Huguelet, P., Brandt, P.-Y., & Mohr, S. (2016). Encephale, 42(3), 219-225.
[The assessment of spirituality and religiousness in patients with psychosis]
Résumé. Les psychiatres ignorent souvent le rôle que joue la religion dans la vie de leurs patients, particulièrement lorsqu’ils souffrent de psychose chronique. Or, si certains patients présentent des délires à thèmes religieux, ils peuvent dans le même temps avoir des croyances spirituelles et des pratiques religieuses qui jouent un rôle favorable. Nous détaillons dans ce travail les résultats d’une étude prospective randomisée menée à Genève, Suisse, portant sur l’évaluation spirituelle par les psychiatres de centres ambulatoires de psychiatrie publique de leurs patients atteints de schizophrénie. Nous mettons en évidence la bonne tolérance par les patients de cette démarche, avec à son terme plusieurs domaines d’intervention psychiatrique et/ou psychothérapeutiques recommandés. L’investigation de la spiritualité et de la religiosité des patients souffrant de psychose apparaît donc nécessaire ; elle est de surcroît justifiée par l’Association mondiale de psychiatrie qui a souligné l’utilité de considérer les aspects culturels dans lesquels les troubles psychiatriques s’inscrivent. L’évaluation spirituelle est relativement simple à réaliser, à condition de s’abstenir de commenter la pertinence de la croyance du patient et d’éviter de prescrire ou de déconseiller la religion.
Objectives. There is evidence that psychiatrists are rarely aware of how religion may intervene in their patient’s life. That is particularly obvious concerning patients with psychosis. Yet, even for patients featuring delusions with religious content, religious activities and spiritual coping may have a favourable influence. Indeed, patients with psychosis can use religion to cope with life difficulties related to their psychotic condition, in a social perspective but also in order to gain meaning in their lives. Also, religion may be part of explanatory models about their disorder with, in some cases, a significant influence on treatment adhesion.
Patients and methods. This paper describes a prospective randomized study about a spiritual assessment performed by the psychiatrists of patients with schizophrenia. The outpatient clinics in which the sample was collected are affiliated with the department of psychiatry at the university hospitals of Geneva. Eighty-four outpatients with psychosis were randomized into two groups: an experimental group receiving both traditional treatment and spiritual assessment with their psychiatrist and a control group of patients receiving only their usual treatment. Psychiatrists were supervised by a clinician (PH) and a psychologist of religions (PYB) for each patient in the spiritual assessment group. Data were collected from both groups before and after 3 months of clinical follow-up.
Results. Spiritual assessment was well-tolerated by all patients. Moreover, their wish to discuss religious matters with their psychiatrist persisted following the spiritual assessment. Even though clinicians acknowledged the usefulness of the supervision for some patients, especially when religion was of importance for clinical care, they reported being moderately interested in applying spiritual assessments in clinical settings. Compared to the control group, there were no differences observed in the 3 months’ outcome in terms of primary outcome measures for satisfaction with care, yet the attendance at the appointments was significantly increased in the group with spiritual assessment. The same result was found when restricting analyses to patients for whom an intervention was suggested or patients who invested more in religion. Areas of potential intervention were frequent both in a psychiatric and psychotherapeutical perspective.
Conclusions. Spiritual assessment appears to be useful for patients with psychosis. This is in accordance with the recommendations of the World Psychiatric Association which promotes considering the whole person in clinical care. Spiritual assessment is quite simple to perform, providing that clinicians do not prescribe or promote religion, and that no critical comments are made concerning religious issues. Clinicians do not need to know in depth the religious domains of each of their patients, as it appears that each patient accommodates his/her religious background his/her own way.]
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