Les facteurs de rémission du trouble de l'adaptation : la parole aux patients. Une étude qualitative

Background. - Adjustment disorder (AD) is a frequent clinical diagnosis defined by the patient's reaction to an external factor and reversibility. While it is known that the prevalence of AD varies depending on setting and diagnostic tools utilized, the literature is rather scarce when it comes to AD's investigation or remission factors. Unlike other psychiatric disorders, the fact that there is a factor triggering AD makes it especially suitable to learn more about triggering elements, reversibility and factors of remission. Objectives. - To study the evolution of AD, to identify and categorize AD remission factors from the patient's perspective. Methods. - We interviewed by means of semi-structured approach patients (n = 11) who consulted the emergency and crisis psychiatric unit of Lausanne University Hospital (CHUV) for an AD and who presented a positive evolution in the following four months. Interviews were transcribed and then analyzed to identify and categorize the remission factors evoked by the patients; categorization was then confirmed by a consensus within the research group. Results. - We identified three main categories of remission factors (aggregated from 11 subcategories and 101 items) based on the interviews: (i) relational factors (5 subcategories, 46 items), (ii) personal factors (5 subcategories, 36 items) and (iii) factors related to life events (3 subcategories, 19 items). No patient explained his remission by factors of one single category. On the contrary, our study reveals that a variety of remission factors exists, with 4 to 14 different factors having been reported to play a crucial role in remission of AD. Conclusions. - Relationships play an important role in remission of AD, but personal and life events also contribute in a complex way. According to the patients, mental health professionals are part of a favorable evolution of AD, especially by means of their containing presence, their neutrality and their invitation to "think with the patient". Our observations call for a therapeutic intervention with a particular focus on the therapeutic relationship - therapeutic alliance - in which the clinician is aware that remission of AD is multifactorial and dynamic. (C) 2018 Elsevier Masson SAS. All rights reserved.