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International audience; Background: Prior research on informal caregivers of people with schizophrenia (PWS) has primarily focused on parental caregivers. However, siblings also play an important role in the recovery process of PWS. Aims: The aim of this study is to compare the coping profiles of family caregivers according to whether they are siblings or parents of the PWS. Method: Parent and sibling caregivers (N ¼ 181) completed the Family Coping Questionnaire (FCQ), which assessed their coping strategies. Results: The results reveal that parents and siblings do not use the same coping strategies and styles. Three coping profiles were identified depending on the caregiver's relationship with the PWS. Most parents displayed an undifferentiated profile (96.7%), while siblings were more heterogeneously distributed among the undifferentiated profile (58.3%), problem-focused profile (37.5%), and emotion and social support-focused profile (4.2%). Conclusions: These findings suggest that the coping capacities of family caregivers to deal with the illness of their sibling or child with schizophrenia are diverse and that it is important to differentiate among them. This would enable these caregivers to benefit from support that could be tailored to their specific needs.

The Covid-19 health crisis has disrupted the organization and functioning of European mental health and psychiatric services, impacting the working conditions - already difficult before the epidemic - of professionals working therein. The Psy-GIPO2C project investigated the impact of the pandemic on these professionals. The Psy-GIPOC2C project has been co-funded by theThis research took the form of a collaborative mixed methods study. The data collected through qualitative and quantitative research were analyzed during a working session held by the research consortium, which resulted in the formulation of recommendations for action to optimize the occupational health of European mental health professionals.This research made it possible to identify and explain the extent to which, and the ways in which, the reorganization of European mental health services has impacted the mental health of the professionals working therein, and, in particular, to highlight the fact that the unprecedented use of digital devices has generated stress, and even tension, within these services.It is important to promote well-being at work among European mental health professionals, by involving them in the development of

Purpose: The current COVID-19 pandemic confronts psychiatric patients and mental health services with unique and severe challenges. Methods: In order to identify these trans-national challenges across Europe, an ad-hoc survey was conducted among 23 experts, each answering for one European or aligned country. Results: A number of important themes and issues were raised for the impact of COVID-19 on mental health and mental health services, barriers to service provision and future consequences. A number of key issues were reported by colleagues across several jurisdictions, even though these were at different stages of their national epidemics. Conclusions: Based on these findings, we articulate some important learnings from the early stages of the COVID-19 European pandemic, and highlight key considerations for all countries’ mental health services as the current pandemic develops and for future pandemics. Jo Joosten, Ingegerd Karlsson, Gabriela Kelemen, Maria Korman, Krzysztof Krysta, Boleslav Lichterman, Konstantin Loganovsky, Donatella Marazziti, Margarita Maraitou, Serge Mertens deWilmars, Merja Reunamen, Shyhrete Rexhaj, Muhammet Sancaktar, Javier Sempere, Isabelle Tournier, Emilie Weynant, Christiaan Vis, Marie-Clotilde Lebas & Laurence Fond-Harmant

IntroductionInformal caregivers play a major role in the support and maintenance of community patients with severe psychiatric disorders. A pilot study showed that an individualised brief intervention such as the Ensemble programme leads to significant improvements in psychological health state and optimism.Methods and analysisThis randomised controlled trial aims to compare the efficacy of using Ensemble in improving informal caregivers’ psychological health states and the ability to play an active role in their situations with that of support as usual. Improvements on the psychological health global index will be measured three times (T0-pre, T1-post and T3 2 months follow) with standardised questionnaires (the Global Severity Index of Brief Inventory Symptoms, the Life Orientation Test-Revised, the 36-item Medical Outcome Study Short-Form Health Survey and the French Zarit Burden Interview). Differences between groups in post-test and pretest values will be examined using an analysis of covariance for each outcome variable. The severity of illness measured by the Social and Occupational Functioning Assessment Scale will also be collected at T0 and T2 to compare eventual patient improvements. At the end of the programme, the experiences of the 20 patients participating in the Ensemble programme will be evaluated qualitatively.Ethics and disseminationThe research protocol received full authorisation from the Human Research Ethics Committee of the Vaud state, Switzerland. The principal paper will concern the results of the experimental design used to test the Ensemble programme. The research team will prioritise open access publications.Trial registration numberNCT04020497

Background: Negative symptoms are frequent in patients with schizophrenia and are associated with marked impairments in social functioning. The efficacy of drug-based treatments and psychological interventions on primary negative symptoms remains limited. The Positive Emotions Programme for Schizophrenia (PEPS) is designed to improve pleasure and motivation in schizophrenia patients by targeting emotion regulation and cognitive skills relevant to apathy and anhedonia. The main hypothesis of this study is that patients who attend 8 one-hour sessions of PEPS and treatment as usual (TAU) will have lower total apathy-avolition and anhedonia-asociality composite scores on the Scale for the Assessment of Negative Symptoms (SANS) than patients who attend only TAU. Methods: Eighty participants diagnosed with schizophrenia or schizoaffective disorder were randomized to receive either TAU or PEPS + TAU. The participants were assessed by independent evaluators before randomization (T0), in a post-test after 8 weeks of treatment (T1) and at a 6-month follow-up (T2). Results: The post-test results and 6-month follow-up assessments according to an intention-to-treat analysis showed that the apathy and anhedonia composite scores on the SANS indicated statistically greater clinical improvements in PEPS participants than in non-PEPS participants. In the post-test, anhedonia but not apathy was significantly improved, thus favouring the PEPS condition. These results were sustained at the 6-month follow-up. Conclusions: PEPS is an effective intervention to reduce anhedonia in schizophrenia. PEPS is a short, easy-to-use, group-based, freely available intervention that is easy to implement in a variety of environments (ClinicalTrials.gov ID: NCT02593058).

Resume Objectifs Les proches aidants de personnes atteintes de troubles psychiques peuvent presenter un faible niveau de sante, une baisse de qualite de vie et des emotions douloureuses. Or, dans la litterature, un manque de soutien professionnel specifique centre sur les besoins individuels des proches aidants est identifie. Cette etude descriptive presente une approche permettant de cibler le soutien professionnel. Participants et Methode Le cadre methodologique la « Mapping Intervention Design » a permis de developper l’approche a utiliser. Ainsi, 21 proches aidants ont participe a la faisabilite et a l’acceptabilite de cette approche. Resultats Les outils cliniques selectionnes ont permis de proposer un soutien professionnel sur mesure. Les resultats montrent que les proches aidants ont plusieurs difficultes, principalement dans les domaines de la vie comme la famille, les enfants, les relations sentimentales et la sante psychique. Leurs besoins d’aide non combles necessitant une aide tres urgente sont la sante psychique et les enfants. Les proches vivent diverses emotions douloureuses, particulierement de la tristesse, de l’impuissance, de l’anxiete et de la colere. Les ressources sociales des proches aidants sont importantes en nombre la plupart du temps, mais la qualite de ces relations est parfois soulevee comme problematique. Conclusions Les soins individualises grâce a des outils adaptes et prenant en compte l’autoevaluation de l’ensemble des indices (difficultes, besoins d’aide supplementaire, emotions douloureuses et ressources sociales) permettent un accompagnement sur mesure. Une etude evaluant un soutien professionnel cible en integrant cette approche serait necessaire.

International audience; Family members of patients with schizophrenia, especially when they assume caregivers' positions, experience difficulties to adapt to the situation. To gain insight into these caregivers' coping style is a challenge to decrease the stress of family members, and in this way, improve patient related outcome. The FCQ (Family Coping Questionnaire) is an adapted clinical assessment tool that focuses on specific ways to cope with dysfunction that characterize the psychotic pathology. The goal of this study was to provide validity evidence about the French version of the FCQ. Swiss and French family members of individuals suffering from schizophrenia (n = 204) responded to the FCQ. A confirmatory factor analysis (CFA) was applied estimating two models. The seven-factor model showed adequate fit to the data while the three-factor model fit was poor. This FCQ internal validation showed an adequate model fit with a French population including various family members (parents, siblings, etc.) of persons with enduring mental illness.

Resume La psychoeducation peut etre definie comme une intervention didactique et psychotherapeutique systematique qui vise a informer les patients et leurs proches sur le trouble psychiatrique et a promouvoir les capacites pour y faire face. Ce n’est pas seulement une transmission d’information, mais aussi une methode pedagogique adaptee aux troubles ayant pour but une clarification de l’identite, une appropriation du pouvoir et une modification des attitudes et des comportements. L’introduction de l’education dans le traitement des troubles mentaux est a l’origine du « traitement moral ». Le terme de psychoeducation nait initialement dans la litterature scientifique de la preoccupation de surmonter les difficultes d’apprentissage des enfants souffrant de problemes de sante mentale. Cette origine est commune au terme d’education therapeutique, applique ensuite principalement pour les problemes de sante somatique. Le terme de psychoeducation a ensuite ete utilise des les annees 1980 pour qualifier la transmission d’un savoir sur les troubles psychiatriques a des fins therapeutiques, d’abord aux proches, puis aux personnes souffrant de schizophrenie. Depuis la fin des annees 1990, l’utilisation de la psychoeducation a ensuite ete etendue a d’autres troubles psychiques comme les troubles alimentaires, les troubles bipolaires, les attaques de panique et l’agoraphobie ou le stress post-traumatique. L’efficacite therapeutique de la psychoeducation familiale pour reduire le risque de rechute et de readmission dans la schizophrenie constitue une revolution des therapies familiales dans les annees 1980. De maniere polemique, la psychoeducation a ete critiquee comme un exercice du pouvoir du medecin et de l’industrie pharmaceutique pour imposer une conception de la maladie mentale. Toutefois, des la fin des annees 1990, les patients et les proches se sont appropries la psychoeducation comme une source de pouvoir, de savoir et de connexions sociales. En conclusion, la psychoeducation est une methode therapeutique qui a demontre son efficacite de maniere scientifique, associee a d’autres methodes de traitement, notamment medicamenteux ou de rehabilitation psychosociale. Dans une perspective medicale moderne, elle precede et complete en psychiatrie les notions de « consentement eclaire », de « decision partagee » ou de « litteratie en sante mentale ». Les limitations sont liees aux risques de transmettre des informations obsoletes, non orientees vers le retablissement ou inappropriees aux besoins, d’imposer un discours medical non integre, ou de viser une reeducation plutot qu’une appropriation du pouvoir par la personne. De plus, des programmes specifiques independants du diagnostic devraient etre developpes pour les phases precoces des troubles psychiatriques.

Résumé La conscience du trouble ou insight est un concept multidimensionnel incluant la reconnaissance de la maladie la compréhension des effets des médicaments et la reconnaissance des symptômes. L’entraînement métacognitif (EMC) devrait améliorer spécifiquement la reconnaissance des idées délirantes comme faisant partie du trouble par rapport à l’acceptation de la maladie ou la reconnaissance du besoin de traitement. L’amélioration de cette variable ne devrait pas forcément conduire à la dépression. Cinquante deux participants de 18 à 65 ans remplissant les critères de la CIM 10 pour une schizophrénie ou un trouble schizo affectif ont été répartis aléatoirement dans deux groupes un recevant le traitement habituel (TH) et l’autre bénéficiant de l’EMC. Les patients ont été évalués avec la Scale to Assess Unawareness of Mental Disorder (SUMD) avant la randomisation (T0) à la fin de l’EMC (T1) et six mois après le post test (T2). La reconnaissance des idées délirantes comme faisant partie du trouble à T2 est statistiquement et cliniquement significative dans le groupe ayant bénéficié de l’entraînement métacognitif. Ce qui n’est pas le cas pour les autres dimensions de la conscience du trouble ou pour le groupe témoin. L’amélioration de cette variable n’est pas associée à une augmentation de la dépression. L’insight est souvent confondu avec la symptomatologie psychotique. L’estime de soi et la dépression pourraient être associées aux symptômes psychotiques et non pas à la modification de l’insight. SummaryIntroduction Insight is a multidimensional concept including awareness of having a mental illness understanding of the therapeutic effects of medication and recognition of symptoms as part of the disorder (David 1990). The meta cognitive training program (MCT) developed by Moritz et al. (2010) is a new way of approaching the psychological treatment of psychotic symptoms. The principal goal of MCT is to make patients aware of and reduce cognitive biases associated with psychosis. The program focuses on attributional biases jumping to conclusions incorrigibility theory of mind overconfidence in memory errors and negative cognitive schematas. Since the MCT program improves awareness of cognitive biases it should also specifically improve recognition of delusions as part of the disorder compared to acknowledgment of the disease or recognition of the need for treatment. The improvement of this variable should not necessarily lead to depression. Methods Fifty two participants from 18 to 65 meeting the criteria of ICD 10 for schizophrenia or schizoaffective disorder were randomized into two groups: one receiving the usual treatment (TAU) and the other one receiving the TAU + MCT. Patients were assessed with the Scale to Assess Unawareness of Mental Disorder (SUMD) before randomization (T0) at the end of the MCT (T1) and 6 months after the post test (T2). Participants receiving MCT were invited to participate in 8 one hour sessions and received homework assignments. The program is composed of a manual and slides. MCT is currently available in 30 languages and can been downloaded from the following web address: http://www.uke.de/mct. Results The participants undergoing TAU only did not improve on any measure of insight assessed by the SUMD. However participants who followed MCT showed statistically significant results and a moderate to strong effect sizes for understanding the therapeutic effects of drugs (Cohen's d = 0.46) awareness of delusions (Cohen's d = 0.60) and attribution of delusions to the illness (Cohen's d = 0.47) of the SUMD to 6 months follow up (T2). At post test (T1) only awareness of delusions was statistically and clinically significantly improved (Cohen's d = 0.42). Given the number of statistical comparisons a Bonferroni correction was required. This statistical significance was set at P < 0.01. With this rule only awareness of delusions improved (t = 2.9 df (23) P = 0.008 Cohen's d = 0.60) at 6 months follow up. The item of the PANSS depression did not change for the TAU group and moderately improved for the TAU + MCT group but it was not statistically significant. Discussion From a theoretical point of view it is interesting to see that MCT had a specific effect on the most relevant variable confirming certain independence between the variables included in the multidimensional concept of insight. Indeed metacognitive training seeks to improve awareness of cognitive biases associated with delusions and leads to an improvement of awareness of delusions. The improvement of awareness of delusion did not appear to be associated with an increase in depression. This study has some limitations. First these data are secondary outcomes (Favrod et al. 2014) and the sample size was calculated on the basis of the scale “delusions” of Psychotic Rating Scales. In this context the size of the sample may not be large enough to detect effects. Second depression is measured with the PANSS item G6 and not with a full scale depression. However this is an exploratory study to investigate the effect of an intervention on a specific variable of the concept of insight.

Persistent psychotic symptoms represent a major challenge for psychiatric care. Basic research has shown that psychotic symptoms are associated with cognitive biases. Metacognitive training (MCT) aims at helping patients to become aware of these biases and to improve problem-solving. Fifty-two participants fulfilling diagnostic criteria of schizophrenia or schizoaffective disorders and persistent delusions and stabilized antipsychotic medication were enrolled in this study. Following baseline assessment patients were randomized either to treatment as usual (TAU) conditions or TAU + MCT. The intervention consisted of eight weekly 1-hour sessions (maximum: 8 hours). Participants were assessed at 8 weeks and 6-months later by blind assessors. Participants were assessed with the Psychotic Symptoms Rating Scales (PSYRATS) and the positive subscale of the PANSS. Between-group differences in post- and pre-test values were significant at a medium effect size in favor of the MCT for the PSYRATS delusion scale and the positive scale of the PANSS both at post and follow-up. The results of this study indicate that MCT training has a surplus antipsychotic effect for patients suffering from schizophrenia-related disorders who demonstrate only a partial response to antipsychotic treatment and that the effect of the intervention persists for at least 6 months after the intervention.

Verbal auditory hallucinations can have a strong impact on the social and professional functioning of individuals diagnosed with schizophrenia. The safety-seeking behaviours used to reduce the threat associated with voices play a significant role in explaining the functional consequences of auditory hallucinations. Nevertheless, these safety-seeking behaviours have been little studied. Twenty-eight patients with schizophrenia and verbal auditory hallucinations were recruited for this study. Hallucinations were evaluated using the Psychotic Symptom Rating Scale and the Belief About Voice Questionnaire and safety behaviours using a modified version of the Safety Behaviour Questionnaire. Our results show that the vast majority of patients relies on safety behaviours to reduce the threat associated with voices. This reliance on safety behaviours is mostly explained by beliefs about origin of voices the omnipotence attributed to hallucinations and the behavioural and emotional reactions to the voices. Safety-seeking behaviours play an important role in maintaining dysfunctional beliefs with respect to voices. They should be better targeted within the cognitive and behavioural therapies for auditory hallucinations.

Resume Objectifs Vingt a 50 % des personnes atteintes de schizophrenie souffrent de symptomes psychotiques malgre un traitement neuroleptique. Il est donc primordial de developper des methodes therapeutiques pour aider les patients a mieux gerer ces symptomes. L’entrainement a la pleine conscience offre une piste dans cette direction au travers de nouvelles perspectives pour modifier le rapport aux symptomes positifs. Patients et methode Quatre patients atteints de schizophrenie et une patiente souffrant d’un trouble schizo-affectif ont participe a huit seances de pleine conscience en groupe. Avant, pendant et apres l’entrainement, ces personnes ont evalue hebdomadairement la gene causee par un symptome psychotique cible. Resultats La courbe des evaluations des participants montre une diminution de la gene provoquee par le symptome cible entre le debut et la fin de l’entrainement. Conclusions Cette experience pilote encourage la poursuite de recherches mieux controlees dans ce domaine.

Resume Objectif L’abus de cannabis est un probleme frequent chez les personnes qui souffrent de schizophrenie. Cette etude pilote a pour but de tester la faisabilite et de mesurer l’efficacite d’une intervention motivationnelle de groupe developpee par Van Horn et Bux. Methode Quinze patients avec un trouble du spectre de la schizophrenie faisant partie d’une etude sur l’efficacite d’une intervention motivationnelle breve ont participe a un cycle de trois seances de groupe motivationnel. Le nombre de joints fumes par semaine a ete mesure a l’entree dans l’etude, a trois, six et 12 mois. L’intervention motivationnelle s’est deroulee durant les six premiers mois de l’etude, puis les participants ont ete suivis jusqu’a 12 mois apres leur entree dans l’etude. Resultats Les participants ont suivi en moyenne 5,7 (2,7) seances individuelles d’entretien motivationnel et 2,6 (1,2) seances de groupe. Les participants ont significativement reduit leur consommation de cannabis a trois, six et 12 mois, avec une taille d’effet forte a trois et six mois et moderee a 12 mois. Discussion L’application de groupes motivationnels est realisable dans un contexte francophone chez des patients qui fument de grandes quantites de cannabis. Les resultats de l’etude sont limites par le fait que cet aspect specifique de l’intervention n’a pas ete controle.

Accessible summaryWhat is known on the subject? Negative perceptions of illnesses can increase caregivers’ use of ineffective coping strategies, which may increase their burdens and distress. Scientific and theoretical framework showed that culture and health organization system influence perception of illnesses and thus also has an impact on the coping strategies used. There is a lack of data on comparative perceptions of illnesses and coping styles between India and Switzerland and that is why this hypothesis needs to be confirmed. The comparison between two countries with large cultural and socioeconomics differences will provide a more significant impact. What this paper adds to existing knowledge? This cultural comparative study explores the associations between representations of illness and three forms of coping styles (i.e. problem-focused, emotion-focused and social support-focused coping) among caregivers of people diagnosed with schizophrenia spectrum disorders in Mangalore, India, and in French-speaking Switzerland. Results showed significant differences between Swiss and Indian caregivers practically in all illness’ perceptions and coping styles, which is in accord with the theoretical framework. However, two results showed also similarities: the perception that schizophrenia can have cyclical episodes and that it can have negative consequences for caregivers. These differences and similarities allow to confirm the hypothesis that culture and health organization system influence illness’ perception which impact the used coping styles. However, to develop specific nursing interventions for each culture, more research is needed to specify qualitatively the content of these differences and similarities. What are the implications for practice? Knowledge of how culture influences perceptions and coping styles is essential to develop quality interventions. Nurses should evaluate caregivers’ perceptions and the causes they attribute to illnesses to help them maintain or develop efficient coping strategies. Knowledge of specific cultural differences and similarities can help nurses to provide individualized care that takes into account personal values to ensure recovery processes. AbstractIntroduction Scientific and theoretical framework showed that culture and health organization system influence perception of illnesses and thus also has an impact on the coping strategies used. Aim/question This cultural comparative study explores illness’ perception and coping styles among the caregivers of people diagnosed with schizophrenia spectrum disorders in Mangalore, India, and Lausanne, Switzerland. Method The answers of 92 Swiss caregivers, using paper or electronic surveys depending on the participants’ preference, and 100 Indian caregivers via an interview with a nurse were examined. Results The results confirm the hypothesis that culture and health organization system influence illness’ perception which impact the used coping styles. Significant differences between Swiss and Indian caregivers practically in all illness’ perceptions and coping styles were present, which is in accord with the theoretical framework. However, two results showed also similarities: the perception that schizophrenia can have cyclical episodes and that it can have negative consequences for caregivers. Discussion These differences will affect the development of interventions for caregivers in both countries. Implications for Practice The cultural differences observed in this study not only will allow interventions to be adapted to the specific needs of the two populations but also to identify their shared needs.

BACKGROUND: Recent literature has distinguished the negative symptoms associated with a diminished capacity to experience (apathy, anhedonia) from symptoms associated with a limited capacity for expression (emotional blunting, alogia). The apathy-anhedonia syndrome tends to be associated with a poorer prognosis than the symptoms related to diminished expression. The efficacy of drug-based treatments and psychological interventions for these symptoms in schizophrenia remains limited. There is a clear clinical need for new treatments. METHODS: This pilot study tested the feasibility of a program to reduce anhedonia and apathy in schizophrenia and assessed its impact on 37 participants meeting the ICD-10 criteria for schizophrenia or schizoaffective disorders. Participants were pre- and post-tested using the Scale for the Assessment of Negative Symptoms (SANS) and the Calgary Depression Scale for Schizophrenia (CDSS). They took part in eight sessions of the Positive Emotions Program for Schizophrenia (PEPS)--an intervention that teaches participants skills to help overcome defeatist thinking and to increase the anticipation and maintenance of positive emotions. RESULTS: Thirty-one participants completed the program; those who dropped out did not differ from completers. Participation in the program was accompanied by statistically significant reductions in the total scores for Avolition-Apathy and Anhedonia-Asociality on the SANS, with moderate effect sizes. Furthermore, there was a statistically significant reduction of depression on the CDSS, with a large effect size. Emotional blunting and alogia remain stable during the intervention. DISCUSSION: Findings indicate that PEPS is both a feasible intervention and is associated with an apparently specific reduction of anhedonia and apathy. However, these findings are limited by the absence of control group and the fact that the rater was not blind to the treatment objectives. CONCLUSIONS: PEPS is a promising intervention to improve anhedonia and apathy which need to be tested further in a controlled study. TRIAL REGISTRATION NUMBER: ISRCTN registry ISRCTN74048461, registered 18 may 2015.

In this review of recent therapeutic developments in psychiatry, we will report on three domains where new strategies have been proposed. First we will discuss the concept of neuroprotection in patients at "ultra high risk" to develop psychosis and the encouraging results of a randomised controlled trial comparing the effect of placebo and fish oil. We will then present the impact of metacognition programs which aim at adding some flexibility to thought processes used by patients with psychosis in order to reduce psychotic symptoms. We finally will report on a program of supported employment which was developed in order to help patients find an active place in society.

In clinical practice, anhedonia and apathy are challenging symptoms of schizophrenia. Anhedonia in schizophrenia appears to be associated with impairment in anticipatory pleasure. However, the problem is complicated since comorbid depression occurs in 50 % of patients and the symptoms of the different disorders may overlap. This chapter presents an intervention to train anticipatory pleasure in patients with schizophrenia. This intervention has been evaluated in an exploratory pilot study. Results show that the patients improved on the anticipatory scale of the Temporal Experience of Pleasure Scale. Patients also increased their daily activities. The program is still being improved and should be tested in a controlled study.

BACKGROUND: Caring for individuals with schizophrenia can create distress for caregivers which can, in turn, have a harmful impact on patient progress. There could be a better understanding of the connections between caregivers' representations of schizophrenia and coping styles. This study aims at exploring those connections. METHODS: This correlational descriptive study was conducted with 92 caregivers of individuals suffering from schizophrenia. The participants completed three questionnaires translated and validated in French: (a) a socio-demographic questionnaire, (b) the Illness Perception Questionnaire for Schizophrenia and (c) the Family Coping Questionnaire. RESULTS: Our results show that illness representations are slightly correlated with coping styles. More specifically, emotional representations are correlated to an emotion-focused coping style centred on coercion, avoidance and resignation. CONCLUSION: Our results are coherent with the Commonsense Model of Self-Regulation of Health and Illness and should enable to develop new interventions for caregivers.

Background Most scales that assess the presence and severity of psychotic symptoms often measure a broad range of experiences and behaviours, something that restricts the detailed measurement of specific symptoms such as delusions or hallucinations. The Psychotic Symptom Rating Scales (PSYRATS) is a clinical assessment tool that focuses on the detailed measurement of these core symptoms. The goal of this study was to examine the psychometric properties of the French version of the PSYRATS. Methods A sample of 103 outpatients suffering from schizophrenia or schizoaffective disorders and presenting persistent psychotic symptoms over the previous three months was assessed using the PSYRATS. Seventy-five sample participants were also assessed with the Positive And Negative Syndrome Scale (PANSS). Results ICCs were superior to .90 for all items of the PSYRATS. Factor analysis replicated the factorial structure of the original version of the delusions scale. Similar to previous replications, the factor structure of the hallucinations scale was partially replicated. Convergent validity indicated that some specific PSYRATS items do not correlate with the PANSS delusions or hallucinations. The distress items of the PSYRATS are negatively correlated with the grandiosity scale of the PANSS. Conclusions The results of this study are limited by the relatively small sample size as well as the selection of participants with persistent symptoms. The French version of the PSYRATS partially replicates previously published results. Differences in factor structure of the hallucinations scale might be explained by greater variability of its elements. The future development of the scale should take into account the presence of grandiosity in order to better capture details of the psychotic experience.