Le Praecox Feeling : présentation historique du concept et aspects épistémologiques

IF 0.5 4区 医学 Q4 PSYCHIATRY Annales medico-psychologiques Pub Date : 2024-05-01 DOI:10.1016/j.amp.2021.10.001
Antoine-Marie Serafino , Tudi Gozé , Clara Hauck , Christophe Gauld , Jean-Arthur Micoulaud-Franchi , Jean Naudin , Michel Cermolacce
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引用次数: 0

Abstract

Objectives

The aim of this review is to explore the multiple aspects of the « Praecox Feeling » as introduced and developed by the Dutch Psychiatrist H.C Rümke in 1941 and re-assessed over the following years by its peers.

Methods

We present a historical review of this subject from the first description to the most recent research and proposed related notions like typification processes and gut feeling.

Results

The Praecox Feeling, as presented by Rümke, may be considered as the most sensible tool in order to diagnose schizophrenia. This phenomenon appears in the in-between of the clinical encounter (i.e. the intersubjective space). It may be felt by the clinician as an experience of bizarreness during the interaction with a patient suffering from schizophrenia. Those feelings suggest fundamental aspects of schizophrenia that can be recognized as a peculiar form of embodiment. Rümke finally concludes that schizophrenia is not diagnosed by strictly examining patients’ symptoms, but psychiatrists’ own feelings. The recognition of such feelings remains hard to describe explicitly, since it takes place in a very basic (« pre reflexive ») state. However, numbers of researchers tried to explore praecox feeling more accurately. A phenomenological approach, with Minkowski, Binswanger or Tellenbach among others, developed several related terms: “Diagnostic by intuition”, “Diagnostic by penetration” or “Atmospheric diagnosis”. Although the precocity of the diagnosis is mentioned in Rümke's original paper, it does not precisely define the Praecox Feeling, contributing to the misunderstanding of the Rümke's original formulation. The very notion of Praecox Feeling in terms of psychiatric diagnoses fell into disuse with the development and the widespread diffusion of criteriological approaches, with the risk of an impoverishment of the clinical diagnosis. However, the study of specific subjective perspectives showed a renewed interest over the last decade, especially with the contribution of cognitive and social neurosciences. Furthermore, studies on psychiatrists’ daily-practice suggest that the Praecox Feeling is still relevant. Moreover, “the subjective tool” represented by the Praecox Feeling remains as used today as it was fifty years ago, in a pre-DSM III era. Temporal aspects have, nevertheless, lead to several studies suggesting that many clinical indices are identified during the first minutes of a clinical interview, especially for schizophrenia. In order to specify this very intuitive pathway, authors developed and worked on the typifications processes that lead to such feelings, involving diagnosis through prototypes. The passive synthesis of such subtle clinical clues may induce for the clinician a “pattern recognition” phenomenon that reminds a “gestaltic” diagnosis. This specific aspect of typification may not be specific of psychiatry. The “Guts Feeling” is a notion first developed by Dutchs physicians, particularly in General medicine but also among other medicals disciplines, theoretically very close from the notion of intuitive typification. It may allow benefits in term of diagnoses, reassurance or alarm sense. It suggests that clinical experience added to criteriology provides risks reductions. The crucial role of clinical experience in the diagnosis decision making tends to be underexplored, but still represents a crucial aspect of the evidence-based medicine as firstly described.

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Praecox Feeling:概念的历史表述和认识论问题
本综述旨在探讨荷兰精神病学家吕姆克(H.C Rümke)于 1941 年提出并发展的 "燎原感觉 "的多个方面,并在随后的几年中由同行对其进行了重新评估。这种现象出现在临床接触的中间地带(即主体间空间)。临床医生在与精神分裂症患者互动的过程中,可能会感受到这种怪异的体验。这些感受暗示了精神分裂症的基本特征,可以被认为是一种特殊的体现形式。吕姆克最后得出结论,精神分裂症的诊断并不是通过严格检查病人的症状,而是精神科医生自己的感受。对这种感觉的认识仍然很难明确描述,因为它是在一种非常基本的("前反射")状态下发生的。然而,许多研究人员试图更准确地探索 "痘感"。闵科夫斯基(Minkowski)、宾斯旺格(Binswanger)或特伦巴赫(Tellenbach)等人的现象学方法提出了几个相关术语:"直觉诊断"、"渗透诊断 "或 "大气诊断"。虽然 Rümke 的原始论文中提到了诊断的早熟性,但它并没有准确定义 "早衰感觉",从而导致了对 Rümke 原始提法的误解。随着标准学方法的发展和广泛传播,精神病诊断中的 "亢奋感 "这一概念本身已被废弃,这有可能导致临床诊断的贫乏。然而,对特定主观视角的研究在过去十年中再次受到关注,尤其是认知科学和社会神经科学的贡献。此外,对精神科医生日常工作的研究表明,"普拉克索感觉 "仍然具有现实意义。此外,以 "悔恨感觉 "为代表的 "主观工具 "在五十年前的前 DSM III 时代仍被广泛使用。然而,时间方面的研究表明,许多临床指标都是在临床访谈的最初几分钟内确定的,尤其是精神分裂症。为了明确这种非常直观的途径,作者们开发并研究了导致这种感觉的分型过程,包括通过原型进行诊断。临床医生被动地综合这些微妙的临床线索,可能会产生一种 "模式识别 "现象,使人联想到 "酝酿式 "诊断。这种类型化的具体表现可能并不是精神病学所特有的。内脏感觉"(Guts Feeling)是荷兰医生首先提出的一个概念,尤其是在普通医学领域,但也包括其他医学学科,理论上与直觉分型的概念非常接近。它可以在诊断、保证或警觉方面带来好处。这表明,在标准学中加入临床经验可以降低风险。临床经验在诊断决策中的关键作用往往未得到充分探讨,但仍代表着循证医学的一个重要方面。
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来源期刊
Annales medico-psychologiques
Annales medico-psychologiques 医学-精神病学
CiteScore
1.30
自引率
33.30%
发文量
196
审稿时长
4-8 weeks
期刊介绍: The Annales Médico-Psychologiques is a peer-reviewed medical journal covering the field of psychiatry. Articles are published in French or in English. The journal was established in 1843 and is published by Elsevier on behalf of the Société Médico-Psychologique. The journal publishes 10 times a year original articles covering biological, genetic, psychological, forensic and cultural issues relevant to the diagnosis and treatment of mental illness, as well as peer reviewed articles that have been presented and discussed during meetings of the Société Médico-Psychologique.To report on the major currents of thought of contemporary psychiatry, and to publish clinical and biological research of international standard, these are the aims of the Annales Médico-Psychologiques.
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