[Crisis intervention: assessment process and long-term follow-up of patients]

The aim of this work, which was performed in a Crisis Centre in Geneva, Switzerland, was to study the relationship between a patient's long-term follow-up and the range of the patient's difficulties as assessed during screening by a clinician. Out of the 78 patients who were referred to the Centre during a two-month period in 1985, 31 were followed-up during a complete crisis intervention program. All these patients with severe symptoms would have been hospitalized if they had not been transferred to this program. The clinician's opinion of these patients' difficulties was obtained by using a questionnaire containing open-response questions. The data obtained was then subjected to specific content analysis. The patients' clinical state, diagnosis and changes during therapy were also assessed, using various questionnaires. Our results show that there is a negative correlation between the number or range of difficulties attributed and noted by the clinician and the long-term evolution of the patient, especially after two years. This relationship is dependent on the number, not the type of difficulties noted. Thus, although it is not possible to generalize these results, we have shown that it is possible to study parameters involved in the process of a psychotherapeutic-type treatment, using a questionnaire. We have also shown that crisis intervention can be considered as an especially interesting analogue of the early steps of psychotherapy, spread over a longer period. This is an aspect which is rarely studied.

[Various aspects of cognitive activities of schizophrenics. III. Maladjustment assimilation/accommodation and generalization of reasoning]

Paranoid schizophrenics are unable to balance affirmation and negation. Using the terms of Jean Piaget, they therefore only partially achieve the "équilibrations majorantes" of level II and never those of level III. In their thinking, they have access to the "généralisations inductives" (often excessive ones), but rarely to the "généralisations constructives complétives". They do not have access to the "généralisations synthétisantes" or to the feeling that logic is necessary. They oscillate between the positivist need to measure or verify and absolute beliefs issued from magical thinking.

[The speech of hebephrenic patients (maladjustment between assimilation and accommodation)]

Previous studies indicate that schizophrenic thought processes show a disturbance in the balance between assimilation and accommodation, as Piaget uses these terms. The authors postulated that this phenomenon could also account for the typical language disorders of hebephrenics, particularly semantic slippage. Every fourth word was deleted from linguistic material produced by eight controls and thirteen hebephrenics (Silverman). Three judges were then asked to fill in the blanks. The deleted words used by the subjects were compared with the replacement words chosen by the judges. The comparison revealed such disorders in hebephrenic speech as semantic alteration (metaphorical and metonymic) of the linguistic tropic type and syntax disorders including inhibition of the expansion of phrases introduced by functional monemes (morphemes), whether primary or secondary. These observations confirm those of other authors, more especially those of Roch Lecours et al. On the basis of Martinet's functional linguistics, Chomsky's generative grammar and Piaget's cognitive psychology, the authors conclude that the psychopathology underlying hebephrenic speech is a disturbance of language rather than of parole and that hebephrenic syntactical distortions are linked to the disturbance in the balance between assimilation and accommodation characteristic of schizophrenic thought processes.