Psychosis in adolescence: A prognosis or a diagnosis? Integrated treatment with psychodynamic peer support

Abstract

Introduction

Our work comprises an integrated intervention strategy for the treatment of psychotic manifestations and functioning in adolescents which, following the theories of Laufer and Chan, questions the usefulness of the diagnosis ‘psychotic’ during adolescence. We apply an “open light treatment” (IPOLT), which includes psychodynamically oriented peer-support.

Objectives

To build a new form of therapeutic alliance with peer-support based on shared real life experiences enabling adolescents to reintegrate within their environment and re-establish cognitive functioning which has become disorganised, aiding a gradual return of the cohesion of ego and self and in some cases, cessation of psychotic symptoms.

Methodology

An observational study of one year on a group of ten adolescents aged 17 to 20 in institutional and private settings with psychotic manifestations and functioning. The group were tested at the start and end of the study using WAIS-IV and MMPI-A.

Results

The adolescents recruited showed a faster recovery of the cohesive processes of their fragmented ego as well as a quicker resumption of social relations. Our model provided an organising function and a flexible yet secure ‘container’ (Bion, 1988) for the young people's psychic structure. The tests showed a demonstrable improvement in their verbal comprehension, visual-spazial reasoning, fluid reasoning, working memory and processing speed.

Conclusions

Psychotic manifestations occurring in adolescence may decrease with an immediate integrated and rehabilitative intervention, without need of an institutional psychiatric setting. In conclusion, we find that “psychosis” in adolescence is a prognosis and not a diagnosis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.