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La pair-aidance repose sur l'apport de personnes ayant expérimenté le rétablissement de troubles psychiques à d'autres personnes qui font face à de tels troubles. L'adhésion renvoie aux facteurs psychosociaux qui interviennent sur l'observance, c'est-à-dire le suivi d'un traitement prescrit, des conseils et des règles hygiénodiététiques. Quel impact l'intervention des pair-aidants a-t-elle sur l'observance médicamenteuse ? Cette étude répond à cette question à travers une description des pratiques professionnelles des pair-aidants dans ce domaine. Une enquête a été diffusée aux personnes exerçant la pair-aidance en santé mentale en France, quels que soient leur mode d'exercice ou leur formation. Elle a porté sur leur pratique en matière de traitements psychopharmacologiques et d'adhésion médicamenteuse, sur leur formation de pair-aidant, leurs conditions d'exercice et leurs missions, ainsi que sur leur vécu personnel en termes de prise de médicaments psychopharmacologiques et d'effets indésirables. Cent quarante-deux sujets ont participé à l'enquête, dont 47,9 % ont suivi une formation dans le passé, 28,2 % en suivent actuellement une et 23,9 % n'en ont pas suivi. Parmi ceux qui ont suivi une formation, 55,9 % ont obtenu le diplôme universitaire de pair-aidance de l'université Lyon 1 et 32,4 % la licence parcours médiateur de santé pair de l'université Paris 13. L'adhésion médicamenteuse a été abordée dans la formation de 36,8 % des participants. Parmi les 142 participants, 54,9 % estimaient avoir des connaissances sur le sujet et 81 % souhaitaient s'y former. Dans leur pratique professionnelle, 69 % des participants considéraient la question du traitement psychopharmacologique ; parmi eux, 48,2 % abordaient celle de l'adhésion médicamenteuse. Aborder les médicaments est lié au statut de la formation, c'est-à-dire que le fait d'avoir bénéficié d'une formation de pair-aidant facilite les échanges en matière d'adhésion médicamenteuse et de connaissances générales portant sur ce domaine. Le métier de pair-aidant se professionnalise depuis peu et les savoirs expérientiels sont maintenant reconnus et valorisés. Les pair-aidants sont envisagés comme des acteurs complémentaires de la prise en charge psychopharmacologique, notamment concernant l'amélioration de l'adhésion au traitement médicamenteux. Il est nécessaire de clarifier leur cadre d'intervention et leurs missions, ainsi que leur formation initiale et continue. Peer support is defined as the contribution of people who have themselves recovered from psychological disorders given to others coping with similar disorders. Adherence refers to the psychosocial factors involved in compliance, i.e., following a prescribed treatment and the associated advice on health and dietary rules. What impact does the intervention of peer helpers have on medication adherence? This study answers this question by describing the professional practices of peer helpers in this field. A survey was sent to people working as peer helpers in mental health in France, regardless of their mode of practice or training. It focused on their practice in terms of psychopharmacological treatments and medication adherence, their training as peer helpers, the conditions of their practice and their missions, as well as their personal experience in terms of taking psychopharmacological medications and any adverse side effects. One hundred and forty-two participants responded to the survey, of whom 47.9% had taken a training course in the past, 28.2% were currently taking one and 23.9% had not. Of those who had received training, 55.9% had obtained a university diploma in peer support from the University of Lyon 1, and 32.4% a bachelor's degree in peer health mediation from the University of Paris 13. Medication adherence was addressed in the training of 36.8% of the participants. Of the 142 participants, 54.9% felt they knew something about the subject, and 81% wanted to learn more. In their professional practice, 69% of the participants considered the question of psychopharmacological treatment; of these, 48.2% addressed the issue of medication adherence. Addressing medication is linked to their training status, i.e., having benefited from peer-helper training facilitates exchanges on medication adherence and general knowledge in this area. The peer-support profession has just recently become professionalized, and experiential knowledge is now recognized and valued. Peer helpers are complementary players in psychopharmacological care, particularly with regard to improving adherence to medication. We need to clarify the scope of their intervention and missions, as well as their initial and ongoing training. [ABSTRACT FROM AUTHOR]

En renforçant le pouvoir de décision et d'action, les outils thérapeutiques de la réhabilitation psychosociale (psychoéducation, remédiation cognitive, thérapie cognitive et entraînement des compétences sociales) sont favorables au rétablissement des personnes ayant des troubles psychiques. La posture soignante adoptée doit être propice à l'autodétermination. Le plan de soin de réhabilitation psychosociale est construit selon les besoins et les objectifs propres à la personne accompagnée. Il s'appuie sur une évaluation multidisciplinaire destinée à mettre en évidence les capacités, les limitations et les éventuels obstacles à la réussite du projet. Afin de pouvoir instaurer une relation thérapeutique positive et de pouvoir recourir à la nécessaire technicité, les professionnels de santé mentale qui mettent en œuvre la réhabilitation psychosociale ont été spécifiquement formés. Ils doivent faire des liens entre le contenu des séances de réhabilitation psychosociale et les situations concrètes auxquelles la personne concernée est confrontée pour que les bénéfices de la prise en charge puissent se transférer dans son quotidien et se généraliser. Psychosocial rehabilitation empowers people to make decisions and take action. This effect favors the self-determination of people with mental disorders and, consequently, their recovery. To do so, it relies on specific therapeutic tools and a specific caregiving posture. Cognitive remediation, psychoeducation, social skills training and/or behavioral and cognitive therapy can be proposed according to the needs and objectives of the person, after a multidisciplinary integrative evaluation that has highlighted his or her capacities, limitations and possible obstacles to the success of his or her own project. Each therapeutic action gives the person new possibilities to overcome these obstacles. The caregivers implementing psychosocial rehabilitation must be committed and trained, which is a guarantee of a positive therapeutic relationship and a necessary technicality. They support the construction of the person's recovery plan, by co-constructing the person's personalized psychosocial rehabilitation project. They establish links between the content of the therapeutic sessions and the person's daily life, in order to promote the generalization and transfer of benefits. [ABSTRACT FROM AUTHOR]

• Dysfunctions of posterior brain regions during cognitive control in schizophrenia. • Impaired connectivity between frontal and posterior regions in schizophrenia. • When processing immediate (present) cues important for the task at hand. Cognitive control, the ability to use goal-directed information to guide behaviour, is impaired in schizophrenia, and mainly related to dysfunctions within the fronto-posterior brain network. However, cognitive control is a broad cognitive function encompassing distinct sub-processes that, until now, studies have failed to separate and relate to specific brain regions. The goal of this preliminary fMRI study is to investigate the functional specialization of posterior brain regions, and their functional interaction with lateral prefrontal cortex (LPFC) regions, in schizophrenia. Fourteen healthy participants and 15 matched schizophrenic patients participated in this fMRI study. We used a task paradigm that differentiates two cognitive control sub-processes according to the temporal framing of information, namely the control of immediate context (present cues) vs. temporal episode (past instructions). We found that areas activated during contextual and episodic controls were in dorsal posterior regions and that activations did not significantly differ between schizophrenic patients and healthy participants. However, while processing contextual signals, patients with schizophrenia failed to show decreased connectivity between caudal LPFC and areas located in ventral posterior regions. The absence of group difference in the functional specialization of posterior regions is difficult to interpret due to our small sample size. One interpretation for our connectivity results is that patients present an inefficient extinction of posterior regions involved in attention shifting by prefrontal areas involved in the top-down control of contextual signals. Further studies with larger sample sizes will be needed to ascertain those observations. [ABSTRACT FROM AUTHOR]

The 22q11.2 deletion syndrome (22q11.2DS) is one of the most common microdeletion syndromes, with a widely underestimated prevalence between 1 per 2000 and 1 per 6000. Since childhood, patients with 22q11.2DS are described as having difficulties to initiate and maintain peer relationships. This lack of social skills has been linked to attention deficits/hyperactivity disorder, anxiety and depression. A high incidence of psychosis and positive symptoms is observed in patients with 22q11.2DS and remains correlated with poor social functioning, anxiety and depressive symptoms. Because 22q11.2DS and schizophrenia share several major clinical features, 22q11.2DS is sometimes considered as a genetic model for schizophrenia. Surprisingly, almost no study suggests the use of cognitive and behavioral therapy (CBT) in this indication. We reviewed what should be learned from schizophrenia to develop specific intervention for 22q11.2DS. In our opinion, the first step of CBT approach in 22q11.2DS with psychotic symptoms is to identify precisely which tools can be used among the already available ones. Cognitive behavioral therapy (CBT) targets integrated disorders, i.e. reasoning biases and behavior disorders. In 22q11.2DS, CBT-targeted behavior disorders may take the form of social avoidance and withdrawal or, in the contrary, a more unusual disinhibition and aggressiveness. In our experience, other negative symptoms observed in 22q11.2DS, such as motivation deficit or anhedonia, may also be reduced by CBT. Controlled trials have been studying the benefits of CBT in schizophrenia and several meta-analyses proved its effectiveness. Therefore, it is legitimate to propose this tool in 22q11.2DS, considering symptoms similarities. Overall, CBT is the most effective psychosocial intervention on psychotic symptoms and remains a relevant complement to pharmacological treatments such as antipsychotics. [ABSTRACT FROM AUTHOR]

Résumé Malgré leur absence de spécificité diagnostique, les troubles cognitifs constituent l’une des caractéristiques centrales des troubles du spectre schizophrénique, du fait de leur fréquence et de leur retentissement. De ce fait, tout patient souffrant de tels troubles devrait pouvoir bénéficier d’une évaluation fonctionnelle pluridisciplinaire comprenant un bilan neuropsychologique. Ce bilan, réalisé en période de stabilité clinique et thérapeutique, permet de décrire le profil cognitif qui est propre à chaque patient et qui peut comprendre des atteintes de la neurocognition (fonctions exécutives, attentionnelles et mnésiques), de la cognition sociale et de la métacognition. Alors que les traitements médicamenteux et psychothérapiques influencent peu les troubles cognitifs primaires, la remédiation cognitive a montré, à travers de nombreux essais contrôlés et plusieurs méta-analyses, son efficacité dans la réduction de ceux-ci, ainsi que de leurs impacts. Différents programmes ciblant certains processus cognitifs spécifiques sont disponibles en langue française. Ces outils de soins non médicamenteux s’appuient sur des tâches rééducatives permettant de renforcer des capacités atteintes ou de compenser leurs altérations par le renforcement des capacités préservées, tout en visant l’impact fonctionnel des déficits cognitifs. La remédiation cognitive vient ainsi compléter l’action des médicaments et de la psychothérapie et apparaît comme un nouvel outil de soin permettant de favoriser le rétablissement des personnes. Cognitive impairments represent a core deficit of schizophrenia spectrum disorders. Cognition is severely impaired in patients with schizophrenia and compromises the recovery process. All patients should have an initial baseline assessment including neuropsychological and medical evaluation. After the initial treatment and stabilization of patients, neuropsychological profile of schizophrenia spectrum disorders regularly shows neurocognitive (attention, memory and cognitive function), social cognitive and metacognitive deficits. While antipsychotic medications and psychotherapy appear to have little effect on primary cognitive impairments, cognitive remediation has shown its effectiveness in reducing the cognitive deficits and their impacts in many controlled trials and meta-analyses. Many programs targeting specific components of cognition are available in French. These non-drug approaches are behavioral training based intervention that aims to improve cognitive processes and functional outcome. Cognitive remediation does not replace medical treatments or certain types of psychotherapy, but complements their effects for promoting people's recovery. [ABSTRACT FROM AUTHOR]

Abstract: In the context of desinstitutionalisation of the psychiatric care system, the question of the possibility and the limits of the reinsertion of people with severe mental disease has risen. If cognitive science actually contributes, in a functional perspective, to a better understanding of crucial aspects of reinsertion by the identification and treatment of cognitive dysfunctions, others factors can also contribute to a better understanding of reinsertion. Among them, several subjective factors can take place. They can be approached under two ways. The first is rehabilitation: through, for example, aspects as metacognition, insight, self-stigma or motivation. The second way is recovery: the recovery approach, by using generally narrative analysis, contributes to identify human processus of recovery and reinsertion, as hope, sense of agency of the own actions and redefinition of identity. [Copyright &y& Elsevier]

Abstract: Lived experiences mentioned by patients with schizophrenia can be addressed with neurocognitive models. In particular, these models allow us to better understand self-consciousness and social cognition impairment that is a core feature of schizophrenia. Abnormal brain functioning related to this impairment has been shown. These data show that these symptoms are related to specific neurocognitive correlates. They shed a new light on the understanding of schizophrenic symptoms. [ABSTRACT FROM AUTHOR]

Abstract: Impairments in facial affect recognition have been well-established in schizophrenia. Programs of cognitive remediation specifically aiming at correcting these deficiencies are being developed. This paper reviews these programs’ results, and presents a critical perspective on the connections between cognitive remediation and social cognition. [Copyright &y& Elsevier]

Abstract: We used facial affect labeling and matching tasks to study effects of (1) emotion and (2) identity on facial affect processing in patients with remitted schizophrenia (n=30) compared with healthy controls (n=30). The patients (1) had a specific deficit for labeling facial affects of sadness and anger but not happiness, disgust and fear; they (2) performed as well as controls in matching facial affects in one face but were impaired in matching facial affects in two different faces. The patients'' impairment in facial affect processing may be emotion-specific. The effects of identity on facial affect processing are discussed in the light of several hypotheses (a deficit of context processing, a global–local processing impairment or a selective attention deficit), and may be related to frontal, prefrontal or amygdala dysfunctions. [Copyright &y& Elsevier]

Patients with first-rank symptoms (FRS) of schizophrenia do not experience all of their actions and personal states as their own. FRS may be associated with an impaired ability to correctly attribute an action to its origin. In the present study, we examined regional cerebral blood flow (rCBF) with positron emission tomography during an action-attribution task in a group of patients with FRS. We used a device previously used with healthy subjects that allows the experimenter to modulate the subject''s degree of movement control (and thus action attribution) of a virtual hand presented on a screen. In healthy subjects, the activity of the right angular gyrus and the insula cortex appeared to be modulated by the subject''s degree of movement control of the virtual hand. In the present study, the schizophrenic patients did not show this pattern. We found an aberrant relationship between the subject''s degree of control of the movements and rCBF in the right angular gyrus and no modulation in the insular cortex. The implications of these results for understanding pathological conditions such as schizophrenia are discussed. [Copyright &y& Elsevier]

Schizophrenia is associated with cognitive deficits and information-processing anomalies. Several studies have shown impairments in frontal lobe functions such as discovering rules, adopting strategies and working memory. We have evaluated the performances of schizophrenic patients on three different tasks of information processing. The first was a simple reaction time task, the second consisted of discriminating the color of the stimuli, and the third required the use of a rule of permutation. The schizophrenic patients (n=17) showed a task-dependent increase in time for responses in comparison with the control group (n=17). This increase was particularly important in the last task, which requires the use of the rule. These results confirm and expand the previously described impairment of patients with schizophrenia in the ability to use rules. They are discussed in terms of deficit in executive functions probably due to frontal lobe malfunctioning. [Copyright &y& Elsevier]

Left temporoparietal repetitive transcranial magnetic stimulation (rTMS) reportedly diminishes verbal hallucinations. A 21-year-old schizophrenic man, who had killed his mother in the belief that she was a demon, failed to respond to combined treatment with a variety of antipsychotic agents. His persistent hallucinations consisted of two voices (God and the Devil). As an adjunct to continued antipsychotic medication, the patient received a course of rTMS: 10 sessions of 1-Hz stimulations near Wernicke''s area. After rTMS, the patient''s hallucinations grew less intrusive and he no longer required isolation. Although the improvement could be a delayed effect of medication, further trials of rTMS in cases of this type appear justified. [Copyright &y& Elsevier]

Résumé Objectifs Les mouvements oculaires sont utilisés à des fins diagnostiques en psychopathologie depuis les années 1980. Ce type d’investigation a montré sa pertinence mais seuls les mouvements de poursuite régulière (i.e. de glissement régulier ou de pistage) ont fait l’objet de procédures expérimentales, que ce soit dans cette discipline, en psychologie cognitive ou encore en ergonomie. Il existe pourtant une deuxième catégorie de mouvements impliqués dans le comportement de changement de direction du regard, les saccades oculaires (passage d’un point de fixation à un autre), qui, elles, n’ont fait l’objet d’aucune investigation scientifique en psychopathologie, à tout le moins en situation d’interaction. Méthode Afin de mesurer la fréquence des saccades oculomotrices dans la dynamique du discours et du dialogue, nous avons mis au point un double système d’enregistrement simultané axé à la fois sur le comportement visio-moteur et sur le comportement verbal. Nous l’avons testé en situation clinique « personne porteuse de schizophrénie–psychologue » comparée à une situation « personne typique–psychologue ». Ces mouvements involontaires de contrôle de l’attention sont eux aussi susceptibles de nous fournir des informations précises en matière de confirmation ou d’anticipation diagnostique mais encore relativement aux stratégies d’adaptation comportementale de l’un et l’autre interlocuteur dans le cours de l’entretien clinique. Résultats Convertis en marqueur d’attention, nos résultats montrent que le nombre de saccades par seconde permet de différencier le comportement interlocutoire des personnes souffrant de schizophrénie à celui des sujets témoins. De même, cet indicateur permet d’apprécier les variations comportementales que l’interlocuteur–psychologue adopte lorsqu’il interagit avec la personne atteinte de schizophrénie ou lorsqu’il interagit avec les sujets témoins. Discussion Tout en étant parfaitement adaptée à la situation clinique, la mesure des saccades oculaires confirme les principaux résultats fournis par les mesures des mouvements oculaires de poursuite linéaire, en particulier au plan diagnostique. Mais le type de mesure que nous avons mis au point permet de plus d’analyser les mouvements comportementaux asymétriques qui opposent le patient à son interlocuteur. Enfin les marqueurs de la variation du comportement attentionnel des interlocuteurs que sont les saccades, pourront être bientôt combinés à l’analyse du déplacement du regard au cours de l’interaction (fixations), puis rapportés à l’analyse des discontinuités discursives et autres spécificités langagières des patients accueillis en psychiatrie. Conclusion Cet article a donc pour principal objectif d’anticiper la mise au point d’une stratégie diagnostique (confirmatoire puis prodromique) et d’analyse clinique nettement plus heuristique que ce dont nous disposons actuellement et qui s’appuiera conjointement sur la modélisation d’attitudes comportementales visuo-motrices associées à la compétence verbale. Aims Eye movements have been used for diagnostic purposes in psychopathology since the 1980s. While this investigation has demonstrated some relevance, only smooth pursuit (regular pursuit or tracking) has been the subject of investigations, whether in this discipline, in cognitive psychology or in ergonomics. Yet there is a second category of movements implicated in charges in eye movement, that is to say saccades (shifting from one fixed point to another), which have not been scientifically investigated in psychopathology, or at least not in situations of interaction. Methods In order to measure the frequency of oculo-motor saccades in the dynamics of discourse and dialogue, we developed a system for simultaneous recording of visual-motor behaviour and verbal behaviour. This was tested in a clinical setting with the dyad “schizophrenic–psychologist”, in comparison with the dyad “typical subject–psychologist”. These involuntary movements in the control of attention are liable to provide precise information to confirm or anticipate diagnosis, and also information on the behavioural adaptation strategies of the different protagonists in the clinical interviews. Results Once converted into attention indicators, our results show that the number of saccades per second enables a differentiation of the conversational interaction behaviour between subjects with schizophrenia and control subjects. Likewise, this indicator enables the assessment of behavioural variations adopted by the psychologist protagonist in the dyad, when interacting with subjects with schizophrenia or with controls. Discussion Not only is measurement of ocular saccades perfectly suited to clinical situations, it also confirms the main results provided by measures of smooth, linear, eye pursuit, in particular in the area of diagnosis. However; this type of measure also enables analysis of the asymmetric behaviours of patient and interviewer. Finally, the indicators for variations in attention provided by saccades could be combined with analysis of shifts in points of fixation, and then related to analyses of discontinuities in discourse and other language features among patients seen in psychiatric care. Conclusion This article thus aims to anticipate the development of a diagnostic strategy (confirmatory and then prodromic) and a considerably more heuristic clinical analysis than what we have available today. It could be based on a combination of a modelling of visual-motor behavioural attitudes and verbal skills and behaviours. [ABSTRACT FROM AUTHOR]

Abstract: Social cognition, which refers to how people think about themselves and others in the social world, is a core component for social, professional and interpersonal functioning and is commonly impaired in schizophrenia. This cognitive domain has strong associations with daily activities and could act as a link between social functioning and neurocognition. Two primary domains of social cognition: theory of mind and emotions perception have been studied for long and many arguments highlighted the direct relationship between impairments of these processes and the alteration of functional outcomes in schizophrenia. During the past 15years, researchers are interested in social cognition and developed, in the field of cognitive remediation, some therapeutic approaches with the aim of reducing difficulties and handicaps. The first programs were supported by the assumption that the improvement of neurocognition was necessary before enhancing social cognition. At the same time, other authors hypothesized that it is possible to improve the performance of people with schizophrenia by directly targeting impaired functions, and so developed specific programs. More recently, researchers intend to develop global programs that take into account all components of social cognition impaired in schizophrenia in order to improve functional outcomes. [Copyright &y& Elsevier]

Abstract: Patients with schizophrenia have pronounced deficits in face recognition memory that severely hamper their social skills. The functional mechanisms of these impairments remain unknown. According to the dual-process theory, recognition memory comprises two distinct components: recollection and familiarity. Studies using the Remember/Know procedure in patients with schizophrenia showed impairments in conscious recollection as measured by remember responses, but not in familiarity as measured by know responses. Unfortunately, none of these studies used face material. We investigated both recognition memory components using words and faces and the ‘Remember/Know’ procedure in 25 patients with schizophrenia and 24 control participants. In the same task, size congruency of stimuli was manipulated between the study and test phases to have a selective impact on know responses for faces. Patients reported fewer remember responses than controls. Size changes between the study and the test affected know responses in controls but not in patients. These results reveal that patients with schizophrenia are impaired in terms of their ability to recollect details about previously seen faces as they are for words. [Copyright &y& Elsevier]

Abstract: The schizophrenia deficit in facial emotion recognition could be accounted for by a deficit in processing the configural information of the face. The present experiment was designed to further test this hypothesis by studying the face-inversion effect in a facial emotion recognition task. The ability of 26 schizophrenic patients and 26 control participants to recognize facial emotions on upright and upside-down faces was assessed. Participants were told to state whether faces expressed one of six possible emotions (happiness, anger, disgust, fear, sadness, neutrality) in two sessions, one with upright faces and the other with upside-down faces. Discriminability and the decision criterion were computed. The results indicated that the schizophrenic patients were impaired in upright facial emotion discrimination by comparison with the controls. They also exhibited an inversion effect similar to the controls. However, whereas controls tended to adopt a more conservative criterion for all emotions and a liberal criterion for neutrality when the faces were upside-down, schizophrenic patients presented a decision criterion pattern that was similar for the two orientations and similar to controls in upside-down emotion recognition. The lack of a decision criterion shift was associated with positive symptoms such as delusions, hallucinations, and bizarre behavior. Moreover, positive and negative symptoms were associated with inversion effect on discriminability; the more severe the symptoms, the weaker the inversion effect. We conclude that individuals with schizophrenia do process the configural information of the face. However, further investigations are needed to assert whether this information is of good quality in schizophrenia. [Copyright &y& Elsevier]

Neuropsychological studies have revealed that schizophrenic (SZ) patients have severe impairments in the cognitive integration of static and moving perceptual stimuli. Research on knowledge structures has shown that sequences of continuous actions are represented in memory as clusters of goal-directed events in a hierarchical manner. In the present study, we investigated the ability to segment familiar sequences of dynamic goal-directed actions into small and large meaningful units in a group of patients with schizophrenia (N=16) and a group of healthy control subjects (N=17). While viewing two videotaped movies, participants were requested to detect the transitions between component events at both low and high levels of the action categorical structure. Both groups detected significantly more events under the small-oriented condition as compared to the large-oriented condition. Differently from normal controls, patients recalled the event scenes in a detailed and fragmentary manner and showed considerable difficulties in detecting large action units. Moreover, low performance on action boundary detection significantly correlated with higher levels of disorganisation symptoms in patients with schizophrenia. A defective conceptual organisation of perceptive action knowledge would help to explain the severe everyday difficulties of these patients both in monitoring their own actions and in understanding others'' intentions. [Copyright &y& Elsevier]

Résumé Les troubles cognitifs, dont ceux qui touchent la cognition sociale, sont présents dès la phase précoce des troubles psychotiques. Avec les troubles de la motivation, de la métacognition et de l’insight, ces facteurs ont été identifiés comme ayant un rôle primordial dans la genèse du handicap psychique. Par ailleurs, les interventions proposées qui répondent aux besoins spécifiques des usagers, indépendamment d’une certitude diagnostique et la prise en compte des difficultés d’insight, ont été identifiées comme des facteurs permettant de réduire la durée de psychose non traitée, favorisant ainsi le pronostic d’évolution des personnes présentant une psychose émergente. Une enquête a été conduite pendant quatre mois auprès de 16 personnes présentant une schizophrénie ou un trouble schizo-affectif ayant bénéficié de l’ERF-CS et auprès des quatre infirmières ayant conduit les entretiens. Elle était destinée à interroger les effets de la conduite d’un entretien évaluant les répercussions fonctionnelles des troubles de la cognition sociale (ERF-CS) sur l’engagement dans les soins des personnes présentant une psychose en stimulant différentes composantes de la motivation pour les soins. Les résultats sont en faveur d’un impact positif de la définition d’objectifs fonctionnels sur la motivation à participer à une remédiation de la cognition sociale et sur l’alliance thérapeutique. Un impact positif sur l’insight et une meilleure compréhension des difficultés éprouvées par les participants dans leurs relations avec autrui ont été rapportés. L’étude pointe aussi les limites de l’ERF-CS : certaines questions sont trop peu claires et une formation préalable est nécessaire. L’ERF-CS peut donc être considéré comme un support favorisant l’engagement dans les soins, y compris en début de maladie. Cette dernière perspective reste toutefois à confirmer par des études menées directement auprès de cette population. Objective Cognitive impairments and particularly social cognitive deficits are present from the early stages of schizophrenia. With other factors such as motivation, metacognitive processes and insight, social cognition appeared as having an essential role in the genesis of psychosocial disability of patients suffering from this disease. Furthermore, it seems that interventions which meet the specific needs of users, despite both the uncertainly of the diagnosis and the lack of insight, have been identified as a determinant factor to reduce the period of untreated psychosis and thus favoring long-term prognosis. The study here aims to observe if the assessment of functional outcomes of social cognitive impairments, thanks to a semi-structured interview (Social Cognition-Functional Outcomes Scale ERF-CS), could favor involvement of people with psychosis in their health care, by encouraging motivation and therapeutic alliance. The ERF-CS is composed of 14 items that depict different social situations in which each component of social cognition is likely to have an impact. The scale provides qualitative information on difficulties lived by patients in social situations in the daily life and an overall score of functional outcomes ranging from 0 to 154. The questionnaire took around one hour to complete. Materials and methods For this purpose, a survey was carried out of 16 people with schizophrenia or schizoaffective disorder and the 4 nurses who have conducted the interviews. Symptomatic activity, level of social autonomy and social cognition performances were controlled. Data have been collected thanks to questionnaires proposed to the patients and the caregivers during the 24 hours following the ERF-CS interview. Questions focused on: (1) interest, advantages and disadvantages felt during the interview, (2) the possibility of identifying concrete goals for cognitive remediation after the interview, (3) the motivation for care, and (4) the therapeutic alliance. Concerning advantages and disadvantages of the interview, a thematic analysis has been conducted on patients and nurses comments. Results Results revealed globally more benefits than inconvenient of the ERF-CS. According to both patients and caregivers, it allows a greater awareness of cognitive or functional impairments. A criticism often been expressed by patients and nurses concerns the complexity of some items of the scale. Moreover, professionals pointed both the necessity of a prior training to the interview, and the importance of having strong skills concerning social cognition. The ERC-CS is perceived by the caregivers and patients has a valuable tool for favoring the identification of concrete goals for the intervention, Even if feedbacks of patient population are here not as positive as those of professionals. Results highlighted for both the patients and the nurses a positive impact of the semi-structured interview on direct and indirect motivation. They seem to be both more implicated in the care proposed after the ERF-CS interview. Moreover, the ERF-CS has been judged positively on therapeutic alliance in both populations surveyed. Conclusions This study encourages the use of the ERF-CS interview prior to starting social cognitive remediation therapy. Actually, the scale promotes motivation of patients and caregivers and helps therapists to define concrete goals, which are crucial to ensure the transfer of skills to daily life. The ERF-CS also constitutes a mediating tool promoting the therapeutic alliance between the patient and his/her therapist. However, these results should be confirmed with larger populations of patients and caregivers, working in different teams. To conclude, while this study did not concern specifically people with early psychosis, the ERF-CS interview seems useful to favor involvement of this population in health care. Further studies should consider this assumption. [ABSTRACT FROM AUTHOR]

The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) has been validated in general population samples in many countries. Interest in using this measure in clinical populations is growing, particularly for tertiary prevention and mental health promotion. This paper reports validation of the French WEMWBS in healthy and chronic remitted schizophrenia populations. The French WEMWBS was administered to 319 workers, 75 students and 121 patients. For non-patients, self-reported Trait- and State-Anxiety, Mindfulness, Positive and Negative Affect and the General Health Questionnaire were completed. For patients, the Positive and Negative Syndrome Scale, Clinical Global Impression Severity Scale, Birchwood Insight Scale, Social Adjustment Scale, and Global Assessment of Functioning scale were completed. Test-retest reliability and responsiveness to intervention was assessed at 6 months. Whatever the sample, response frequencies showed normal distributions, and internal consistency was good (Cronbach's α). Scree plots of eigenvalues suggested a single factor in the samples. The one-dimensional solution yielded suboptimal fit indices. Construct validity was confirmed. Significant improvement in scores was observed before and after intervention. Test-retest variation was non-significant. Impairment of insight and cognition in the assessed patients implies that attention must be paid before applying WEMWBS to all patients. Nevertheless, WEMWBS proved valid and reliable in a further European population, suggesting transcultural validity for both monitoring and evaluation of interventions in healthy as well as chronic remitted schizophrenia populations. [ABSTRACT FROM AUTHOR]

The tendency to over-interpret events of daily life as resulting from voluntary or intentional actions is one of the key aspects of schizophrenia with persecutory delusions. Here, we ask whether this characteristic may emerge from the abnormal activity of a basic cognitive process found in healthy adults and children: the intentionality bias, which refers to the implicit and automatic inclination to interpret human actions as intentional (Rosset, 2008, Cognition 108, 771-780). In our experiment, patients with schizophrenia and healthy controls were shown sentences describing human actions in various linguistic contexts, and were asked to indicate whether the action was intentional or not. The results indicated that people with schizophrenia exhibited a striking bias to over attribute intentionality regardless of linguistic context, contrary to healthy controls who did not exhibit such a general intentionality bias. Moreover, this study provides some insight into the cognitive mechanisms underlying this bias: an inability to inhibit the automatic attribution of intentionality. [ABSTRACT FROM AUTHOR]

Abstract: In psychiatric field, rehabilitation aims at assisting patients suffering from chronic disorders towards a social insertion or employment. It takes into account their desires, subjective factors, environmental factors, cognitive deficits and their preserved abilities, within the framework of the construction of a relevant project. Comprehensive assessment and specific therapeutic tools have been developed. They are proposed according to each patient''s specificities. Rehabilitation leads to the development of social skills, improvement of cognitive functioning, better knowledge about troubles and their treatment, and amelioration of social and professional activities. The frame given by this care leads to a psychic reorganization and permits the construction of a relevant life project. [Copyright &y& Elsevier]

Background: In schizophrenia, disturbances of cognitive control have been associated with impaired functional specialization within the lateral prefrontal cortex (LPFC), but little is known about the functional interactions between specialized LPFC subregions. Here, we addressed this question with a recent model that describes the LPFC functioning as a cascade of control processes along a rostrocaudal axis, whereby anterior frontal regions influence the processing in posterior frontal regions to guide action selection on the basis of the temporal structure of information. Methods: We assessed effective connectivity within the rostrocaudal axis of the LPFC by means of functional magnetic resonance imaging in 15 schizophrenic patients and 14 matched healthy control subjects with structural equation modeling and psychophysiological interactions. Results: In healthy subjects, activity in the left caudal LPFC regions was under the influence of left rostral LPFC regions when controlling information conveyed by past events. By contrast, schizophrenic patients failed to demonstrate significant effective connectivity from rostral to caudal LPFC regions in both hemispheres. Conclusions: The hierarchical control along the rostrocaudal axis of the LPFC is impaired in schizophrenia. This provides the first evidence of a top-down functional disconnection within the LPFC in this disorder. This disruption of top-down connectivity from rostral to caudal LPFC regions observed in patients might affect their ability to select the appropriate sets of stimulus-response associations in the caudal LPFC on the basis of information conveyed by past events. This impaired hierarchical control within the LPFC could result from poorly encoded contextual information due to abnormal computations in the caudal LPFC. [Copyright &y& Elsevier]

Abstract: It has been suggested that thought disorder in schizophrenia is associated with impaired executive functions and with a defective understanding of others’ behaviour. Action sequence knowledge processing and goal detection are considered as crucial components of executive functioning. Here, we used a picture-sequencing task to assess the ability of schizophrenic patients (n =40) with and without disorganisation symptoms to arrange different types of action sequence representations. Disorganisation symptoms appear to be associated with a general sequencing impairment, while patients without disorganisation symptoms displayed difficulties in ordering sequences requiring subjects to infer mental states in story characters along with a relatively preserved performance in correctly arranging mechanical or behavioural event sequences. These results reveal that only schizophrenic patients without disorganisation symptoms show a selective deficit in mentalising abilities whereas disorganisation symptoms are associated with a more severe event sequencing impairment probably reflecting basic failures of inferential reasoning. [Copyright &y& Elsevier]

Abstract: Several studies have shown that schizophrenia is characterized by impaired frontal lobe functions, functions that are responsible, for example, for the management of rules, strategic reasoning, and selective attention. Using event-related potentials (ERP), we assessed the brain''s electrical activity in a group of patients with schizophrenia (n=11) and a healthy control group (n=14) during a reaction time task requiring the use of a rule. ERP waves were compared with those elicited in a similar task based on a direct sensory association. In the control group, ERP analyses showed a negative wave moving from the posterior to the anterior regions of the scalp in a latency range of 250–400 ms. Then, the negativity remained at the frontal scalp region in a latency range of 400–800 ms. In this group, the amplitude was higher during the rule operation than during the sensory association task. In schizophrenic patients, the anteroposterior component of the negative wave was totally absent in both tasks, and we did not find a modulation of the ERP by the task. Frontal scalp negativity was observed, but its latency was longer and its amplitude lower than in the control group. We discuss these findings in terms of the frontoposterior disconnection hypothesis. [Copyright &y& Elsevier]

Abstract: Previous studies showed that schizophrenic patients have a deficit in facial information processing. The purpose of the present study was to test the abilities of patients with schizophrenia and normal controls in emotion and identity matching when these two dimensions were varied orthogonally. Subjects (20 schizophrenic patients and 20 controls) had to report if two faces had the same emotion or belonged to the same person. When the task concerned one type of information (i.e. emotion or identity), the other one was either constant (same person or same emotion) or changed (different person or different emotion). Schizophrenic patients performed worse than controls for both kinds of facial information. Their deficit was more important when the secondary factor was changed. In particular, they performed at chance level when they had to match one emotion expressed by two distinct persons. Finally, correlation analysis indicated that performance/deficit in identity and emotion matching co-varied and that in such tasks performance is negatively correlated with the severity of negative symptoms in patients. Schizophrenic patients present a generalised deficit for accessing facial information. A facial emotion and an identity-processing deficit are related to negative symptoms. Implications for face-recognition models are discussed. [Copyright &y& Elsevier]

Abstract: Psychologists have shown that recall of sentences describing previously performed actions is enhanced compared to recall of heard-only action-phrases (enactment effect). One interpretation of this effect argues that subjects benefit from a multi-modal encoding where movement plays a major role [see Engelkamp, J. (1998). Memory for actions. Hove, UK: Psychology Press, for a review]. In line with this motor account, it is conceivable that the beneficial effect of enactment might rely, at least in part, on procedural learning, thus tapping more directly implicit memory functions. Neuropsychological observations support this hypothesis, as shown by the fact that the enactment effect is quite insensitive to perturbations affecting declarative memories. i.e. Alzheimer disease [Karlsson, T., Bäckman, L., Herlitz, A., Nilsson, L. G., Winblad, B., & Osterlind, P. O. (1989). Memory improvement at different stages of Alzheimer''s disease. Neuropsychologia, 27, 737–742] or Korsakoff syndrome [Mimura, M., Komatsu, S., Kato, M., Yashimasu, H., Wakamatsu, N., & Kashima, H. (1998). Memory for subject performed tasks in patients with Korsakoff syndrome. Cortex, 34, 297–303]. The present study attempts to evaluate whether pure motor activity is sufficient to guarantee the described memory facilitation or alternatively, whether first-person experience in carrying out the action (i.e. true enactment) would be required. To this purpose, in a first experiment on healthy subjects, we tested whether sentence meaning and content of the executed action should match in order to produce facilitation in recall of enacted action-phrases. In a second experiment, we explored whether the enactment effect is present in patients suffering from psychiatric disorders supposed to spare procedural memory but to alter action awareness (e.g. schizophrenia). We show that better recall for action phrases is found only when the motor component is a true enactment of verbal material. Moreover, this effect is nearly lost in schizophrenia. This latter result, on the one hand, queries the automatic/implicit nature of the enactment effect and supports the role of the experience of having performed the action in the first-person. On the other hand, it questions the nature of the memory impairments detected in schizophrenia. [Copyright &y& Elsevier]