Evaluation of the relevance of wearable cameras as cognitive remediation tools for autobiographical memory in schizophrenia

L’objectif de nos travaux de thèse était d’évaluer la pertinence de l’utilisation d’appareils photo portables (APP) dans l’accompagnement des troubles de la mémoire autobiographique rencontrés dans la schizophrénie. Après avoir entrepris une étude de preuve-de-concept évaluant la faisabilité de ce dispositif innovant, nous avons testé son potentiel thérapeutique dans un contexte de remédiation cognitive au moyen d’un protocole expérimental en cas uniques impliquant trois personnes présentant une schizophrénie. Enfin, dans une perspective transdiagnostique, ce protocole a été répliqué auprès d’une personne présentant un trouble bipolaire de l’humeur. Nos résultats ont montré qu’il était envisageable d’utiliser des APPs dans un contexte de troubles psychiques sévères, et que cette approche visuelle présentait plusieurs avantages vis-à-vis de l’utilisation plus classique d’un entraînement verbal des souvenirs (et comparativement à l’absence d’intervention) : 1) le niveau de détails rapporté par les patients est supérieur lorsque leurs souvenirs sont soutenus par des photos, 2) ce bénéfice se maintient à très long-terme et 3) cette technique semble favoriser la motivation intrinsèque à retravailler ses souvenirs personnels, voire à initier de nouvelles activités en vie quotidienne. En conclusion, nous abordons les perspectives de recherche découlant de nos travaux et la façon dont les APPs pourraient être employés dans le cadre d’une pratique clinique.The aim of our thesis work was to evaluate the relevance of using wearable cameras to address autobiographical memory disorders encountered by patients with schizophrenia. After undertaking a proof-of-concept study evaluating the feasibility of this innovative device, we tested its therapeutic potential in a cognitive remediation context by conducting a single-case experimental design involving three individuals diagnosed with schizophrenia. Finally, in a transdiagnostic perspective, this protocol was replicated with a person presenting a bipolar mood disorder. Our results showed that it was conceivable to use wearable cameras in the context of severe mental disorders, and that this visual approach had several advantages over the more traditional use of verbal memory training and compared to a control condition without intervention: 1) the level of details reported by the patients was higher when their memories were supported by pictures, 2) this benefit was maintained over the very long term and 3) this technique seemed to promote intrinsic motivation to rework personal memories, and even to initiate new activities in daily life. In conclusion, we discuss the research perspectives raised by our work and how wearable cameras could be used in clinical practice

Évaluation de l’intérêt des appareils photo portables comme outils de remédiation cognitive de la mémoire autobiographique dans la schizophrénie

The aim of our thesis work was to evaluate the relevance of using wearable cameras to address autobiographical memory disorders encountered by patients with schizophrenia. After undertaking a proof-of-concept study evaluating the feasibility of this innovative device, we tested its therapeutic potential in a cognitive remediation context by conducting a single-case experimental design involving three individuals diagnosed with schizophrenia. Finally, in a transdiagnostic perspective, this protocol was replicated with a person presenting a bipolar mood disorder. Our results showed that it was conceivable to use wearable cameras in the context of severe mental disorders, and that this visual approach had several advantages over the more traditional use of verbal memory training and compared to a control condition without intervention: 1) the level of details reported by the patients was higher when their memories were supported by pictures, 2) this benefit was maintained over the very long term and 3) this technique seemed to promote intrinsic motivation to rework personal memories, and even to initiate new activities in daily life. In conclusion, we discuss the research perspectives raised by our work and how wearable cameras could be used in clinical practice.L’objectif de nos travaux de thèse était d’évaluer la pertinence de l’utilisation d’appareils photo portables (APP) dans l’accompagnement des troubles de la mémoire autobiographique rencontrés dans la schizophrénie. Après avoir entrepris une étude de preuve-de-concept évaluant la faisabilité de ce dispositif innovant, nous avons testé son potentiel thérapeutique dans un contexte de remédiation cognitive au moyen d’un protocole expérimental en cas uniques impliquant trois personnes présentant une schizophrénie. Enfin, dans une perspective transdiagnostique, ce protocole a été répliqué auprès d’une personne présentant un trouble bipolaire de l’humeur. Nos résultats ont montré qu’il était envisageable d’utiliser des APPs dans un contexte de troubles psychiques sévères, et que cette approche visuelle présentait plusieurs avantages vis-à-vis de l’utilisation plus classique d’un entraînement verbal des souvenirs (et comparativement à l’absence d’intervention) : 1) le niveau de détails rapporté par les patients est supérieur lorsque leurs souvenirs sont soutenus par des photos, 2) ce bénéfice se maintient à très long-terme et 3) cette technique semble favoriser la motivation intrinsèque à retravailler ses souvenirs personnels, voire à initier de nouvelles activités en vie quotidienne. En conclusion, nous abordons les perspectives de recherche découlant de nos travaux et la façon dont les APPs pourraient être employés dans le cadre d’une pratique clinique

Comparative analysis of anticholinergic burden scales to explain iatrogenic cognitive impairment in schizophrenia: results from the multicenter FACE-SZ cohort

International audienceAim: The anticholinergic properties of medications are associated with poorer cognitive performance in schizophrenia. Numerous scales have been developed to assess anticholinergic burden and yet, there is no consensus indicating which anticholinergic burden scale is more relevant for patients with schizophrenia. We aimed to identify valid scales for estimating the risk of iatrogenic cognitive impairment in schizophrenia.Methods: We identified 27 scales in a literature review. The responses to neuropsychological tests of 839 individuals with schizophrenia or schizoaffective disorder in the FACE-SZ database were collected between 2010 and 2021. We estimated the association between objective global cognitive performance and the 27 scales, the number of psychotropic drugs, and chlorpromazine and lorazepam equivalents in bivariable regressions in a cross-sectional design. We then adjusted the bivariable models with covariates: the predictors significantly associated with cognitive performance in multiple linear regressions were considered to have good concurrent validity to assess cognitive performance.Results: Eight scales, the number of psychotropic drugs, and drug equivalents were significantly associated with cognitive impairment. The number of psychotropic drugs, the most convenient predictor to compute, was associated with worse executive function (Standardized β = -0.12, p = .004) and reasoning (Standardized β = -0.08, p = .037).Conclusion: Anticholinergic burden, the number of psychotropic drugs, and drug equivalents were weakly associated with cognition, thus suggesting that cognitive impairment in schizophrenia and schizoaffective disorder is explained by factors other than medication. The number of psychotropic drugs was the most parsimonious method to assess the risk of iatrogenic cognitive impairment

Predictors of medication adherence in a large 1-year prospective cohort of individuals with schizophrenia: insights from the multicentric FACE-SZ dataset

International audienceSchizophrenia is characterized by the most salient medication adherence problems among severe mental disorders, but limited prospective data are available to predict and improve adherence in this population. This investigation aims to identify predictors of medication adherence over a 1-year period in a large national cohort using clustering analysis. Outpatients were recruited from ten Schizophrenia Expert Centers and were evaluated with a day-long standardized battery including clinician and patient-rated medication adherence measures. A two-step cluster analysis and multivariate logistic regression were conducted to identify medication adherence profiles based on the Medication Adherence rating Scale (MARS) and baseline predictors. A total of 485 participants were included in the study and medication adherence was significantly improved at the 1-year follow-up. Higher depressive scores, lower insight, history of suicide attempt, younger age and alcohol use disorder were all associated with poorer adherence at 1 year. Among the 203 patients with initially poor adherence, 86 (42%) switched to good adherence at the 1-year follow-up, whereas 117 patients (58%) remained poorly adherent. Targeting younger patients with low insight, history of suicide, alcohol use disorder and depressive disorders should be prioritized through literacy and educational therapy programs. Adherence is a construct that can vary considerably from year to year in schizophrenia, and therefore may be amenable to interventions for its improvement. However, caution is also warranted as nearly one in five patients with initially good adherence experienced worsened adherence 1 year later