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.
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.