Psychologie cognitive

« LÕEncŽphale, 2006 ; 32 : 18995, cahier 1 189 MƒMOIRE ORIGINAL Impact de la remŽdiation cognitive dans la schizophrŽnie sur les stratŽgies de rŽsolution de problmes et lÕautonomie sociale : utilisation du logiciel REHACOM ¨ A.

COCHET, M.

SAOUD, S.

GABRIELE, V.

BROALLIER, C.

EL ASMAR, J.

DALƒRY, T.

DÕAMATO (1) (1)EA 3092, UCBL Lyon1, IFR 19, Institut FŽdŽratif des Neuroscienc es de Lyon (IFNL), CH Ç Le Vinatier È, 95, boulevard Pinel, 69677 Bron cedex, France . Travail reu le 20 dŽcembre 2004 et acceptŽ le 24 fŽvrier 2005. TirŽs ˆ part : T.

dÕAmato (ˆ lÕadresse cidessus). RŽsumŽ.

MalgrŽ des avancŽes rŽcentes, lÕimpact des stra tŽgies thŽrapeutiques mŽdicamenteuses sur lÕamŽlioration de lÕautonomie sociale et des capacitŽs de rŽsolution de pro blmes interpersonnels des patients schizophrnes reste limitŽ, avec des consŽquences en termes de rŽinsertion socioprofessionnelle.

En effet, indŽpendamment des symp t™mes positifs, nŽgatifs et/ou de dŽsorganisation, le dŽficit fonctionnel des patients schizophrnes dŽpend principale ment de dŽficits cognitifs variŽs.

Nos objectifs Žtaient de dŽterminer lÕimpact dÕune stratŽgie de remŽdiation des dŽfi cits cognitifs sur les capacitŽs de rŽsolution de problmes interpersonnels, lÕautonomie sociale et les sympt™mes des patients schizophrnes.

Trente patients schizophrnes ont participŽ ˆ un programme constituŽ de 14 sŽances dÕentra” nement de 4 fonctions cognitives (attention/concentration, mŽmoire topologique, raisonnement logique, fonctions exŽ cutives) au moyen du logiciel REHACOM ¨ .

Les capacitŽs dÕattention soutenue, mŽmoire et fonctions exŽcutives, ainsi que les capacitŽs de rŽsolution de problmes interpersonnels et lÕautonomie sociale et enfin les sympt™mes Žtaient ŽvaluŽs au dŽbut et ˆ la fin des 14 sŽances de remŽdiation .

Les fonc tions cognitives, les capacitŽs de rŽsolution de problmes interpersonnels, lÕautonomie sociale et les sympt™mes ont ŽtŽ significativement amŽliorŽs ˆ lÕissue des sŽances de remŽdiation.

Nos rŽsultats confirment lÕintŽrt thŽrapeutique dÕune remŽdiation cognitive chez 30 patients schizophrnes Impact of a new cognitive remediation strategy on interpersonal problem solving skills and social autonomy in schizophrenia Introduction. Despite recent developments, the impact of pharmacotherapy on s ocial autonomy and interpersonal problem solving skills in patients with schizophrenia remains l imited, with consequences in terms of socioprofessional functioning.

Indeed, independently of the positive, negative an d/or disorganization symptoms, functional deficits in patients with schizophrenia rely mainly on various cognitive impairments .

Objectives. To determine the impact of a new Cognitive Remediation Strategy on interpersonal problem solving skills, s ocial autonomy and symptoms in patients with schizophre nia.

Methods. Thirty patients with schizophrenia were enrolled in a program consisting of 14 training sessions of 4 cognitive functions (attention/concentration, topological memory, logical reasoning, executive functions) using the REHACOM ¨ software.

Measurements of attention (Continuous Performance Tes t, CPT), memory (Rivermead Behavioural Memory Test, RBMT) and executive functions (Wisconsin Card Sorting Tes t, WCST) as well as interpersonal problem solving skills (Assessment of Interpersonal ProblemSolving Skills, AIP SS) and social autonomy (Social Autonomy Scale, EAS) and finally schizophrenia symptoms (Positive And Negative Syndr om Scale, PANSS) were undertaken at the beginning and the end of the 14 remediation meetings.

Results. Cognitive functions, interpersonal problems solving skills, soc ial autonomy and symptoms were significantly improved by the Cognit ive Remediation Strategy.

Conclusion. Our results confirm the therapeutic impact of a Cognitive Remediation Strat egy among 30 schizophrenic patients stabilised on clinical, therapeutic and functional levels.

The question of the longter m maintenance of such improvements still requires further investigation. Key words : Cognitive remediation strategy ; Interpersonal problem solving skills ; Schizophrenia ; Social autonomy.. »