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Exploratory Investigation of a Customized cognitive remediation program for individuals living with schizophrenia

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... Silverstein and Wilkniss (2004), Demily and Franck (2008), as well as Levaux et al. (2009) underlined the need to develop more individualized cognitive rehabilitation treatments to take into account the cognitive heterogeneity characterizing this disorder. More targeted interventions might increase the benefits of therapy so RECOScognitive remediation for schizophreniawas developed to fill this gap (Vianin et al., 2010). ...
... One hundred and fifty-one outpatients with schizophrenia were referred to the trial from the 8 French and Swiss psychiatric departments participating in the study. They were included if they met the following criteria: DSM-IV-TR criteria for schizophrenia (APA, 2000) confirmed with a semi-structured interview (M.I.N.I., Lecrubier et al., 1997); age from 18 to 45 years old with an unquestionable cognitive impairment (score b 7 on the neuropsychological battery developed by Vianin et al., 2010); being native French speakers or provided with French schooling since aged 7, and clinically stable (assessed twice one month apart carried out by a psychiatrist on the Brief Psychiatric Rating Scale (BPRS, Overall and Gorham, 1962). They were excluded if they had a visual or auditory disorder, a history of neurological illness or trauma, an alcohol or drug dependence, or learning disability. ...
... Comprehensive neuropsychological assessment (Vianin et al., 2010) is a reliable set of tests assessing executive functions, working memory, verbal memory, selective attention, visuospatial memory, and attention (see Table 2). As far as possible, parallel versions for post-assessment were used (for example, the list of words is not the same in the RAVLT in T1, T2, and T3). ...
Article
The functional outcome of schizophrenia is partly conditioned by cognitive disorders associated with this disease. The functional outcome of schizophrenia depends not only on psychotropic medications, but also on non-pharmacological measures and in particular on cognitive remediation. All patients suffering from schizophrenia should benefit from a multidisciplinary functional evaluation including neuropsychological assessment. The restitution of the functional evaluation's results values preserved skills rather than deficits. Cognitive remediation should be considered when cognitive disorders have a functional impact. It reduces the impact of the patient's cognitive disorders and improves the success of his/her concrete projects. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
... Silverstein and Wilkniss (2004), Demily and Franck (2008), as well as Levaux et al. (2009) underlined the need to develop more individualized cognitive rehabilitation treatments to take into account the cognitive heterogeneity characterizing this disorder. More targeted interventions might increase the benefits of therapy so RECOScognitive remediation for schizophreniawas developed to fill this gap (Vianin et al., 2010). ...
... One hundred and fifty-one outpatients with schizophrenia were referred to the trial from the 8 French and Swiss psychiatric departments participating in the study. They were included if they met the following criteria: DSM-IV-TR criteria for schizophrenia (APA, 2000) confirmed with a semi-structured interview (M.I.N.I., Lecrubier et al., 1997); age from 18 to 45 years old with an unquestionable cognitive impairment (score b 7 on the neuropsychological battery developed by Vianin et al., 2010); being native French speakers or provided with French schooling since aged 7, and clinically stable (assessed twice one month apart carried out by a psychiatrist on the Brief Psychiatric Rating Scale (BPRS, Overall and Gorham, 1962). They were excluded if they had a visual or auditory disorder, a history of neurological illness or trauma, an alcohol or drug dependence, or learning disability. ...
... Comprehensive neuropsychological assessment (Vianin et al., 2010) is a reliable set of tests assessing executive functions, working memory, verbal memory, selective attention, visuospatial memory, and attention (see Table 2). As far as possible, parallel versions for post-assessment were used (for example, the list of words is not the same in the RAVLT in T1, T2, and T3). ...
... Silverstein and Wilkniss (2004), Demily and Franck (2008), as well as Levaux et al. (2009) underlined the need to develop more individualized cognitive rehabilitation treatments to take into account the cognitive heterogeneity characterizing this disorder. More targeted interventions might increase the benefits of therapy so RECOScognitive remediation for schizophreniawas developed to fill this gap (Vianin et al., 2010). ...
... One hundred and fifty-one outpatients with schizophrenia were referred to the trial from the 8 French and Swiss psychiatric departments participating in the study. They were included if they met the following criteria: DSM-IV-TR criteria for schizophrenia (APA, 2000) confirmed with a semi-structured interview (M.I.N.I., Lecrubier et al., 1997); age from 18 to 45 years old with an unquestionable cognitive impairment (score b 7 on the neuropsychological battery developed by Vianin et al., 2010); being native French speakers or provided with French schooling since aged 7, and clinically stable (assessed twice one month apart carried out by a psychiatrist on the Brief Psychiatric Rating Scale (BPRS, Overall and Gorham, 1962). They were excluded if they had a visual or auditory disorder, a history of neurological illness or trauma, an alcohol or drug dependence, or learning disability. ...
... Comprehensive neuropsychological assessment (Vianin et al., 2010) is a reliable set of tests assessing executive functions, working memory, verbal memory, selective attention, visuospatial memory, and attention (see Table 2). As far as possible, parallel versions for post-assessment were used (for example, the list of words is not the same in the RAVLT in T1, T2, and T3). ...
... Whatever the type of CR program, neurocognitive or social cognition, the nodal point is the link between CR and transfer to daily life (19). For neurocognition or social cognition this transfer can take place in different ways: 1) through homework tasks such as in Recos (Remediation Cognitive dans la Schizophreńie-Cognitive Remediation for Schizophrenia) (25,26) or CRT (Cognitive Remediation Therapy) programs (27,28), social cognition programs such as SCIT (Social Cognition Interaction Training) (29) or TomRemed (Remediation en Theórie de l'Esprit-Theory of Mind Remediation) (30) programs. 2) transfer to everyday life can also be facilitated through group sessions oriented toward full explanations of the cognitive domains and consequences in daily life, and explicit work on transfer of benefits such as in the NEAR (Neuropsychological Educational Approach to Remediation) program (31) or as we develop it in the Virtual Reality serious game program "Jeu Mathurin", which trains planning abilities and prospective memory in a virtual town (17). ...
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Employment rate in psychiatry is around 10 to 30%. Cognitive remediation (CR) associated with psychosocial rehabilitation shows good functional outcomes, with a high level of satisfaction in participants provided by tailored CR. However, few studies looked at the long-term outcome in participants who experienced such a program. This retrospective survey examines the outcome of persons having psychiatric diseases 2 to 9 years after being treated with a personalized CR program. The survey included 12 domains with questions relevant to work, studies, before CR (T1) and at the moment of the survey (T2), questions about housing, relatedness, familiar relationships and daily activities at T2. Finally, a narrative interview was included to express feelings of the participants about CR. Sixty-six participants completed the survey, and were treated with neurocognitive or social cognition programs. Their diagnosis was: schizophrenia (80.3%), neurodevelopment disorder (autism as well as genetic or metabolic disease with psychiatric expression) (15.2%) and bipolar disorder (4.5%). The comparison between T1 and T2 showed significant difference for job employment (P < 0.001), even for competitive jobs (p < 0.007), for performing studies (p = 0.033), for practicing a physical activity (0.033) or reading (0.002). Outcome was also examined in reference to the delay from CR to highlight changes in patient characteristics and service delivery over the years. Hence, the total sample was split in two subgroups: CR delivered in 2009–2013 (n = 37); CR delivered in 2014–2016 (n = 29). While in the former group more participants were working (p = 0.037), in the latter group, which was younger (p = 0.04), more participants were studying (p = 0.02). At T2, a majority of persons experienced no relapse, three years (79.1%) to 8 years (56.8%) after CR, when referring to the anamnesis. Concerning subjective perception of CR, participants expressed feelings concerning positive impact on clarity of thought, on cognitive functions, self-confidence, perceiving CR as an efficient help for work and studies. To conclude, even long years after a personalized CR program, good benefits in terms of employment or studies emerge when compared to the status before CR, with good determinants for recovery in terms of leisure or physical activity practice.
... In a more recent study, Gaudelus et al. (23) compared the GAÏA s-face program with the RECOS program of neurocognitive remediation therapy that focuses on selective attention (24), and they utilized subject performances on the test of facial emotion recognition (TREF) (22) as the main measure of treatment outcome. They showed significantly improved recognition of facial emotion in the GAÏA group but also in RECOS group (with a significantly smaller effect), no effect of social cognitive remediation on ToM, attributional style, or empathy in either group, and significantly improved scores of social autonomy (EAS, [Echelle d'Autonomie Sociale]; social autonomy scale) (25) in the GAÏA group only. ...
Article
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Objective: Patients with schizophrenia exhibit impaired social cognition, especially in the recognition and expression of facial emotions, aspects of communication profoundly interlinked in an embodied approach of cognition. Nevertheless, many training programs have been developed that focus on either of these deficits but not both. We therefore designed a training program, Cinemotion, intended to remedy the 2 deficits and investigated its feasibility and effects in patients with schizophrenia. Design: Thirty-one patients undergoing treatment for schizophrenia and presenting deficit in emotion recognition were randomized to a group of 16 to undergo Cinemotion training, delivered in weekly group sessions, and to a control treatment group of 15. At the conclusion of training or after 10 weeks in controls, we reassessed and compared original and final results to determine improvement. Methods: Facial emotions recognition (TREF), empathy (Questionnaire of Cognitive and Affective Empathy, QCAE), and attributional style (Ambiguous Intentions Hostility Questionnaire, AIHQ) were assessed before (T0) and after (T1) the program. External evaluators also assessed ability and accuracy of Cinemotion participants to self-generate facial emotion expression in response to verbal instruction. Results: Between T0 and T1, Cinemotion participants significantly improved total TREF, sadness, disgust, and anger scores, compared to findings in control treatment group. They also improved their ability and accuracy to self-generate facial expressions, especially sadness and fear, with no significant improvement in other components of social recognition. Conclusions: Our findings show the apparent efficacy of training using the Cinemotion program to improve the recognition and expression of facial emotions in schizophrenia.
... The GAÏA s-face (Schizophrenia-Facial Affects recognition Cognitive Enhancement) program (44,45) is an individual, computer-assisted cognitive remediation therapy focusing on facial emotion recognition. The present controlled efficacy study compares the GAÏA s-face program with the RECOS program, an individual, computer-assisted neurocognitive remediation therapy focusing on attentional processes (46,47). ...
... The GAÏA s-face program (44,45) is an individual, computerassisted cognitive remediation therapy focusing on facial emotion recognition. The present controlled efficacy study compares the GAÏA s-face program with the RECOS program, an individual, computer-assisted neurocognitive remediation therapy focusing on attentional processes (46,47). ...
... Our study is part of a multi-center clinical trial that took place in France and Switzerland between 2008 and 2011. It specifies at comparing the effects between two individualized 3-months cognitive remediation programs, one including only paper and pencil sessions, using CRT, and one with both computerized and paper-pencil exercises using RECOS (Cognitive Remediation for Schizophrenia) program [22]. An equal number of clinically stable patients were recruited in this group-parallel-randomizedclinical-trial. ...
Article
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Purpose: Cognitive deficits in schizophrenia mainly affect memory, attention and executive functions. Cognitive remediation is a technique derived from neuropsychology, which aims to improve or compensate for these deficits. Working memory, verbal learning, and executive functions are crucial factors for functional outcome. Our purpose was to assess the impact of the cognitive remediation therapy (CRT) program on cognitive difficulties in patients with schizophrenia, especially on working memory, verbal memory, and cognitive flexibility. Methods: We collected data from clinical and neuropsychological assessments in 24 patients suffering from schizophrenia (Diagnostic and Statistical Manual of mental Disorders-Fourth Edition, DSM-IV) who followed a 3-month (CRT) program. Verbal and visuo-spatial working memory, verbal memory, and cognitive flexibility were assessed before and after CRT. Results: The Wilcoxon test showed significant improvements on the backward digit span, on the visual working memory span, on verbal memory and on flexibility. Cognitive improvement was substantial when baseline performance was low, independently from clinical benefit. Conclusions: CRT is effective on crucial cognitive domains and provides a huge benefit for patients having low baseline performance. Such cognitive amelioration appears highly promising for improving the outcome in cognitively impaired patients.
... Elle favorise aussi la prise en compte de l'environnement et la capacité à se détacher des distracteurs externes ou internes. Des méthodes telles que CRT [19] ou RECOS [20] ont été validées avec de grands échantillons. Plus qu'un entraînement, elles permettent le transfert des stratégies mises en place en séance à des situations concrètes de la vie quotidienne. ...
Article
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In psychiatric field, rehabilitation aims at assisting patients suffering from chronic disorders towards a social insertion or employment. It takes into account their desires, subjective factors, environmental factors, cognitive deficits and their preserved abilities, within the framework of the construction of a relevant project. Comprehensive assessment and specific therapeutic tools have been developed. They are proposed according to each patient's specificities. Rehabilitation leads to the development of social skills, improvement of cognitive functioning, better knowledge about troubles and their treatment, and amelioration of social and professional activities. The frame given by this care leads to a psychic reorganization and permits the construction of a relevant life project.
Article
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Cognitive impairment associated with schizophrenia are very frequent. Deficits associated with cognitive impairment may impact both neurocognition and social cognition, including facial emotion recognition. These deficits significantly impair functional recovery, and also the social and vocational rehabilitation of people with schizophrenia. Previous studies in this area clearly demonstrated the interest of cognitive remediation to improve neurocognitive and social cognitive functioning in schizophrenia. They also established clear links between facial emotion recognition skills and attentional processes. The present study compares the GAÏA s-face program (GAÏA arm), which focuses on facial emotion recognition processes, with the RECOS program (RECOS arm), a neurocognitive remediation therapy focusing on selective attention. Forty people with schizophrenia were randomly distributed between each study arm and assessed pre- (T1) and post- (T2) therapy. The single blind assessment focused on facial emotion recognition (the main criteria), symptoms, social and subjective functioning, and neurocognitive and social cognitive performance. Both programs were conducted by nurses after a three day training session. The study showed a significant improvement in facial emotion recognition performance in both groups, with a significantly larger effect in the GAÏA arm. Symptoms and social functioning also improved in the GAÏA arm, and certain neurocognitive and social cognitive processes improved in both study arms. Further studies are recommended, with larger population samples and a follow up assessing the long term preservation of these improvements.
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