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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]

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]

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: 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]

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]

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]

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]