L’évaluation des répercussions fonctionnelles des altérations de la cognition sociale favorise-t-elle l’engagement dans les soins des personnes ayant des troubles psychotiques ?

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]