Psychoses à l'adolescence

Psychosis is a major concern for adolescent psychiatrists who have great difficulties in establishing a diagnosis in case of acute or torpid symptomatology; at this age, such symptoms have no systematic correlations with a specific mental disorder. Adolescence is indeed a developmental phase when psychotic symptoms are relatively frequent because they express in a polymorphic way a psychic suffering due to adolescence process. As the time of many deep internal and external changes, adolescence is also the age of onset of most chronic mental disorders. As they begin, most of these disorders do not take the typical recognizable form they will have later on, making at that time the diagnosis easier. In case of psychotic symptoms in an adolescent, the clinician has to go beyond descriptive symptom to find out the underlying psychopathological organisation that may be more informative in terms of diagnosis and prognosis. Managing adolescence psychosis imposes then to accept the uncertainty of the disorder prognosis and to assess the value of the premorbid symptoms that emerge at this age: vulnerability factors or prodromal manifestations, distinction that is still in debate, with many important consequences on preventive and therapeutic strategies.