Anticipating the unknown: A mixed method study assessing French psychiatrists opinions towards prognosis in adolescent and young adult psychiatry

Abstract

The early treatment of psychiatric disorders has become a central goal of mental health policies worldwide. Yet little is known about the attitudes of psychiatrists regarding prognosis in their daily work. When treating young patients with acute psychotic symptoms, how do psychiatrists manage diagnostic uncertainty? Do they anticipate the risk of schizophrenia or avoid making prognostications? To what extent do they communicate their expectations to patients and their families?

Methods

This is a mixed method study. Firstly, a series of in depth interviews addressed French youth psychiatrists’ opinions towards prognosis. Participants worked in a variety of settings, public institutions, private practice, and student help. Secondly, an online survey investigated French psychiatrists’ opinion toward prognosis. The survey consisted of the presentation of a clinical vignette in which a psychiatrist communicates on prognosis to a young patient with acute psychotic symptoms. The vignette was randomly shown in four versions with different predictions and outcomes. Respondents were then asked questions regarding prognosis communication.

Results

Qualitative analysis stresses psychiatrists’ uncertainty in their daily work with teenagers presenting unclear symptoms that might be the sign of a beginning psychotic process or might as well reflect adolescent unease. Psychiatrists are reluctant to commit into prognosticating or using standardized tools. The contradiction between the expectations that psychiatrists be able to predict what will happen to a young patient and their impossibility to do so, raises an ambivalence that is only managed through a deep emotional involvement. The survey received more than 400 answers, and statistical analysis is in progress.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.