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"Psychiatric rehabilitation In schizophrenia Psychiatric rehabilitation is based, on the one hand, on a conception of care oriented towards the search for recovery and, on the other hand, on specific evaluation and therapeutic tools (cognitive remediation, psychoeducation and social skills training in particular) designed to highlight and strengthen the decision-making and action capacities of people with schizophrenia or, more generally, a serious mental illness. The implementation of psychiatric rehabilitation includes 5 steps: commitment to care, which makes it possible to establish a positive therapeutic relationship and assess availability for rehabilitation; multidisciplinary evaluation, which highlights the capacities and limitations, as well as the objectives and needs of the person; co-construction of the psychiatric rehabilitation and recovery project; psychiatric rehabilitation care (including: psychoeducation, cognitive remediation and social skills training); generalization and transfer based on the implementation of the benefits of the treatment sessions in the person's life context. Overall, psychiatric rehabilitation takes into account the needs and demands of people and promotes the success of their own projects.", Competing Interests: L’auteur déclare n’avoir aucun lien d’intérêts.

Context: cognitive remediation involves either intensive training of impaired functions or implementing strategies to compensate for these impairments. In cases of schizophrenia, both methods have demonstrated benefits in terms of behavior and cerebral activity. However, despite the major differences between these two approaches, their impact has not yet been compared., Method: We searched the PsychInfo, Pubmed, and ScienceDirect databases using the key words "cognitive remediation," "schizophrenia," "cerebral activity," and "magnetic resonance imaging," in order to select studies investigating the effects of cognitive remediation on patients with schizophrenia. The studies selected had to present their approach in detail and measure its impact in terms of both cerebral activity and cognitive function, both before and after therapy. We divided the studies into two groups, those using the strategy method and those using the training method., Results: Eight studies were included in the review, four for the strategy method (88 patients, 44 of whom underwent remediation) and 4 for the training method (87 patients, 43 of whom underwent remediation). The analysis of the results of this study indicates that the training method is capable of activating more the targeted brain areas than the strategy method. However, the latter appears to encourage more extensive activation of the cerebral networks., Discussion: The studies used for this review vary widely in terms of the imaging methods and protocol. However, differences were found between the two methods and lead us to suggest that further studies, with proper bias control, should be conducted to systematically compare the two approaches.

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]

The different dimensions of recovery (clinical, social, functional) allows us to better understand its definitions and thus to identify obstacles or, conversely, determinants of the recovery process. The study of recovery factors leads to consider several principles that can guide the practices of health professionals: self-determination is the common thread. Practices known as "psychosocial rehabilitation" seem able to support the recovery process, in particular by their willingness and ability to restore, at least in part, the power to act and to choose of the user suffering from severe psychic disorders. Cognitive remediation, a tool that comes from the field of psychosocial rehabilitation, appears to support the recovery of people with cognitive deficits with significant functional impacts. But beyond the creation of innovative practices, it is a territorial organization of these care practices that we need if we are actually aiming at the development of recovery. It is in particular the goal of the Resource Center for Psychosocial Rehabilitation (CRR) to disseminate, train and structure practices and knowledge oriented towards the recovery of the person. [ABSTRACT FROM AUTHOR]

Only one out of seven patients recovers after a first episode of psychosis despite psychiatric care. Rehabilitation interventions have been developed to improve functional outcomes and to promote recovery. We conducted a systematic review of the effectiveness of the main psychiatric rehabilitation interventions following a search of the electronic databases Pubmed, ScienceDirect, and Google Scholar using combinations of terms relating to cognitive remediation, psychoeducation, cognitive-behavioral therapies, and schizophrenia. Eighty articles relevant to the topic of interest were found. According to results, cognitive remediation has been found to be effective in reducing the impact of cognitive impairment, social skills in the learning a variety of skills and to a lesser extent in reducing negative symptoms, psychoeducation in improving compliance and reducing relapses, and cognitive therapy in reducing the intensity of or distress related to positive symptoms. All psychosocial rehabilitation interventions should be considered as evidence-based practices for schizophrenia and need to become a major part of the standard treatment of the disease. [ABSTRACT FROM AUTHOR]

Cognitive impairments associated with schizophrenia are very frequent. They concern both neurocognition and social cognition, including facial emotion recognition. These impairments have a negative impact on the daily functioning, in particular the social and vocational rehabilitation of people with schizophrenia. Previous studies in this area clearly demonstrated the interest of cognitive remediation to improve neurocognitive and social cognitive functioning in schizophrenia. They also established clear links between facial emotion recognition skills and attentional processes. The present study compares the GAÏA s-face program (GAÏA arm), which focuses on facial emotion recognition processes, with the RECOS program (RECOS arm), a neurocognitive remediation therapy focusing on selective attention. Forty people with schizophrenia were randomly distributed between each study arm and assessed pre- (T1) and post- (T2) therapy. The single-blind assessment focused on facial emotion recognition (the main criteria), symptoms, social and subjective functioning, and neurocognitive and social cognitive performance. Both programs were conducted by nurses after a 3-day training session. The study showed a significant improvement in facial emotion recognition performance in both groups, with a significantly larger effect in the GAÏA arm. Symptoms and social functioning also improved in the GAÏA arm, and certain neurocognitive and social cognitive processes improved in both study arms. Further studies are recommended, with larger population samples and a follow-up assessing the long-term preservation of these improvements. [ABSTRACT FROM AUTHOR]

Difficulties in social interactions are a central characteristic of people with schizophrenia, and can be partly explained by impairments of social cognitive processes. New strategies of cognitive remediation have been recently developed to target these deficits. The RC2S therapy is an individualized and partly computerized program through which patients practice social interactions and develop social cognitive abilities with simulation techniques in a realistic environment. Here, we present the results of two case-studies involving two patients with schizophrenia presenting with specific profiles of impaired social cognition. Each patient completed three baseline sessions, 14 treatment sessions, and 3 follow-up sessions at the end of the therapy - and for 1 patient, another 3 sessions 9 months later. We used a multiple baseline design to assess specific components of social cognition according to the patients' profiles. Functioning and symptomatology were also assessed at the end of the treatment and 6 months later. Results highlight significant improvements in the targeted social cognitive processes and positive changes in functioning in the long term. The RC2S program seems, thus, to be a new useful program for social cognitive remediation in schizophrenia. [ABSTRACT FROM AUTHOR]

Attentional, visuospatial, and social cognition deficits have a negative impact on children's adaptative and social competences and, as a result, on their ability to achieve a normal functioning and behavior. Until now and despite the frequency of those deficits, there is a lack of children's specific cognitive remediation tools specifically dedicated to attentional and visuospatial areas. The «Cognitus & Moi» program involves a variety of exercises in a paper and/or pencil (n = 30) or a computerized format (n = 29) and a strategy coaching approach. Each module of «Cognitus & Moi» targets a single impaired cognitive area, within the limits of cognitive domains' overlapping. The little cartoon character named Cognitus, who illustrates the program, is supposed to be very friendly and kind toward children. Cognitus will accompany them throughout the program for an effective and positive reinforcement. The main goal of «Cognitus & Moi» is to adjust to children's difficulties in daily life. Moreover, since the cognitive remediation benefit is complex to apply in daily life, the program is based on a metacognitive strategy. After a complete neuropsychological assessment and a psychoeducational session (with the child and the parents), 16 1-h-sessions of cognitive remediation with the therapist are proposed. Each session is composed of three parts: (1) computerized tasks focusing on specific attentional or visuospatial components (20 min). The attentional module targets hearing, visual, and divided attention. A double attention task is also proposed. The visuospatial module targets eye tracking and gaze direction, spatial orientation, visuospatial memory and construction, and mental imagery; (2) pen and paper tasks focusing on the same processes (20 min) and a facial emotion recognition task; (3) a proposal of a home-based task (during 20 min). Weekly, specific attentional and visuospatial home tasks are proposed to the child and analyzed with the parents and the therapist. Indeed, home exercises are useful to promote the transfer of strategies to daily life and their subsequent automation. The heterogeneity of cognitive deficits in intellectual deficiency necessitates an individualized cognitive remediation therapy. In this regard, «Cognitus & Moi» seems to be a promising tool. [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]

In people with psychiatric disorders, particularly those suffering from schizophrenia and related illnesses, pronounced difficulties in social interactions are a key manifestation. These difficulties can be partly explained by impairments in social cognition, defined as the ability to understand oneself and others in the social world, which includes abilities such as emotion recognition, theory of mind (ToM), attributional style, and social perception and knowledge. The impact of several kinds of interventions on social cognition has been studied recently. The best outcomes in the area of social cognition in schizophrenia are those obtained by way of cognitive remediation programs. New strategies and programs in this line are currently being developed, such as RC2S (cognitive remediation of social cognition) in Lyon, France. Considering that the social cognitive deficits experienced by patients with schizophrenia are very diverse, and that the main objective of social cognitive remediation programs is to improve patients' functioning in their daily social life, RC2S was developed as an individualized and flexible program that allows patients to practice social interaction in a realistic environment through the use of virtual reality techniques. In the RC2S program, the patient's goal is to assist a character named Tom in various social situations. The underlying idea for the patient is to acquire cognitive strategies for analyzing social context and emotional information in order to understand other characters' mental states and to help Tom manage his social interactions. In this paper, we begin by presenting some data regarding the social cognitive impairments found in schizophrenia and related disorders, and we describe how these deficits are targeted by social cognitive remediation. Then we present the RC2S program and discuss the advantages of computer-based simulation to improve social cognition and social functioning in people with psychiatric disorders. [ABSTRACT FROM AUTHOR]

Abstract: Background: This study assesses the benefits of an individualized therapy (RECOS program) compared with the more general cognitive remediation therapy (CRT). Methods: 138 participants took part with 65 randomized to CRT and 73 to RECOS. In the RECOS group, participants were directed towards one of five training modules (verbal memory, visuo-spatial memory and attention, working memory, selective attention or reasoning) corresponding to their key cognitive concern whereas the CRT group received a standard program. The main outcome was the total score on BADS (Behavioural Assessment of Dysexecutive Syndrome) and the secondary outcomes were: cognition (executive functions; selective attention; visuospatial memory and attention; verbal memory; working memory) and clinical measures (symptoms; insight; neurocognitive complaints; self-esteem). All outcomes were assessed at baseline (T1), week 12 (posttherapy, T2), and follow-up (week 36, i.e., 6months posttherapy, T3). Results: No difference was shown for the main outcome. A significant improvement was found for BADS' profile score for RECOS at T2 and T3, and for CRT at T3. Change in BADS in the RECOS and CRT arms were not significantly different between T1 and T2 (+0.86, p=0.108), or between T1 and T3 (+0.36, p=0.540). Significant improvements were found in several secondary outcomes including cognition (executive functions, selective attention, verbal memory, and visuospatial abilities) and clinician measures (symptoms and awareness to be hampered by cognitive deficits in everyday) in both treatment arms following treatment. Self-esteem improved only in RECOS arm at T3, and working memory improved only in CRT arm at T2 and T3, but there were no differences in changes between arms. Conclusions: RECOS (specific remediation) and CRT (general remediation) globally showed similar efficacy in the present trial. [Copyright &y& Elsevier]

Mobus is a cognitive orthotic designed for people with difficulties managing Activities of Daily Living (ADL), as encountered in schizophrenia. It provides a schedule manager as well as the possibility to report occurrences of symptomatic experiences. Receiving this information by Internet, caregivers can assist the patient rehabilitation process. Our aim was to explore the use and satisfaction of Mobus by people with schizophrenia. Nine outpatients tested Mobus for 6 weeks. Indicators of cognitive functioning and autonomy were measured with the CAmbridge Neuropsychological Tests Automated Battery (CANTAB) and the Independant Living Skills Scale (ILSS). On average, 42.6% of the planned ADL were validated and more than 1 symptom per week were reported. Mainly because of technical breakdown, more than 50% of the outpatients evaluated the Mobus satisfaction below 1.7/5, nevertheless 3 participants appreciated it greatly. Some enhancements were found on subscales of CANTAB and ILSS and some participants reported that they acquired planning skills by using Mobus. To ensure ease of use, refinements are needed from rehabilitation and technical approaches, especially to personalize the device. Discussions on ethical and methodological issues lead to an improved version of Mobus that will be tested with a larger sample size. [ABSTRACT FROM PUBLISHER]

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]

Therapeutic alliance determines medical treatment adherence, the success of psychotherapy, and the effectiveness of care. This systematic review aims at better understanding its determinants. The electronic databases Pubmed, Cochrane Library, and Web of Science were searched, using combinations of terms relating to psychosis and therapeutic alliance. Studies were selected and data were extracted using a PRISMA statement. Forty-one studies were selected, including 20 cross-sectional studies, 10 cohort studies, five randomized controlled trials, four literature reviews, and two retrospective studies. The quality of therapeutic alliance correlates with clinical symptoms, insight, social and family support, the therapist's qualities, the availability of shared therapeutic decision making, and the types of hospitalization. Although current evidence needs to be completed with further studies, it is already clear that group and family psychoeducation, cognitive remediation, community-based psychiatric services, and shared therapeutic decision making are essential approaches in the management of patients with psychosis. [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: 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]