Perception et vécu de la maladie somatique selon les formes cliniques de schizophrénie

RésuméLes nombreuses études sur la santé somatique des patients schizophrènes soulignent un enjeu de santé publique. Elles signalent une surmortalité et de nombreuses comorbidités somatiques par rapport à la population générale. De plus, leur prise en charge somatique par le système médical demeure problématique. Dans notre recherche, nous avons étudié l’influence de la schizophrénie sur la prise en charge par le patient des maladies somatiques. Notre étude cherche à montrer l’existence d’une différence de perception de la maladie somatique selon le type de symptomatologie schizophrénique, positive ou négative. Cela nous amène à l’idée que le lien entre psyché et soma a des répercussions importantes sur la représentation et la perception de la maladie somatique chez les patients schizophrènes et donc indirectement sur la prise en charge somatique de ces patients. Dans la pratique, l’importance de ce lien amène à une réflexion sur une prise en charge globale du patient et sur la place que pourrait y occuper le psychologue.

Studies about schizophrenic somatic health are numerous and tend to demonstrate that it is a current issue at stake in current public health. Unlike common population, various comorbidity and excess death rate characterized schizophrenic patients. Moreover, their somatic care seems not concerned by health system. We wonder if this problem of somatic health of schizophrenic patients is due to their psychiatric condition or the care system that seems divided between support for somatic and psychiatric. The aim of our work is the study of psychic mechanisms and psychopathological factors underlying the difficulties of management of somatic comorbidity in schizophrenia patients. In order to study the care of schizophrenic patients, we conducted ten semi-directive interviews with volunteer schizophrenic in-patients. Based on preliminary discussions, we realized that according to the clinical form of schizophrenia, positive or negative, the concept of physical illness and his conscience seemed different. So we decided to divide the patients in two groups. The first group includes the patients with positive symptomatology such as non-systematized delirious ideas and unmotivated laughter. The second group includes patients with negative symptomatology such as autism and emotional disorders. We focused on insight or the consciousness of somatic disease and its care by the health system. Regarding positive symptomatology patients, we noted the assignment of a cause outside their physical illness and an altered consciousness of the somatic disease. This alteration of insight is the result of some features of schizophrenia, particularly dissociation and its effects on thoughts and emotions as well as paranoid delusions and its impact on the perception of reality. In addition, physical illness can be integrated into delirium by interpretative mechanisms or coenesthetic hallucinatory mechanisms. This results in a delusional interpretation of somatic symptoms, a perception of coenesthetic hallucinations as somatic symptoms and a denial of physical illness. Therefore, these patients adopt a passive behaviour that prevents them from an adapted care, active attitudes not adapted to the disease and eventually; they are poorly attended concerning somatologic aspect. They are often afraid to confront the disease and have a negative representation, sometimes delirious, of medical care. Naturally, they have difficulty accepting to receive such medical care, even when they are needed. Very few have a regular medical follow-up. On the other hand, negative symptomatology patients have predominantly a preserved insight and easily cared for somatic disease. The preservation of this ability allows some insight into the cause of the patients of their disease. However, some show a lived without affect of physical illness that can be understood in the context of an emotional detachment as a result of dissociation. The preservation of insight also facilitates the administration of medical care and accepts medical follow more easily. Our study intends to demonstrate the various perceptions of somatic diseases according to the symptomatology of patient. This study leads us to the idea that the link between psyche and soma has repercussions on the representation and the perception of the somatic disease for schizophrenic patient. In practical, the importance of the link between body and psychism asks the question of the way of taking care of patient at all levels including the somatic one.