symptomatology and the course of illness between bipolar affective disorder and schizophrenia with first-episode psychosis. In coherence with other scholastic literature, duration of untreated psychosis (DUP) associates with remission(Crumlish et al., 2009;Chang et al., 2012a), positive symptoms(Barnes et.al., 2008; Chang et.al., 2012b; Clarke et al., 2006; Crumlish et.al., 2009;), and functional outcomes(Barnes et al., 2008; Chang et al., 2012b; Clarke et.al., 2006; Crumlish et.al, 2009; Fusar-Poli et al., 2009). Moreover, further exploration about the diagnostic-specific therapeutic window for early intervention, symptoms management, and rehabilitation strategies in occupational training are in demand. / published_or_final_version / Psychological Medicine / Master / Master of Psychological Medicine

Background Mental illness is one of the most stigmatized conditions in our society. Since 1990, Yankelovich [1] revealed that the mass media, including television and broadcast news, are the primary source of information about mental illness. The media are believed to play a major role in contributing to mental illness stigma via the images they portray of characters with mental illness as well as the misinformation communicated, inaccurate use of psychiatric terms, and unfavorable stereotypes of people with mental illness according to Wahl’s study [2]. However, little is known about the influence of Hong Kong media especially the TV broadcast. Therefore, this study is going to investigate Cantonese TV dramas which related on psychosis, which strongly influence the public recognition of the illness. Objective The objective of this study is to1)analyze the selected terms ‘ 痴線’ , ‘精神病’ ‘思覺失調’ and ‘精神分裂’ which were related to mental illness that present in the target dramas; 2) to investigate negative images of mental illness in the Cantonese TV dramas; 3)to investigate the relationship between the characters and the terms. Method This study investigated the domestic free television program service licensees TVB about the drama series they provide within 2001 to 2012 which broadcasted during 8pm to 10:30pm. The dramas in year 2001, 2002, 2006, 2007, 2011 and 2012 would be chosen. The terms‘ 痴線’ , ‘精神病’ ‘思覺失調’ and ‘精神分裂were selected to be analyzed. All episodes were classified by category and analyzed quantitatively. Results the term of痴線still remained the highest than other terms within the same period of these six selected year. In year 2007, the term of ‘思覺失調’ started being used 0.7% but still in a low frequency comparatively to 痴線13.3% and 精神病1.9Similar results were found in the year of 2011 and 2012. There was a decreased in using 痴線, from approximately 30 % to 10% from 2001 to 2012. There was also an obvious decrease in using the term of ‘精神病’ from 10% to 1% from 2001 to 2012. In general, many of the references to mental illness were about a character's actions in a situation rather than a character's nature or mental state. Characters who received these terms were depicted negatively in the majority of occurrences. Conclusion The stigma of psychiatric illness is a negative factor in its presentation, detection and treatment. The mass media’s power to impact public perception and the degree to which people are exposed to media representations makes the mass media one of the most significant influences in developed societies. Many studies including this study showed that the media tends to skew reality. People with mental illness were depicted in negative ways and it damaged their self-esteem as a result, they would not going to seek treatment. / published_or_final_version / Psychological Medicine / Master / Master of Psychological Medicine

The outbreak of the first psychotic episode disarrays the person's everyday experience and of significant others. This work takes the notion of experience as the key mediating variable to understand how the cultural and social frame affects the experience of psychosis. Culture contributes to the articulation of the experience of psychosis through its influence on individual, family, and community reactions. I focused on the first psychotic experience of low-income youth living in Sao Paulo, Brazil because one can see more clearly the role played by the cultural and social dimensions, since the process of experiencing psychosis is not yet totally settled. / I emphasized the basic strategies created by psychotic patients and their families to reorganize their experience of themselves and of the world, and the dynamics and underpinning of these strategies in relation to cultural signifiers. I particularly explored how psychotic patients and their families appropriate, borrow and transform cultural signifiers, and more specifically religious signifiers, in their attempt to cope with psychosis. Religious signifiers are pervasive and diverse in Brazilian culture; furthermore different people may or may not resort to or be affected by religious idioms and signifiers in a similar way. A wide range of variation in the use of religious idioms and signifiers can be expected among patients, at different moments of their life history, and when the experiences of patients and significant others are compared. Religion can have a positive impact over the experience of psychosis, a negative, or even a neutral impact depending on the person and circumstances. / My work also demonstrates that psychotic patients are subjected to a double-process of marginality due to their poor living conditions and to urban violence; and to the fact that their marginality is further accentuated by the psychotic episode. People's reactions also vary and change in relation to the kinds of behaviours manifested by psychotic patients, in addition to the social role of each family member and the family dynamics at play. More generally, people's reactions work in a kind of "feed-back loop," since family reactions modify the subjective world and reactions of patients, while patients' reactions modify family attitudes and behaviours.

Thesis (Ph.D.)--University of Chicago, 2001. / Includes bibliographical references. Also available on the Internet.

Ce travail dérive d’un parcours clinique et institutionel, à partir du quel s’est formulé la question sur les effets dans les liens sociaux du reencontre aves la specificité de la position psychique des sujets psychotiques. On raconte des passages d’un itinéraire de recherche, fait du pari à la réinscription des bordes de la clinique psychanalytique – lequel se montre par les experiences des ateliers thérapeutiques et de l’accompagnement thérapeutique, mais pas seulement –, pour dire des modes par lesquelles la question a pris la forme d’un discours en interrogation. On part de la formulation lacanienne sur la structure discursive des liens sociaux – en considerant, surtout, le discours universitaire et le discours capitaliste – et de la place extérière que la structure psychotique tient par rapport le discours. Puis on situe l’hospitalité, selon l’élabore Derrida, comme possibilité de accuellir les différences portées par les psychotiques. Dans ce chamin, les concepts de transfert, résistance et témoin, d’après Freud et Lacan, apparaissent comme manières de nommer l’espace-temp où l’hospitalité à l’hors-discours peut émerger – dont la specificité se present dans les impasses de l’inscription des contours subjetifs entre le Je/moi et l’autre-Autre, le prope et l’ailleurs. De cette façon, on suggère que offrir l’hospitalité à l’alterité de la position subjetive des psychoses implique accueillir la tension inhérente aux limits du propre et de l’ailleurs comme une demande de la strutucture. On problematise la façon par laquelle le discours universitaires de la science, dans um moment de l’histoire de la culture, a répondu à cette “demande” en edifiant les murs de l’hospice et de la catégorie “maladie mental”, qui n’ont pas inscrit la différence, mais, contrairement, ont produit une intensification de l’impasse du narcissisme. On se demande donc comment le discours universitaire de la science d'aujourd'hui, en complicité avec le discours du capitalisme, peut être affecté, si l’hors-discours retrouve l’hospitalité du chercheur. À l’horizont, la question: offrir l’hospitalité aux psychoses produirait des effets de méthode? Serait l’hospitalité aux psychoses une opportunité pour que nous nous replaçons sur le plan éthique et politique par rapport à la manière dont, aujourd'hui, nous faisons nos incursions dans le monde de la connaissance? / Este trabalho deriva de um percurso clínico e institucional, a partir do qual se formulou uma pergunta pelos efeitos para os laços sociais do encontro com a especificidade da posição psíquica dos sujeitos nas psicoses. Narram-se passagens de uma trajetória de pesquisa, feita da aposta na reinscrição das bordas da clínica psicanalítica – que pode ser observada nas experiências em oficinas terapêuticas e acompanhamentos terapêuticos, mas não somente –, para dizer dos modos pelos quais tal questão foi ganhando a forma de um discurso em interrogação. Parte-se da formulação lacaniana em torno da estrutura discursiva dos laços sociais – tomandose em consideração, especialmente, o discurso universitário e o discurso capitalista – e do lugar de exterioridade que a estrutura psicótica mantém em relação aos discursos. Em seguida, situa-se a hospitalidade, tal qual elaborada por Derrida, como possibilidade de acolhimento às diferenças que as psicoses portam. Nesse caminho, os conceitos de transferência, resistência e testemunho, desde Freud e Lacan, aparecem como formas de nomear o espaço-tempo em que pode emergir uma hospitalidade ao fora-do-discurso, cuja especificidade se apresenta na forma de impasses na inscrição dos contornos subjetivos entre o eu e o outro-Outro, o próprio e o alheio. Desde aí, sugere-se que dar hospitalidade à alteridade da posição subjetiva nas psicoses implica acolher a tensão inerente aos limites do próprio e do alheio, como um pedido estrutural. Problematiza-se o modo como o discurso universitário da ciência, em determinado momento da história da cultura, respondeu a este “pedido” edificando os muros do hospício e da categoria “doença mental”, que não fizeram inscrever a diferença, mas, ao contrário, operaram o recrudescimento do beco do narcisismo. Pergunta-se então como o discurso universitário da ciência de nossos dias, em cumplicidade com o discurso do capitalismo, pode ser afetado, caso o fora-do-discurso das psicoses encontre uma posição de hospitalidade desdobrada do lado do pesquisador. No horizonte, o interrogante: dar hospitalidade às psicoses produziria efeitos de método? Seria a hospitalidade às psicoses uma oportunidade para nos reposicionarmos ética e politicamente sobre o modo como, atualmente, concebemos nossas incursões pelo mundo do conhecimento? / This work derives from a clinical and institutional trajectory, from which raised the question about the effects of social ties on encountering with specification the psychic position of psychotic subjects. Then, segments of the path of research are reported, made with the bet of rewriting the edges of the psychoanalytic clinics - that can be observed in experiments with therapeutic workshops and follow-up therapy, but not only – to say the ways in which this issue has been gaining the form of a discourse in question. It starts with the Lacanian formulation around the discursive structure of social ties - especially taking into account the university and capitalistic discourses. In addition, the place of exteriority that maintains the structure in relation to psychotic speeches, for then situate the hospitality, as is elaborated by Derrida, as the possibility of welcoming the differences that the psychoses carries. In this way, the concepts of transference, resistance, and testimony, from Freud and Lacan, appear as ways of naming the space-time on that can emerge hospitality on out-ofspeech, whose specificity appears in the form of impasse on inscription of subjective contours between self and other-Other, self and strange. Since then, it is suggested that giving hospitality to otherness of the subjective position in the psychoses, implies on welcoming, as a structural request, the tension inherent of the limits between the self and the other-Other. Considering the way how the university discourse of science, in sometime of the history of culture, responded to this "request" building the walls of the asylum and the category of "mental illness", which did not include the difference, but rather, operated the fall for the narcissism’s alley. Then wonders how the university discourse in science, nowadays, in complicity with the discourse of capitalism, can be affected in case of the out-of-speech of psychosis find on the researcher a position of hospitality. The question that is on the horizon is: giving hospitality to psychosis would produce method effect's? The hospitality to psychosis would be an opportunity for a repositioning ethical and politically about how, nowadays, we've conceived our forays into the world of knowledge?

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Esta dissertação aborda a prática do acompanhamento terapêutico (AT) num serviço de internação psiquiátrico. Pretende-se afirmar uma clínica nessa prática. Em se tratando de um trabalho numa enfermaria de crise, onde internam-se majoritariamente pacientes psicóticos em estado de crise, reconhece-se significativas diferenças ao manejo do AT. A prática do AT, situada no interior da enfermaria, esbarra com a organização institucional hospitalar, com a rotina da enfermaria e o trabalho do AT regulados pelos horários das atividades diárias; com a primazia do saber psiquiátrico; com a dura dicotomia entre o bem e o mal que muitas vezes aparece nas condutas e falas da equipe. Este funcionamento institucional marcado pela hierarquia de poder e de saber, com definidas regras de rotina, tende a aniquilar as diferenças dos sujeitos e tornar as suas singularidades invisíveis. O acompanhante terapêutico (at), atravessado pela psicanálise, tenta fazer furos nessa regulação institucional, no saber psiquiátrico, nos ideais e valores sobre o bem e o mal, sobre o correto e o errado e nas regras invisíveis da moralidade que se reproduzem no hospital psiquiátrico. O at tenta fazer esses furos, essas descontinuidades quando acolhe a fala do psicótico, sem partir de uma verdade sobre ele ou sobre aquilo do que ele sofre. A escuta analítica se coloca como fundamental para o trabalho clínico do at, quando este busca fazer desvios no funcionamento institucional e nas diversas atribuições a cumprir na enfermaria. Recorre-se brevemente ao processo histórico de tratamento a loucura, passando pela reforma psiquiátrica até o surgimento do AT. Faz-se necessário percorrer as formulações teóricas de S. Freud e J. Lacan sobre as psicoses, bem como o conceito de sujeito, pensando o AT e sua função clínica de acompanhar o sujeito e seus detalhes. Discute-se a questão da transferência na psicose a partir de um caso clínico, ressaltando a função de secretário de alienado

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Esta dissertação aborda a prática do acompanhamento terapêutico (AT) num serviço de internação psiquiátrico. Pretende-se afirmar uma clínica nessa prática. Em se tratando de um trabalho numa enfermaria de crise, onde internam-se majoritariamente pacientes psicóticos em estado de crise, reconhece-se significativas diferenças ao manejo do AT. A prática do AT, situada no interior da enfermaria, esbarra com a organização institucional hospitalar, com a rotina da enfermaria e o trabalho do AT regulados pelos horários das atividades diárias; com a primazia do saber psiquiátrico; com a dura dicotomia entre o bem e o mal que muitas vezes aparece nas condutas e falas da equipe. Este funcionamento institucional marcado pela hierarquia de poder e de saber, com definidas regras de rotina, tende a aniquilar as diferenças dos sujeitos e tornar as suas singularidades invisíveis. O acompanhante terapêutico (at), atravessado pela psicanálise, tenta fazer furos nessa regulação institucional, no saber psiquiátrico, nos ideais e valores sobre o bem e o mal, sobre o correto e o errado e nas regras invisíveis da moralidade que se reproduzem no hospital psiquiátrico. O at tenta fazer esses furos, essas descontinuidades quando acolhe a fala do psicótico, sem partir de uma verdade sobre ele ou sobre aquilo do que ele sofre. A escuta analítica se coloca como fundamental para o trabalho clínico do at, quando este busca fazer desvios no funcionamento institucional e nas diversas atribuições a cumprir na enfermaria. Recorre-se brevemente ao processo histórico de tratamento a loucura, passando pela reforma psiquiátrica até o surgimento do AT. Faz-se necessário percorrer as formulações teóricas de S. Freud e J. Lacan sobre as psicoses, bem como o conceito de sujeito, pensando o AT e sua função clínica de acompanhar o sujeito e seus detalhes. Discute-se a questão da transferência na psicose a partir de um caso clínico, ressaltando a função de secretário de alienado

Ce travail dérive d’un parcours clinique et institutionel, à partir du quel s’est formulé la question sur les effets dans les liens sociaux du reencontre aves la specificité de la position psychique des sujets psychotiques. On raconte des passages d’un itinéraire de recherche, fait du pari à la réinscription des bordes de la clinique psychanalytique – lequel se montre par les experiences des ateliers thérapeutiques et de l’accompagnement thérapeutique, mais pas seulement –, pour dire des modes par lesquelles la question a pris la forme d’un discours en interrogation. On part de la formulation lacanienne sur la structure discursive des liens sociaux – en considerant, surtout, le discours universitaire et le discours capitaliste – et de la place extérière que la structure psychotique tient par rapport le discours. Puis on situe l’hospitalité, selon l’élabore Derrida, comme possibilité de accuellir les différences portées par les psychotiques. Dans ce chamin, les concepts de transfert, résistance et témoin, d’après Freud et Lacan, apparaissent comme manières de nommer l’espace-temp où l’hospitalité à l’hors-discours peut émerger – dont la specificité se present dans les impasses de l’inscription des contours subjetifs entre le Je/moi et l’autre-Autre, le prope et l’ailleurs. De cette façon, on suggère que offrir l’hospitalité à l’alterité de la position subjetive des psychoses implique accueillir la tension inhérente aux limits du propre et de l’ailleurs comme une demande de la strutucture. On problematise la façon par laquelle le discours universitaires de la science, dans um moment de l’histoire de la culture, a répondu à cette “demande” en edifiant les murs de l’hospice et de la catégorie “maladie mental”, qui n’ont pas inscrit la différence, mais, contrairement, ont produit une intensification de l’impasse du narcissisme. On se demande donc comment le discours universitaire de la science d'aujourd'hui, en complicité avec le discours du capitalisme, peut être affecté, si l’hors-discours retrouve l’hospitalité du chercheur. À l’horizont, la question: offrir l’hospitalité aux psychoses produirait des effets de méthode? Serait l’hospitalité aux psychoses une opportunité pour que nous nous replaçons sur le plan éthique et politique par rapport à la manière dont, aujourd'hui, nous faisons nos incursions dans le monde de la connaissance? / Este trabalho deriva de um percurso clínico e institucional, a partir do qual se formulou uma pergunta pelos efeitos para os laços sociais do encontro com a especificidade da posição psíquica dos sujeitos nas psicoses. Narram-se passagens de uma trajetória de pesquisa, feita da aposta na reinscrição das bordas da clínica psicanalítica – que pode ser observada nas experiências em oficinas terapêuticas e acompanhamentos terapêuticos, mas não somente –, para dizer dos modos pelos quais tal questão foi ganhando a forma de um discurso em interrogação. Parte-se da formulação lacaniana em torno da estrutura discursiva dos laços sociais – tomandose em consideração, especialmente, o discurso universitário e o discurso capitalista – e do lugar de exterioridade que a estrutura psicótica mantém em relação aos discursos. Em seguida, situa-se a hospitalidade, tal qual elaborada por Derrida, como possibilidade de acolhimento às diferenças que as psicoses portam. Nesse caminho, os conceitos de transferência, resistência e testemunho, desde Freud e Lacan, aparecem como formas de nomear o espaço-tempo em que pode emergir uma hospitalidade ao fora-do-discurso, cuja especificidade se apresenta na forma de impasses na inscrição dos contornos subjetivos entre o eu e o outro-Outro, o próprio e o alheio. Desde aí, sugere-se que dar hospitalidade à alteridade da posição subjetiva nas psicoses implica acolher a tensão inerente aos limites do próprio e do alheio, como um pedido estrutural. Problematiza-se o modo como o discurso universitário da ciência, em determinado momento da história da cultura, respondeu a este “pedido” edificando os muros do hospício e da categoria “doença mental”, que não fizeram inscrever a diferença, mas, ao contrário, operaram o recrudescimento do beco do narcisismo. Pergunta-se então como o discurso universitário da ciência de nossos dias, em cumplicidade com o discurso do capitalismo, pode ser afetado, caso o fora-do-discurso das psicoses encontre uma posição de hospitalidade desdobrada do lado do pesquisador. No horizonte, o interrogante: dar hospitalidade às psicoses produziria efeitos de método? Seria a hospitalidade às psicoses uma oportunidade para nos reposicionarmos ética e politicamente sobre o modo como, atualmente, concebemos nossas incursões pelo mundo do conhecimento? / This work derives from a clinical and institutional trajectory, from which raised the question about the effects of social ties on encountering with specification the psychic position of psychotic subjects. Then, segments of the path of research are reported, made with the bet of rewriting the edges of the psychoanalytic clinics - that can be observed in experiments with therapeutic workshops and follow-up therapy, but not only – to say the ways in which this issue has been gaining the form of a discourse in question. It starts with the Lacanian formulation around the discursive structure of social ties - especially taking into account the university and capitalistic discourses. In addition, the place of exteriority that maintains the structure in relation to psychotic speeches, for then situate the hospitality, as is elaborated by Derrida, as the possibility of welcoming the differences that the psychoses carries. In this way, the concepts of transference, resistance, and testimony, from Freud and Lacan, appear as ways of naming the space-time on that can emerge hospitality on out-ofspeech, whose specificity appears in the form of impasse on inscription of subjective contours between self and other-Other, self and strange. Since then, it is suggested that giving hospitality to otherness of the subjective position in the psychoses, implies on welcoming, as a structural request, the tension inherent of the limits between the self and the other-Other. Considering the way how the university discourse of science, in sometime of the history of culture, responded to this "request" building the walls of the asylum and the category of "mental illness", which did not include the difference, but rather, operated the fall for the narcissism’s alley. Then wonders how the university discourse in science, nowadays, in complicity with the discourse of capitalism, can be affected in case of the out-of-speech of psychosis find on the researcher a position of hospitality. The question that is on the horizon is: giving hospitality to psychosis would produce method effect's? The hospitality to psychosis would be an opportunity for a repositioning ethical and politically about how, nowadays, we've conceived our forays into the world of knowledge?