Remédiation cognitive et thérapie occupationnelle dans le traitement ambulatoire du patient souffrant de schizophrénie

Dans cet article, les auteurs décrivent un programme de réhabilitation comportementale pour patients souffrant de schizophrénie. Le programme combine la réhabilitation occupationnelle à l’entraînement cognitif, s’attaquant ainsi à deux des déficiences marquantes de ce trouble chronique. En plus de cibler ces deux types de déficiences, les auteurs ont aussi examiné l’impact de l’une sur l’autre. En effet, des recherches suggéraient que les déficiences cognitives peuvent indiquer une limite à la réhabilitation psychosociale de ces patients. L’intention des auteurs était d’examiner si le fait de remédier spécifiquement à ces déficits cognitifs mènerait la réhabilitation occupationnelle à des résultats supérieurs. Après une description détaillée du programme, ils présentent des données à l’appui de l’efficacité de ce type d’approche, à la fois pour améliorer les fonctions cognitives et mener à de meilleurs résultats fonctionnels.In the present paper, we describe a behavioral rehabilitation program for patients with schizophrenia. The program combines vocational rehabilitation with cognitive training, thereby addressing two of the hallmark impairments of this chronic disorder. In addition to targeting these two types of impairments, we also wished to investigate the impact of one on the other. Specifically, previous research has suggested that cognitive impairments may serve as rate-limiters in the psychosocial rehabilitation of patients with schizophrenia. Our intent was to investigate whether specifically addressing and remediating these cognitive deficits would in turn lead to superior outcomes in vocational rehabilitation. Following a detailed description of our program, we offer initial support for the efficacy of this type of approach in both improving cognitive function as well as leading to better functional outcomes.En este artículo, los autores describen un programa de rehabilitación comportamental para los pacientes que sufren de esquizofrenia. El programa combina la rehabilitación ocupacional con el entrenamiento cognitivo, enfrentándose así a dos deficiencias que marcan este trastorno crónico. Además de enfocarse en estos dos tipos de deficiencias, los autores también examinan el impacto de una en la otra. De hecho, los estudios sugieren que las deficiencias cognitivas pueden indicar un límite en la rehabilitación psicosocial de estos pacientes. La intención de los autores fue examinar si el hecho de remediar específicamente estos déficits cognitivos lleva a la rehabilitación ocupacional a resultados superiores. Después de una descripción detallada del programa, presentan datos que apoyan la eficacia de este tipo de enfoque para mejorar las funciones cognitivas y, al mismo tiempo, conducir a mejores resultados funcionales.Neste artigo, os autores descrevem um programa de reabilitação comportamental para pacientes que sofrem de esquizofrenia. O programa associa a reabilitação ocupacional ao treinamento cognitivo, combatendo, assim, duas das deficiências marcantes deste transtorno crônico. Além de tratar destes dois tipos de deficiências, os autores examinaram também o impacto de uma sobre a outra. De fato, as pesquisas salientaram que as deficiências cognitivas podem indicar um limite na reabilitação psicossocial destes pacientes. A intenção dos autores era examinar se o fato de remediar especificamente estes déficits cognitivos levaria a reabilitação ocupacional a resultados superiores. Após uma descrição detalhada do programa, eles apresentam dados para apoiar a eficácia deste tipo de abordagem para melhorar as funções cognitivas e ao mesmo tempo levar a melhores resultados funcionais

A randomized controlled trial examining a cognitive behavioral therapy intervention enhanced with cognitive remediation to improve work and neurocognition outcomes among persons with schizophrenia spectrum disorders

This single blind, three-armed randomized controlled trial compared cognitive behavioral therapy (CBT) enhanced with cognitive remediation (CBT + CR) to CBT alone and an active control condition on work and neurocognition outcomes for persons with schizophrenia spectrum disorders. Seventy-five adult outpatients with schizophrenia or schizoaffective disorder were randomized to three study conditions (N = 25 per group). The CBT intervention was the Indianapolis Vocational Intervention program (IVIP), consisting of weekly group and individual sessions focused on work-related content. Participants in the CBT + CR group received IVIP and Posit Science computer-based cognitive training. The active control group consisted of weekly vocational support groups and individual vocational support sessions. All participants were placed into a noncompetitive work assignment and were followed for 26 weeks. Data collection included hours worked, weekly work performance ratings, and neurocognition assessed at baseline and 6 months. Neurocognition was also assessed at 12 months. Data were analyzed using multilevel linear models to account for nested, repeated measures data. Results indicate that participants in the CBT + CR condition worked significantly more hours and had a more positive trajectory of improving global work performance and work quality across the study compared with the CBT alone and vocational support condition. Compared to the other conditions, CBT + CR also had a significant increase in overall neurocognition that continued to the 12 month follow-up, particularly in the domains of verbal learning and social cognition. In conclusion, CBT + CR may be an effective intervention to improve work functioning and neurocognition in persons with schizophrenia

Interstellar CH absorption in the diffuse interstellar medium along the sight-lines to G10.6–0.4 (W31C), W49N, and W51

We report the detection of the ground state N, J = 1, 3/2 → 1, 1/2 doublet of the methylidyne radical CH at ~532 GHz and ~536 GHz with the Herschel/HIFI instrument along the sight-line to the massive star-forming regions G10.6–0.4 (W31C), W49N, and W51. While the molecular cores associated with these massive star-forming regions show emission lines, clouds in the diffuse interstellar medium are detected in absorption against the strong submillimeter background. The combination of hyperfine structure with emission and absorption results in complex profiles, with overlap of the different hyperfine components. The opacities of most of the CH absorption features are linearly correlated with those of CCH, CN, and HCO^+ in the same velocity intervals. In specific narrow velocity intervals, the opacities of CN and HCO^+ deviate from the mean trends, giving rise to more opaque absorption features. We propose that CCH can be used as another tracer of the molecular gas in the absence of better tracers, with [CCH]/[H_2] ~3.2 ± 1.1 × 10^(−8). The observed [CN]/[CH], [CCH]/[CH] abundance ratios suggest that the bulk of the diffuse matter along the lines of sight has gas densities n_H = n(H) + 2n(H_2) ranging between 100 and 1000 cm^(−3)

Excitation and abundance of C_3 in star forming cores: Herschel/HIFI observations of the sight-lines to W31C and W49N

We present spectrally resolved observations of triatomic carbon (C_3) in several ro-vibrational transitions between the vibrational ground state and the low-energy ν_2 bending mode at frequencies between 1654−1897 GHz along the sight-lines to the submillimeter continuum sources W31C and W49N, using Herschel’s HIFI instrument. We detect C_3 in absorption arising from the warm envelope surrounding the hot core, as indicated by the velocity peak position and shape of the line profile. The sensitivity does not allow to detect C_3 absorption due to diffuse foreground clouds. From the column densities of the rotational levels in the vibrational ground state probed by the absorption we derive a rotation temperature (T_(rot)) of ~50−70 K, which is a good measure of the kinetic temperature of the absorbing gas, as radiative transitions within the vibrational ground state are forbidden. It is also in good agreement with the dust temperatures for W31C and W49N. Applying the partition function correction based on the derived T_(rot), we get column densities N(C_3) ~ 7−9 × 10^(14) cm^(−2) and abundance x(C_3) ~ 10^(−8) with respect to H_2. For W31C, using a radiative transfer model including far-infrared pumping by the dust continuum and a temperature gradient within the source along the line of sight we find that a model with x(C_3) = 10^(−8), T_(kin) = 30−50 K, N(C_3) = 1.5 × 10^(15) cm^(−2) fits the observations reasonably well and provides parameters in very good agreement with the simple excitation analysis

Nitrogen hydrides in interstellar gas: Herschel/HIFI observations towards G10.6-0.4 (W31C)

The HIFI instrument on board the Herschel Space Observatory has been used to observe interstellar nitrogen hydrides along the sight-line towards G10.6−0.4 in order to improve our understanding of the interstellar chemistry of nitrogen. We report observations of absorption in NH N = 1 ← 0, J = 2 ← 1 and ortho-NH_2 1_(1,1) ← 0_(0,0). We also observed ortho-NH_3 1_0 ← 0_0, and 2_0 ← 1_0, para-NH_3 2_1 ← 1_1, and searched unsuccessfully for NH^+. All detections show emission and absorption associated directly with the hot-core source itself as well as absorption by foreground material over a wide range of velocities. All spectra show similar, non-saturated, absorption features, which we attribute to diffuse molecular gas. Total column densities over the velocity range 11−54 km s^(−1) are estimated. The similar profiles suggest fairly uniform abundances relative to hydrogen, approximately 6 × 10^(−9), 3 × 10^(−9), and 3 × 10^(−9) for NH, NH_2, and NH_3, respectively. These abundances are discussed with reference to models of gas-phase and surface chemistry

Reversal of infall in SgrB2(M) revealed by Herschel/HIFI observations of HCN lines at THz frequencies

Aims. To investigate the accretion and feedback processes in massive star formation, we analyze the shapes of emission lines from hot molecular cores, whose asymmetries trace infall and expansion motions. Methods. The high-mass star forming region SgrB2(M) was observed with Herschel/HIFI (HEXOS key project) in various lines of HCN and its isotopologues, complemented by APEX data. The observations are compared to spherically symmetric, centrally heated models with density power-law gradient and different velocity fields (infall or infall+expansion), using the radiative transfer code RATRAN. Results. The HCN line profiles are asymmetric, with the emission peak shifting from blue to red with increasing J and decreasing line opacity (HCN to H^(13)CN). This is most evident in the HCN 12–11 line at 1062 GHz. These line shapes are reproduced by a model whose velocity field changes from infall in the outer part to expansion in the inner part. Conclusions. The qualitative reproduction of the HCN lines suggests that infall dominates in the colder, outer regions, but expansion dominates in the warmer, inner regions. We are thus witnessing the onset of feedback in massive star formation, starting to reverse the infall and finally disrupting the whole molecular cloud. To obtain our result, the THz lines uniquely covered by HIFI were critically important

Dynamical Friction on Star Clusters near the Galactic Center

Numerical simulations of the dynamical friction suffered by a star cluster near the Galactic center have been performed with a parallelized tree code. Gerhard (2001) has suggested that dynamical friction, which causes a cluster to lose orbital energy and spiral in towards the galactic center, may explain the presence of a cluster of very young stars in the central parsec, where star formation might be prohibitively difficult owing to strong tidal forces. The clusters modeled in our simulations have an initial total mass of 10^5-10^6 Msun and initial galactocentric radii of 2.5-30 pc. We have identified a few simulations in which dynamical friction indeed brings a cluster to the central parsec, although this is only possible if the cluster is either very massive (~10^6 Msun), or is formed near the central parsec (<~ 5 pc). In both cases, the cluster should have an initially very dense core (> 10^6 Msun pc-3). The initial core collapse and segregation of massive stars into the cluster core, which typically happens on a much shorter time scale than that characterizing the dynamical inspiral of the cluster toward the Galactic center, can provide the requisite high density. Furthermore, because it is the cluster core which is most likely to survive the cluster disintegration during its journey inwards, this can help account for the observed distribution of presumably massive HeI stars in the central parsec.Comment: Accepted for publication in Ap

Herschel observations of EXtra-Ordinary Sources (HEXOS): Methanol as a probe of physical conditions in Orion KL

We have examined methanol emission from Orion KL withthe Herschel/HIFI instrument, and detected two methanol bands centered at 524 GHz and 1061 GHz. The 524 GHz methanol band (observed in HIFI band 1a) is dominated by the isolated ΔJ = 0, K = −4 → −3, v_t = 0 Q branch, and includes 25 E-type and 2 A-type transitions. The 1061 GHz methanol band (observed in HIFI band 4b) is dominated by the ΔJ = 0, K = 7 → 6, v_t = 0 Q branch transitions which are mostly blended. We have used the isolated E-type v_t = 0 methanol transitions to explore the physical conditions in the molecular gas. With HIFI’s high velocity resolution, the methanol emission contributed by different spatial components along the line of sight toward Orion KL (hot core, low velocity flow, and compact ridge) can be distinguished and studied separately. The isolated transitions detected in these bands cover a broad energy range (upper state energy ranging from 80 K to 900 K), which provides a unique probe of the thermal structure in each spatial component. The observations further show that the compact ridge is externally heated. These observations demonstrate the power of methanol lines as probes of the physical conditions in warm regions in close proximity to young stars

High Proper Motion Stars in the Vicinity of Sgr A*: Evidence for a Supermassive Black Hole at the Center of Our Galaxy

Over a two year period (1995-1997), we have conducted a diffraction-limited imaging study at 2.2 microns of the inner 6"x6" of the Galaxy's central stellar cluster using the Keck 10-m telescope. The K band images obtained reveal a large population of faint stars. We use an unbiased approach for identifying and selecting stars to be included in this proper motion study, which results in a sample of 90 stars with brightness ranging from K=9-17 and velocities as large as 1,400+-100 km/sec. Compared to earlier work (Eckart et al. 1997; Genzel et al. 1997), the source confusion is reduced by a factor of 9, the number of stars with proper motion measurement in the central 25 arcsec^2 of our galaxy is doubled, and the accuracy of the velocity measurements in the central 1 arcsec^2 is improved by a factor of 4. The peaks of both the stellar surface density and the velocity dispersion are consistent with the position of the unusual radio source and blackhole candidate, Sgr A*, suggesting that Sgr A* is coincident (+-0."1) with the dynamical center of the Galaxy. As a function of distance from Sgr A*, the velocity dispersion displays a falloff well fit by Keplerian motion about a central dark mass of 2.6(+-0.2)x10^6 Mo confined to a volume of at most 10^-6 pc^3, consistent with earlier results. Although uncertainties in the measurements mathematically allow for the matter to be distributed over this volume as a cluster, no realistic cluster is physically tenable. Thus, independent of the presence of Sgr A*, the large inferred central density of at least 10^12 Mo/pc^3, which exceeds the volume-averaged mass densities found at the center of any other galaxy, leads us to the conclusion that our Galaxy harbors a massive central black hole.Comment: 19 pages, 8 figures, accepted for publications in the Astrophysical Journa