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

Efficacy of social cognition and interaction training in outpatients with schizophrenia spectrum disorders: randomized controlled trial

Given the relationship between social cognition and functional outcome in schizophrenia, a number of social cognitive interventions have been developed, including Social Cognition Interaction Training (SCIT), a group-based, comprehensive, manualized intervention. In the current trial, we examined SCIT efficacy as well as potential moderators of treatment effects. Fifty-one outpatients were randomized to SCIT or a wait-list-control (WLC), with assessments of social cognition, neurocognition, self-report, symptoms, and functioning conducted at baseline and end of the active phase. Relative to WLC, we did not find significant improvements for SCIT on neurocognition, social cognition, self-report, or symptoms, though there was a trend-level, medium effect favoring the SCIT condition on interpersonal and instrumental role function. Post-hoc analyses indicated that baseline neurocognition did not impact degree of social cognitive or functional change. Shorter duration of illness was significantly associated with better post-training neurocognition and self-esteem and, at trend-level with better symptoms and social functioning. We discuss the importance of outcome measure selection and the need for continued evaluation of potential treatment moderators in order to better match people to existing treatments.Clinical trial registration: Clinicaltrials.gov, Identifier NCT00587561

Effects of the Indianapolis Vocational Intervention Program (IVIP) on defeatist beliefs, work motivation, and work outcomes in serious mental illness

Defeatist beliefs and amotivation are prominent obstacles in vocational rehabilitation for people with serious mental illnesses (SMI). The CBT-based Indianapolis Vocational Intervention Program (IVIP) was specifically designed to reduce defeatist beliefs related to work functioning. In the current study, we examined the impact of IVIP on defeatist beliefs and motivation for work, hypothesizing that IVIP would be associated with a reduction in defeatist beliefs and greater motivation for work. We also examined the effects of IVIP on these variables as well as work outcomes during a 12-month follow-up. Participants with SMI (n=64) enrolled in a four-month work therapy program were randomized to IVIP or a support therapy group (SG). Assessments were conducted at baseline, post-treatment (4months), and follow-up (1year). Compared to those in SG condition, individuals randomized to IVIP condition reported greater reductions in defeatist beliefs and greater motivation for work at follow-up, along with greater supported employment retention rates. Specifically treating and targeting negative expectations for work therapy improves outcomes, even once active supports of the IVIP program and work therapy are withdrawn

Understanding Social Situations (USS): A proof-of-concept social–cognitive intervention targeting theory of mind and attributional bias in individuals with psychosis.

In this proof-of-concept trial, we examined the feasibility and preliminary efficacy of Understanding Social Situations (USS), a new social cognitive intervention that targets higher-level social cognitive skills using methods common to neurocognitive remediation, including drill and practice and hierarchically structured training, which may compensate for the negative effects of cognitive impairment on learning

Decisional Informatics for Psychosocial Rehabilitation: A Feasibility Pilot on Tailored and Fluid Treatment Algorithms for Serious Mental Illness

This study introduces a computerized clinical decision-support tool, the Fluid Outpatient Rehabilitation Treatment (FORT), that incorporates individual and ever-evolving patient needs to guide clinicians in developing and updating treatment decisions in real-time. In this proof-of-concept feasibility pilot, FORT was compared against traditional treatment planning using similar behavioral therapies in 52 adults with severe mental illness attending community-based day treatment. At posttreatment and follow-up, group differences and moderate-to-large effect sizes favoring FORT were detected in social function, work readiness, self-esteem, working memory, processing speed, and mental flexibility. Of participants who identified obtaining a General Education Diploma as their goal, 73% in FORT passed the examination compared with 18% in traditional treatment planning. FORT was also associated with higher agency cost-effectiveness and a better average benefit-cost ratio, even when considering diagnosis, baseline symptoms, and education. Although the comparison groups were not completely equivalent, the findings suggest computerized decision support systems that collaborate with human decision-makers to personalize psychiatric rehabilitation and address critical decisions may have a role in improving treatment effectiveness and efficiency

Motivational Interviewing to Increase Cognitive Rehabilitation Adherence in Schizophrenia

Designed to replace the former Saint-Jacques Cathedral which had burned in 1852, the bishop Msgr. Ignace Bourget wanted to create a scale model of Saint Peter's Basilica in Rome. Work began in 1875 and the new church was consecrated in 1894 as Saint-Jacques Cathedral. At the time it was the largest church in Quebec. It was made a minor basilica in 1919 by Pope Benedict XV. It was rededicated in 1955 to Mary, Queen of the World, by Pope Pius XII.; Designed to replace the former Saint-Jacques Cathedral which had burned in 1852, the bishop Msgr. Ignace Bourget wanted to create a scale model of Saint Peter's Basilica in Rome. Work began in 1875 and the new church was consecrated in 1894 as Saint-Jacques Cathedral. At the time it was the largest church in Quebec. It was made a minor basilica in 1919 by Pope Benedict XV. It was rededicated in 1955 to Mary, Queen of the World, by Pope Pius XII. Source: Archiseek, Online Architecture Resources; http://canada.archiseek.com/ (accessed 6/21/2009

Understanding Social Situations (USS): A proof-of-concept social–cognitive intervention targeting theory of mind and attributional bias in individuals with psychosis.

OBJECTIVES: In this proof-of-concept trial, we examined the feasibility and preliminary efficacy of Understanding Social Situations (USS), a new social cognitive intervention that targets higher-level social cognitive skills using methods common to neurocognitive remediation, including drill and practice and hierarchically structured training, which may compensate for the negative effects of cognitive impairment on learning. METHODS: Thirty-eight individuals with schizophrenia spectrum disorders completed the same baseline assessment of cognitive and social cognitive functioning twice over a one month period to minimize later practice effects, then received 7–10 sessions of USS training, and then completed the same assessment again at post-treatment RESULTS: USS training was well tolerated and received high treatment satisfaction ratings. Large improvements on the USS Skills Test, which contained items similar to but not identical to training stimuli, suggest that we were effective in teaching specific training content. Content gains generalized to improvements on some of the social cognitive tasks, including select measures of attributional bias and theory of mind. Importantly, baseline neurocognition did not impact the amount of learning during USS (as indexed by USS Skills test), nor the amount of improvement on social cognitive measures. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: USS shows promise as a treatment for higher-level social cognitive skills. Given the lack of relationship between baseline cognition and treatment effects, it may be particularly appropriate for individuals with lower-range cognitive function

Understanding Social Situations (USS): A proof-of-concept social-cognitive intervention targeting theory of mind and attributional bias in individuals with psychosis

Objectives: In this proof-of-concept trial, we examined the feasibility and preliminary efficacy of Understanding Social Situations (USS), a new social–cognitive intervention that targets higher level social–cognitive skills using methods common to neurocognitive remediation, including drill and practice and hierarchically structured training, which may compensate for the negative effects of cognitive impairment on learning. Method: Thirty-eight individuals with schizophrenia spectrum disorders completed the same baseline assessment of cognitive and social–cognitive functioning twice over a 1-month period to minimize later practice effects, then received 7–10 sessions of USS training, and then completed the same assessment again at posttreatment. Results: USS training was well tolerated and received high treatment satisfaction ratings. Large improvements on the USS Skills Test, which contained items similar to but not identical to training stimuli, suggest that we were effective in teaching specific training content. Content gains generalized to improvements on some of the social–cognitive tasks, including select measures of attributional bias and theory of mind. Importantly, baseline neurocognition did not impact the amount of learning during USS (as indexed by the USS Skills Test) or the amount of improvement on social–cognitive measures. Conclusions and Implications for Practice: USS shows promise as a treatment for higher level social–cognitive skills. Given the lack of relationship between baseline cognition and treatment effects, it may be particularly appropriate for individuals with lower range cognitive function