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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]

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]

Cognitive sciences research on Schizophrenia has led to the identification of information processing disturbances in Schizophrenia. These cognitive impairments (affecting attention, memory, executive control and social cognition) contribute to the functional outcome and constitute an important factor of social exclusion. They are the specific target of "cognitive remediation", a newly developed therapeutic tool whose rationale is to rehabilitate disturbed cognitive processes and foster preserved processing. Cognitive remediation completes psychotherapy or medication and constitutes an important aspect of rehabilitation programs (alongside with psychoeducation and social skill training). Four programs, each one with specific indications, are currently available (CRT, IPT, RECOS and RehaCom). Further perspectives encompass the development of specific tools (addressing social cognition impairments) and the role of subjective factors (motivation, metacognition…) in determining the outcome of cognitive rehabilitation programs. [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: 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]