[Acute exacerbations in schizophrenia]

In a context of acute psychotic episodes, the occurrence of acute exacerbations offers an interesting perspective on the long-term progression of schizophrenia, which has for too long been considered as a chronic illness. The most recent clinical and epidemiological data confirm the episodic progression of this illness. These data concerning progression have given rise to a proposed model of vulnerability to psychosis. The appearance of the first signs of such an exacerbation in a hitherto stabilised patient requires the immediate institution of medico-psycho-social management strategies for the treatment of this new episode. It has been amply demonstrated that long-term maintenance therapy considerably reduces the risk of relapse. Using this model, a number of authors have proposed that schizophrenia be considered as the outcome of an interaction between permanent vulnerability of multifactorial origin and stress factors. In this theory, only episodic decompensation, and thus acute exacerbation, is modeled rather than the entire schizophrenic pathology. Patients living in families with low emotional expression exhibit a lower range (13%) of relapse than those living in families that are highly emotionally expressive.