Fonctionnement social et rétablissement à la suite d'un premier épisode psychotique

Currently, the idea that several individuals experiencing psychosis can show evidence of recovery over time is gaining in popularity. Although recovery is viewed as the disappearance of symptoms in the medical field, consumers of mental health services see it more as process in which the complete absence of symptoms is not a sine qua non. Nevertheless, the current treatment for psychosis is aimed at regaining a satisfactory level of social functioning.  In individuals experiencing a first psychotic episode, a noticeable decrease in symptoms is rarely associated with a significant improvement in functioning. Therefore, psychosocial interventions are necessary to assist in recovery. The literature has identified a number of variables associated with social functioning in this population, but to date, there are no studies investigating this aspect in details. Furthermore, very little is known about how these youth experience the process of recovery.  This thesis dissertation will therefore address recovery and social functioning in young people experiencing a first episode of psychosis. A first section will serve as an introduction to the concepts of recovery and rehabilitation and a review of the literature on psychosocial interventions promoting recovery and functioning. Specifically, we will illustrate how these interventions can apply to adolescents, a population for which very few studies have been published.   A second section will present the results of a study on the predictive value of variables on three domains of social functioning in 88 young adults in early psychosis. Multiple regression analyses showed that a more severe depression was associated with a less active social life; that a poorer short term verbal learning ability was associated with poorer vocational functioning; and that men showed poorer independent living skills. Furthermore, more severe negative symptoms were associated with poorer performances in all three spheres of social functioning.  Finally, the third section will address the recovery process in early psychosis through the analysis of narratives using a five stage recovery model. We determined that overall, our sample of 47 individuals were classified within the first two stages of recovery at baseline and that those classified in the second stage showed better social engagement and vocational functioning scores, a better narrative development, less severe positive and negative symptoms, and had attained a higher educational level. Furthermore, the analysis of the stages of recovery across two others time points show that these profiles are relatively stable over a 9 month period.   In conclusion, these results show that it is necessary to evaluate social functioning in a more detailed manner, and reaffirms the importance of making psychosocial interventions available to service users experiencing early psychosis. It highlights, in particular, the need for services aimed towards the development of social relationships and educational/vocational integration, or interventions addressing deficits in narrative development. Moreover, this thesis dissertation is a first step towards the study of the recovery process of young adults experiencing psychosis.

Keyphrases: adolescents, first episode psychosis, social functioning, recovery, psychosocial interventions, adolescents, narrative development, negative symptoms