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Purpose/objective: In schizophrenia, insight, the recognition that one has a medical illness that requires treatment, has long been related to deteriorated quality of life. Yet, insight and quality of life are broad constructs that encompass several dimensions. Here, we investigated differential associations between insight and quality-of-life dimensions using a psychological network approach., Research Method/design: We extracted data from the French network of rehabilitation centers REHABase (January 2016 to December 2022, N = 1,056). Our psychological network analysis modeled insight and quality of life as a network of interacting dimensions: three insight dimensions (awareness of illness, reattribution of symptoms to the disease, and recognition of treatment need) and eight quality-of-life dimensions (autonomy, physical and psychosocial well-being, relationships with family, friends and romantic partners, resilience, and self-esteem)., Results: Insight was negatively associated with quality of life. Our psychological network analysis revealed a strong negative association between awareness of disease and self-esteem. Both dimensions were the strongest nodes in the overall network. Our network analysis also revealed a significant but positive connection between recognition of treatment needs and resilience., Conclusion/implications: While insight and quality of life are overall negatively associated, we found both negative and positive connections between insight and quality-of-life dimensions. The negative relationship between insight and quality of life may reflect the deleterious effects of diagnostic labeling on a patient's self-esteem. Yet, acknowledgment of treatment needs may have positive effects on quality of life and may promote recovery, perhaps because it emphasizes the need for support rather than labels and abnormalities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: In schizophrenia, insight, the recognition that one has a medical illness that requires treatment, has long been related to deteriorated quality of life, a phenomenon that has been described as the "insight paradox". Here, we aimed to determine whether certain socio-demographic and clinical characteristics strengthen or weaken this negative relationship., Methods: We used data from the French network of rehabilitation centers REHABase (N = 769). We explored mean differences in quality-of-life scores between patients with good insight vs. poor insight. We also explored modifying effects of socio-demographic and clinical characteristics (sex, education, age, functioning, clinical severity, duration of illness)., Results: Patients with good insight had a decreased quality-of-life total score. Similar effects were found for the following sub-dimensions of quality of life: autonomy, physical and psychological well-being, and self-esteem. The negative effect of insight on quality of life was attenuated for people who had >12 years of education and for people with a higher level of functioning. By contrast, the negative effect of insight on quality of life was accentuated in people with greater clinical severity. Functioning and clinical severity showed similar modifying effects for other quality-of-life dimensions: autonomy, physical and psychological well-being, and self-esteem. Finally, males demonstrated an increased negative association between insight and self-esteem., Conclusions: The relationship between insight and quality of life is moderated by socio-demographic and clinical circumstances. Future inquiries may utilize our findings by integrating socio-demographic and clinical factors in treatment programs designs to conjointly improve insight and quality of life., Competing Interests: Declaration of competing interest None., (Copyright © 2023. Published by Elsevier B.V.)

Aims: Psychosocial rehabilitation (PSR) is at the core of psychiatric recovery. There is a paucity of evidence regarding how the needs and characteristics of patients guide clinical decisions to refer to PSR interventions. Here, we used explainable machine learning methods to determine how socio-demographic and clinical characteristics contribute to initial referrals to PSR interventions in patients with serious mental illness., Methods: Data were extracted from the French network of rehabilitation centres, REHABase, collected between years 2016 and 2022 and analysed between February and September 2022. Participants presented with serious mental illnesses, including schizophrenia spectrum disorders, bipolar disorders, autism spectrum disorders, depressive disorders, anxiety disorders and personality disorders. Information from 37 socio-demographic and clinical variables was extracted at baseline and used as potential predictors. Several machine learning models were tested to predict initial referrals to four PSR interventions: cognitive behavioural therapy (CBT), cognitive remediation (CR), psychoeducation (PE) and vocational training (VT). Explanatory power of predictors was determined using the artificial intelligence-based SHAP (SHapley Additive exPlanations) method from the best performing algorithm., Results: Data from a total of 1146 patients were included (mean age, 33.2 years [range, 16-72 years]; 366 [39.2%] women). A random forest algorithm demonstrated the best predictive performance, with a moderate or average predictive accuracy [micro-averaged area under the receiver operating curve from 'external' cross-validation: 0.672]. SHAP dependence plots demonstrated insightful associations between socio-demographic and clinical predictors and referrals to PSR programmes. For instance, patients with psychotic disorders were more likely to be referred to PE and CR, while those with non-psychotic disorders were more likely to be referred to CBT and VT. Likewise, patients with social dysfunctions and lack of educational attainment were more likely to be referred to CR and VT, while those with better functioning and education were more likely to be referred to CBT and PE., Conclusions: A combination of socio-demographic and clinical features was not sufficient to accurately predict initial referrals to four PSR programmes among a French network of rehabilitation centres. Referrals to PSR interventions may also involve service- and clinician-level factors. Considering socio-demographic and clinical predictors revealed disparities in referrals with respect to diagnoses, current clinical and psychological issues, functioning and education.

Abstract: Unique deficits in synthetic metacognition have been found in schizophrenia when compared with other psychiatric conditions and community controls. Although persons with autism spectrum disorders (ASD) display similar deficits in social cognition relative to those with schizophrenia, to date no study has compared metacognitive function between these groups. We aimed to compare the metacognitive capacities of persons with schizophrenia and ASD and their associations with other outcomes (neurocognition, social cognition, depression, and quality of life). Fifty-six outpatients with schizophrenia or ASD (mean age, 32.50 [9.05]; 67.9% male) were recruited from two French Centers of Reference for Psychiatric Rehabilitation of the REHABase cohort. Evaluation included the Indiana Psychiatric Illness Interview, Metacognition Assessment Scale-Abbreviated, Movie for the Assessment of Social Cognition, and a large cognitive battery. Compared with those with schizophrenia, participants with ASD had higher self-reflectivity ( p = 0.025; odds ratio, 1.38 [1.05-1.86]) in univariable analyses. Metacognitive deficits may be found in ASD with a profile that varies from what is found in schizophrenia. It is possible that methods for enhancing metacognitive abilities during psychiatric rehabilitation may be refined to assist adults with ASD to better manage their own recovery., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

In psychiatry, recent years have seen a change of focus from a clinician- to a patient-centered perspective that emphasizes quality of life as a treatment target. As a complex construct, quality of life is composed of multiple dimensions that interact with one-another (e.g. physical and psychological well-being, relationships, autonomy, self-esteem). Here, we used data from the REHABase cohort, which includes N = 2180 patients from 15 psychosocial rehabilitation centers in France, to explore networks of quality-of-life dimensions among six psychiatric disorders: schizophrenia, neurodevelopmental, bipolar, depressive, anxiety, and personality disorders. Stronger connections (edges) involved the Self-Esteem dimension, such as Self-Esteem-Physical Well-Being, Self-Esteem-Autonomy, Self-Esteem-Psychological Well-Being, and Self-Esteem-Resilience. Self-esteem was also consistently retrieved as the most central node (the dimension with the most connections within each network). Between-group tests did not reveal any differences regarding network structure, overall connectivity, edge-weights, and nodes' centrality. Despite presenting with different symptom profiles, various psychiatric disorders may demonstrate similar inter-relationships among quality-of-life dimensions. In particular, self-esteem may have a crucial inter-connecting role in patients' quality of life. Our findings could support treatment programmes that specifically target self-esteem to improve patients' quality of life in a cost-effective way., (© 2022. The Author(s).)

Self-stigma is associated with poor clinical and functional outcomes in Serious Mental Illness (SMI). There has been no review of self-stigma frequency and correlates in different cultural and geographic areas and SMI. The objectives of the present study were: (1) to review the frequency, correlates, and consequences of self-stigma in individuals with SMI; (2) to compare self-stigma in different geographical areas and to review its potential association with cultural factors; (3) to evaluate the strengths and limitations of the current body of evidence to guide future research. A systematic electronic database search (PubMed, Web of Science, PsycINFO, Scopus, and Ovid SP Cumulative Index to Nursing and Allied Health Literature [CINAHL]) following PRISMA guidelines, was conducted on the frequency, correlates, and consequences of self-stigma in SMI. Out of 272 articles, 80 (29.4%) reported on the frequency of self-stigma (n = 25 458), 241 (88.6%) on cross-sectional correlates of self-stigma and 41 (15.0%) on the longitudinal correlates and consequences of self-stigma. On average, 31.3% of SMI patients reported high self-stigma. The highest frequency was in South-East Asia (39.7%) and the Middle East (39%). Sociodemographic and illness-related predictors yielded mixed results. Perceived and experienced stigma-including from mental health providers-predicted self-stigma, which supports the need to develop anti-stigma campaigns and recovery-oriented practices. Increased transition to psychosis and poor clinical and functional outcomes are both associated with self-stigma. Psychiatric rehabilitation and recovery-oriented early interventions could reduce self-stigma and should be better integrated into public policy., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Female sex/gender has been associated with better longitudinal outcomes in schizophrenia spectrum disorders (SSDs). Few studies have investigated the relationships between female gender and recovery-related outcomes. Women's specific psychiatric rehabilitation needs remain largely unknown., Objective: The objectives of the present study are to investigate sex differences in (1) objective and subjective aspects of recovery and (2) psychiatric rehabilitation needs in a multicenter non-selected psychiatric rehabilitation SSD sample., Methods: 1,055 outpatients with SSD (DSM-5) were recruited from the French National Centers of Reference for Psychiatric Rehabilitation (REHABase) cohort between January 2016 and November 2019. Evaluation included standardized scales for quality of life, satisfaction with life, and well-being and a broad cognitive battery. Socially valued roles at enrollment were recorded. Functional recovery was measured using the Global Assessment of Functioning scale (GAF) and personal recovery with the Stages of Recovery Instrument (STORI)., Results: Female sex was the best predictor of having more than 2 socially valued roles in the multivariate analysis (P < .001; OR [95% CI] = 5.42 [2.34-13.06]). No sex differences were found for functional recovery or personal recovery. Female gender was positively associated with self-stigma (P = .036) and suicidal history (P < .001) and negatively correlated with quality of life (P = .004) and satisfaction with interpersonal relationships (P = .029), an area in which women reported more unmet needs (P = .004)., Conclusions: The present study found that women had poorer subjective recovery-related outcomes and more unmet needs than men. It would therefore be beneficial to develop recovery-oriented interventions addressing women's specific needs and implement these in psychiatric rehabilitation services., (© Copyright 2021 Physicians Postgraduate Press, Inc.)

Background: People suffering from schizophrenia cannot easily access employment in European countries. Different types of vocational programs coexist in France: supported employment, sheltered employment (ShE), and hybrid vocational programs. It is now acknowledged that the frequent cognitive impairments constitute a major obstacle to employment for people with schizophrenia. However, cognitive remediation (CR) is an evidence-based nonpharmacological treatment for these neurocognitive deficits., Methods: RemedRehab was a multicentric randomized comparative open trial in parallel groups conducted in eight centers in France between 2013 and 2018. Participants were recruited into ShE firms before their insertion in employment (preparation phase). They were randomly assigned to cognitive training Cognitive Remediation for Schizophrenia (RECOS) or Treatment As Usual (TAU). The aim of the study was to compare with the benefits of the RECOS program on access to employment and work attendance for people with schizophrenia, measured by the ratio: number of hours worked on number of hours stipulated in the contract., Results: Seventy-nine patients were included in the study between October 2018 and September 2019. Fifty-three patients completed the study. Hours worked / planned hours equal to 1 or greater than 1 were significantly higher in the RECOS group than in the TAU group., Conclusions: Participants benefited from a RECOS individualized CR program allows a better rate of work attendance in ShE, compared to the ones benefited from TAU. Traditional vocational rehabilitation enhanced with individualized CR in a population of patients with schizophrenia is efficient on work attendance during the first months of work integration.

"Psychiatric rehabilitation In schizophrenia Psychiatric rehabilitation is based, on the one hand, on a conception of care oriented towards the search for recovery and, on the other hand, on specific evaluation and therapeutic tools (cognitive remediation, psychoeducation and social skills training in particular) designed to highlight and strengthen the decision-making and action capacities of people with schizophrenia or, more generally, a serious mental illness. The implementation of psychiatric rehabilitation includes 5 steps: commitment to care, which makes it possible to establish a positive therapeutic relationship and assess availability for rehabilitation; multidisciplinary evaluation, which highlights the capacities and limitations, as well as the objectives and needs of the person; co-construction of the psychiatric rehabilitation and recovery project; psychiatric rehabilitation care (including: psychoeducation, cognitive remediation and social skills training); generalization and transfer based on the implementation of the benefits of the treatment sessions in the person's life context. Overall, psychiatric rehabilitation takes into account the needs and demands of people and promotes the success of their own projects.", Competing Interests: L’auteur déclare n’avoir aucun lien d’intérêts.

Competing Interests: L’auteur déclare n’avoir aucun lien d’intérêts.

Cognitive control, the ability to use goal-directed information to guide behaviour, is impaired in schizophrenia, and mainly related to dysfunctions within the fronto-posterior brain network. However, cognitive control is a broad cognitive function encompassing distinct sub-processes that, until now, studies have failed to separate and relate to specific brain regions. The goal of this preliminary fMRI study is to investigate the functional specialization of posterior brain regions, and their functional interaction with lateral prefrontal cortex (LPFC) regions, in schizophrenia. Fourteen healthy participants and 15 matched schizophrenic patients participated in this fMRI study. We used a task paradigm that differentiates two cognitive control sub-processes according to the temporal framing of information, namely the control of immediate context (present cues) vs. temporal episode (past instructions). We found that areas activated during contextual and episodic controls were in dorsal posterior regions and that activations did not significantly differ between schizophrenic patients and healthy participants. However, while processing contextual signals, patients with schizophrenia failed to show decreased connectivity between caudal LPFC and areas located in ventral posterior regions. The absence of group difference in the functional specialization of posterior regions is difficult to interpret due to our small sample size. One interpretation for our connectivity results is that patients present an inefficient extinction of posterior regions involved in attention shifting by prefrontal areas involved in the top-down control of contextual signals. Further studies with larger sample sizes will be needed to ascertain those observations., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Compulsory admission to psychiatric hospital is rising despite serious ethical concerns. Among measures to reduce compulsory admissions, Psychiatric Advance Directives (PAD) are the most promising, with intensive PAD (i.e. facilitated and shared) being the most effective. The aim of the study is to experiment Psychiatric Advance Directives in France., Methods: A multicentre randomized controlled trial and qualitative approach conducted from January 2019 to January 2021 with intent-to-treat analysis., Setting: Seven hospitals in three French cities: Lyon, Marseille, and Paris. Research assistants meet each participant at baseline, 6 months and 12 months after inclusion for face-to-face interviews., Participants: 400 persons with a DSM-5 diagnosis of bipolar I disorder (BP1), schizophrenia (SCZ), or schizoaffective disorders (SCZaff), compulsorily admitted to hospital within the last 12 months, with capacity to consent (MacCAT-CR), over 18 years old, and able to understand French., Interventions: The experimental group (PAD) (expected n = 200) is invited to fill in a document describing their crisis plan and their wishes in case of loss of mental capacity. Participants meet a facilitator, who is a peer support worker specially trained to help them. They are invited to nominate a healthcare agent, and to share the document with them, as well as with their psychiatrist. The Usual Care (UC) group (expected n = 200) receives routine care., Main Outcomes and Measures: The primary outcome is the rate of compulsory admissions to hospital during the 12-month follow-up. Secondary outcomes include quality of life (S-QoL18), satisfaction (CSQ8), therapeutic alliance (4-PAS), mental health symptoms (MCSI), awareness of disorders (SUMD), severity of disease (ICG), empowerment (ES), recovery (RAS), and overall costs., Discussion: Implication of peer support workers in PAD, potential barriers of supported-decision making, methodological issues of evaluating complex interventions, evidence-based policy making, and the importance of qualitative evaluation in the context of constraint are discussed., Trial Registration: ClinicalTrials.gov identifier: NCT03630822. Registered 14th August 2018.

Objectives: To explore whether clozapine users have specific rehabilitation needs compared to users of other antipsychotics., Methods: The study was performed using the REHABase collecting data on persons referred to a French network of psychosocial rehabilitation centers. It was restricted to persons with schizophrenia spectrum disorder using antipsychotics. Multivariate analyses were used to compare baseline functioning and cognitive characteristics in clozapine users vs. users of other antipsychotics., Results: Of the 675 patients identified in the REHABase, one out of ten (n = 70) used clozapine. Compared to users of other antipsychotics, clozapine users had been more frequently hospitalized in psychiatry and presented less frequently with psychoactive substance use. Functional measures did not significantly differ between the two groups. Clozapine users had poorer short-term verbal memory performance than users of other antipsychotics and did not differ on executive performance., Conclusion: Clozapine users may reach a recovery level comparable to that obtained in persons without treatment-resistant schizophrenia. In order to reduce the negative impact of memory deficits on the recovery process of clozapine users, it is necessary to optimize their psychotropic treatment and to promote their access to cognitive remediation programs addressing their specific needs., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Aim: Social cognitive impairments are core features in 22q11.2 deletion syndrome (22q11.2DS) and schizophrenia (SCZ). Indeed, adults with 22q.11.2 DS often have poorer social competence as well as poorer performance on measures of social cognitive skills (emotion recognition and theory of mind, ToM) compared with typically developing people. However, studies comparing specific social cognitive components in 22q11.2DS and SCZ have not yet been widely conducted., Methods: In this study we compared performances of 22q11.2DS and SCZ on both facial emotion recognition and ToM. Patients with 22q11.2DS (n = 18) and matched SCZ patients were recruited. After neuropsychological testing, the facial emotion recognition test assessed the patients' ability to recognize six basic, universal emotions (joy, anger, sadness, fear, disgust, and contempt). The Versailles-situational intentional reading evaluated ToM with six scenes from movies showing characters in complex interactions (involving hints, lies, and indirect speech)., Results: We show that 22q11.2DS exhibited significantly lower performance in emotion recognition than SCZ patients did, especially for disgust, contempt, and fear. This impairment seems to be a core cognitive phenotype in 22q11.2DS, regardless of the presence of SCZ symptoms. Concerning ToM, our results may highlight the same impairment level in 22q11.2DS and SCZ but require to be replicated in a larger cohort., Conclusion: Our results document the existence of threshold social cognitive deficits distinguishing 22q11.2DS from SCZ., (© 2018 John Wiley & Sons Australia, Ltd.)

Phenomenologists have provided a detailed description of the disorders of the subjective experience associated with minimal-self disorders in patients with schizophrenia. Those patients report a range of distortions of their conscious experiences, including a sense of inner void, confusion between self and others, and, sometimes, a disruption of the sense of time. These reports have been interpreted as distortion of the first-person perspective and a lack of immersion in the world, associated with a breakdown of the temporal structure of consciousness, and especially a disruption of the sense of time continuity. Further, it has been proposed that these disruptions are based on a difficulty to retain past information and to predict future information, that is, the mechanisms that help to relate events with one another and to reach a sense of time continuity. Experimental psychology results seem to converge to similar conclusions, inasmuch as some results in patients with schizophrenia suggest a deficient ability to predict sequences of events at the millisecond level. Several studies have underlined this convergence. Here we reflect on the limits of both the phenomenological and experimental psychology approaches, and of the convergence of their hypotheses. We think that this reflection is necessary to avoid premature conclusions on the mechanisms underlying the impairments in patients, but also to enrich our understanding of schizophrenia., (© 2019 The Institute of Psychology, Chinese Academy of Sciences and John Wiley & Sons Australia, Ltd.)

Persons suffering from schizophrenia present cognitive impairments that have a major functional impact on their lives. Particularly, executive functions and episodic memory are consistently found to be impaired. Neuroimaging allows the investigation of affected areas of the brain associated with these impairments and, moreover, the detection of brain functioning improvements after cognitive remediation interventions. For instance, executive function impairments have been associated with prefrontal cortex volume and thickness; cognitive control impairments are correlated with an increased activation in the anterior cingulate cortex, and episodic memory impairments are linked to hippocampal reduction. Some findings suggest the presence of brain compensatory mechanisms in schizophrenia, e.g. recruiting broader cortical areas to perform identical tasks. Similarly, neuroimaging studies of cognitive remediation in schizophrenia focus differentially on structural, functional and connectivity changes. Cognitive remediation improvements have been reported in two main areas: the prefrontal and thalamic regions. It has been suggested that those changes imply a functional reorganisation of neural networks, and cognitive remediation interventions might have a neuroprotective effect. Future studies should use multimodal neuroimaging procedures and more complex theoretical models to identify, confirm and clarify these and newer outcomes. This chapter highlights neuroimaging findings in anatomical and functional brain correlates of schizophrenia, as well as its application and potential use for identifying brain changes after cognitive remediation.

Objectives: The association between schizophrenia and violence represents an important issue in psychiatry. Often highly publicized, violent acts raise the question of their detection, prevention, management and treatment. There is no single, direct and exclusive link between aggressiveness and the underlying psychiatric disorder. On the contrary, the processes underlying this violence are multiple and interlinked. In addition to static and dynamic risk factors, cognitive deficits play an important role in the genesis and maintenance of violent and aggressive behavior., Methods: Using recent data from the international literature and the main databases, we first clarify the role played by cognitive deficits in the violence of patients with schizophrenia. We then evaluate the place of psychosocial interventions such as cognitive remediation and social cognitive training in managing the violent and aggressive behavior of these patients., Results: Executive functions and working memory are the most studied neurocognitive functions in the field of violence in schizophrenia. Impulsivity, lack of cognitive flexibility, lack of adaptation and inhibition of automatic motor responses, and altered anger regulation may explain this relationship. Three main components of social cognition are associated with violent behaviors in schizophrenia: (1) the recognition of facial emotions through the inoperability of systems of "emotional monitoring", violent inhibition and recognition of informative facial zones; (2) the theory of the mind through the erroneous interpretation of the intentions of others; (3) the attributional style through the preferentially aggressive over interpretation of social situations and weak capacities of introspection. Overall, cognitive biases inhibit response in a socially acceptable manner and increase the risk of responding impulsively and aggressively to a stressful or provocative situation. In this context, we studied the place held by psychosocial interventions in the management of the violent and aggressive behaviors of these patients. Various cognitive remediation programs have shown their feasibility in people with schizophrenia and neurocognitive deficits with a history of violence as well as their effectiveness in reducing violence, mainly by reducing impulsivity. Similarly, specific programs dedicated to social cognitive training such as Social Cognition and Interaction Training (SCIT), Reasoning and Rehabilitation Mental Health Program (R&R2 MHP) and Metacognitive Training (MCT) have shown their positive impact on the control and reduction of global aggressive attitudes and on the numbers of physical and verbal aggressive incidents in schizophrenia. The improvement of social cognition would be achieved through the amendment of interpersonal relationships and social functioning. These interventions are effective at different stages of disease progression, in patients with varied profiles, on violent attitudes in general and on the number of verbal and physical attacks, whether for in-patients or out-patients. Beneficial effects can last up to 12months after termination of the study program. The interest of these interventions is preventive if the subject never entered in a violent register or curative in case of a personal history of violence. This type of care can be considered from a symptomatic point of view by limiting downstream the heavy consequences of such acts, but also etiologically by acting on one of the causes of violent behavior. Compliance with the eligibility criteria, carrying out a prior functional analysis and confirmation of the major impulsive part of the patient's violence are prerequisites for the use of these programs. Similarly, the early introduction of such therapies, their repetition over time and the integration of the patient into a comprehensive process of psychosocial rehabilitation will ensure the best chance of success., Conclusions: Some cognitive impairments appear to have their place in the genesis, progression and maintenance of violent acts of individuals with schizophrenia. Their management thus opens new therapeutic perspectives such as cognitive remediation, still rarely used in this aim, to complement the action of the traditional care tools. However, further therapeutic trials are needed before considering cognitive remediation and social cognitive training as central care modalities in the therapeutic control of violence in schizophrenia., (Copyright © 2017 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Context: cognitive remediation involves either intensive training of impaired functions or implementing strategies to compensate for these impairments. In cases of schizophrenia, both methods have demonstrated benefits in terms of behavior and cerebral activity. However, despite the major differences between these two approaches, their impact has not yet been compared., Method: We searched the PsychInfo, Pubmed, and ScienceDirect databases using the key words "cognitive remediation," "schizophrenia," "cerebral activity," and "magnetic resonance imaging," in order to select studies investigating the effects of cognitive remediation on patients with schizophrenia. The studies selected had to present their approach in detail and measure its impact in terms of both cerebral activity and cognitive function, both before and after therapy. We divided the studies into two groups, those using the strategy method and those using the training method., Results: Eight studies were included in the review, four for the strategy method (88 patients, 44 of whom underwent remediation) and 4 for the training method (87 patients, 43 of whom underwent remediation). The analysis of the results of this study indicates that the training method is capable of activating more the targeted brain areas than the strategy method. However, the latter appears to encourage more extensive activation of the cerebral networks., Discussion: The studies used for this review vary widely in terms of the imaging methods and protocol. However, differences were found between the two methods and lead us to suggest that further studies, with proper bias control, should be conducted to systematically compare the two approaches.

Patients with schizophrenia have difficulty in making sensory predictions, in the time domain, which have been proposed to be related to self-disorders. However experimental evidence is lacking. We examined both voluntary and automatic forms of temporal prediction in 28 patients and 24 matched controls. A visual cue predicted (temporal cue) or not (neutral cue) the time (400 ms/1000 ms) at which a subsequent target was presented. In both patients and controls, RTs were faster for targets presented after long versus short intervals due to the temporal predictability inherent in the elapse of time ("hazard function"). This RT benefit was correlated with scores on the EASE scale, which measures disorders of the self: patients with a high 'self-awareness and presence' score did not show any significant benefit of the hazard function, whereas this ability was preserved in patients with a low score. Moreover, all patients were abnormally sensitive to the presence of "catch" trials (unexpected absence of a target) within a testing block, with RTs actually becoming slower at long versus short intervals. These results indicate fragility in patients' ability to continuously extract temporally predictive information from the elapsing interval. This deficit might contribute to perturbations of the minimal self in patients.

A significant correlation exists between violence and schizophrenia (SCZ). Recent studies matched some cognitive deficits like strong risk factors for violence with interesting applications in terms of treatment. Our objective was to conduct a systematic review of the effectiveness of cognitive remediation (CR) and social cognitive training (SCT) in the management of violent and aggressive behaviors in SCZ., Methods: The electronic databases Pubmed, Web of Science, Cochrane Library and ScienceDirect were searched in, using combinations of terms relating to SCZ, CR and violence. Studies were selected and data were extracted using a PRISMA statement. Inclusion criteria were adults with SCZ and a documented collection of disruptive and violent behaviors, for whom researchers had used a CR or SCT program., Results: Eleven studies were identified, two related to non-specific CR intervention and nine to codified CR or SCT programs. Results showed that these programs had a positive impact on the control and reduction of global aggressive attitudes and physical assaults. Therapeutic targets were social cognition and executive functions through the improvement of interpersonal relationships and impulsivity feature respectively. Effectiveness was proved at various stages of the illness, in different types of patients and units, with effects persisting for up to 12 months after interruption of CR. Conclusions are limited by some methodological restrictions., Conclusion: Although current evidences need to be completed with further randomized studies, CR and SCT appear to be promising approaches in the management of violence in SCZ., (Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.)

The 22q11.2 deletion syndrome (22q11.2DS) is one of the most common microdeletion syndromes, with a widely underestimated prevalence between 1 per 2000 and 1 per 6000. Since childhood, patients with 22q11.2DS are described as having difficulties to initiate and maintain peer relationships. This lack of social skills has been linked to attention deficits/hyperactivity disorder, anxiety and depression. A high incidence of psychosis and positive symptoms is observed in patients with 22q11.2DS and remains correlated with poor social functioning, anxiety and depressive symptoms. Because 22q11.2DS and schizophrenia share several major clinical features, 22q11.2DS is sometimes considered as a genetic model for schizophrenia. Surprisingly, almost no study suggests the use of cognitive and behavioral therapy (CBT) in this indication. We reviewed what should be learned from schizophrenia to develop specific intervention for 22q11.2DS. In our opinion, the first step of CBT approach in 22q11.2DS with psychotic symptoms is to identify precisely which tools can be used among the already available ones. Cognitive behavioral therapy (CBT) targets integrated disorders, i.e. reasoning biases and behavior disorders. In 22q11.2DS, CBT-targeted behavior disorders may take the form of social avoidance and withdrawal or, in the contrary, a more unusual disinhibition and aggressiveness. In our experience, other negative symptoms observed in 22q11.2DS, such as motivation deficit or anhedonia, may also be reduced by CBT. Controlled trials have been studying the benefits of CBT in schizophrenia and several meta-analyses proved its effectiveness. Therefore, it is legitimate to propose this tool in 22q11.2DS, considering symptoms similarities. Overall, CBT is the most effective psychosocial intervention on psychotic symptoms and remains a relevant complement to pharmacological treatments such as antipsychotics., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Schizophrenia is characterized not only by symptoms, but also by a reduced insight that contributes to functional outcomes through a bad acceptation of the disease and a low involvement in treatment and care. Functional outcomes of schizophrenia are conditioned by the acceptance of the troubles, by the involvement in psychopharmacological treatment and in psychosocial care and by the expressed emotion level of the family. Psychoeducation improves adherence to treatment. Psychoeducation lowers relapse rate. All the patients suffering from schizophrenia and their families should benefit from psychoeducation., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Objective: We examined Theory of Mind (ToM) abilities in adolescents with early-onset schizophrenia (EOS) and their correlation with clinical findings and Executive Functions (EF)., Methods: The ToM abilities of 12 adolescents with EOS were compared with those of healthy participants matched in age and educational level. The Moving Shapes Paradigm was used to explore ToM abilities in three modalities: random movement, goal-directed movement and ToM - scored on the dimensions of intentionality, appropriateness and length of each answer. EF was tested using Davidson's Battery and the clinical psychopathology with the Positive and Negative Syndrome Scale (PANSS)., Results: Adolescents with EOS were significantly more impaired than controls in the three dimensions evaluated for the goal-directed and ToM modalities. Regarding the random movement modality, the only difference was in appropriateness (p<0.01). No correlation with age or level of education was evident for ToM skills. Total PANSS score was negatively correlated with appropriateness score for the goal-directed (p=0.02) and ToM modalities (p=0.01). No correlation existed between performance in the ToM Animated Tasks and positive, negative or disorganisation PANSS subscores. No correlations were found among the three scores in the Moving Shapes Paradigm and any measures of the accuracy of the three tasks assessing EF., Conclusion: Our results confirm previous findings of ToM deficits in adult individuals with schizophrenia and attest the severity of these deficits in patients with EOS.

Health care that addresses the emotional regulation capacity of patients with schizophrenia confronted with daily stress may contribute to a less anxious life. A psycho-physiological training [cardiac coherence training (CCT)] focusing on emotion regulation is known to decrease anxiety for healthy individuals. We performed a pilot cross sectional survey to explore the benefits of CCT for clinically stable patients with schizophrenia. Ten patients were enrolled in the program consisting of twelve weekly 1-h session programs monitored over a 2-month period. Standardised questionnaires were used before and after the intervention to assess anxiety, well-being outcomes, and how patients deal with stress and stressors. Results showed that this quite-well accepted intervention improved (or tended to improve) well-being outcomes, state-anxiety, and emotional stressors evaluation. The successful transformations were higher for patients with the highest clinical and emotional suffering. Thus, this pilot study revealed that CCT may help patients with schizophrenia to deal with anxiety in daily life., Competing Interests: Compliance with Ethical Standards Conflict of interest The authors declare that there are no competing interests.

Getting and keeping a job are not only one of the criteria of recovery from schizophrenia, but are also one of its main means. Indeed, recovery is partly defined by the ability to work. Despite the lack of data in France about employment of people with schizophrenia, it is widely acknowledged that the employment rate of people with schizophrenia remains quite low, and frequently it is only an employment in sheltered workshops, not on the regular work market. International research data show that it is possible to improve significantly this employment rate, with an appropriate support, that is precisely defined by the current researches, and that is quickly spreading in most developed countries. The aim of this paper is to present, on the basis of a broad current literature review, the key predictive factors of the return to work for people with schizophrenia, and the strategies to optimize vocational services. It will appear that there are several ways to improve practices and interventions in France to support work integration. To begin with individual factors of work integration, dependant on each person, the clinical state and the cognitive skills (in a broad sense, including social cognition and metacognition) are to be taken into account, and optimized by means of the association of a finely tuned pharmacological treatment and psychosocial interventions such as cognitive remediation adjusted to the person's specific needs. The other main kind of factors is environmental factors, particularly the kind of vocational support, which turns out to have a major impact not only on job acquisition, but importantly also on job tenure. The most effective vocational services are based on the "Place and train" model, and even more precisely on the Individual Placement and Support (IPS) model, that allows to the majority of people with a severe mental illness (more than 50%) to obtain a competitive employment after 6 to 18 months of individualized support. This approach is now widely recommended as "an evidence-based practice" of rehabilitation. It is important to promote in France the development of this kind of practice, already implemented as an experiment by few militant and involved associations. This development remains in France slow and delayed (compared to the practices in the other European countries) because of the lack of public funding. It implies an evolution of the social and medico-social practices, taking into account current research data, and assessing the outcomes of their practices in order to improve them. The employment specialist (sometimes called also the "job coach") turns out to play a key role, emphasized by current research, implying, among many other tasks, to coordinate the net of people supporting the work integration, including the clinical team, the employer and the colleagues of the workplace., (Copyright © 2015 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Rehabilitation techniques aim to reduce the functional impact of severe psychological disorders. The recent development of techniques aimed at the manifestations of the pathology, such as psychoeducation and cognitive remediation, raise questions about how they differ from standard therapies. Beyond their functional purpose, the consideration of the individual's current or future action potential, seems to constitute one of the key aspects., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Introduction: The impairment of social cognition, including facial affects recognition, is a well-established trait in schizophrenia, and specific cognitive remediation programs focusing on facial affects recognition have been developed by different teams worldwide. However, even though social cognitive impairments have been confirmed, previous studies have also shown heterogeneity of the results between different subjects. Therefore, assessment of personal abilities should be measured individually before proposing such programs., Purpose: Most research teams apply tasks based on facial affects recognition by Ekman et al. or Gur et al. However, these tasks are not easily applicable in a clinical exercise. Here, we present the Facial Emotions Recognition Test (TREF), which is designed to identify facial affects recognition impairments in a clinical practice. The test is composed of 54 photos and evaluates abilities in the recognition of six universal emotions (joy, anger, sadness, fear, disgust and contempt). Each of these emotions is represented with colored photos of 4 different models (two men and two women) at nine intensity levels from 20 to 100%. Each photo is presented during 10 seconds; no time limit for responding is applied., Method: The present study compared the scores of the TREF test in a sample of healthy controls (64 subjects) and people with stabilized schizophrenia (45 subjects) according to the DSM IV-TR criteria. We analysed global scores for all emotions, as well as sub scores for each emotion between these two groups, taking into account gender differences. Our results were coherent with previous findings. Applying TREF, we confirmed an impairment in facial affects recognition in schizophrenia by showing significant differences between the two groups in their global results (76.45% for healthy controls versus 61.28% for people with schizophrenia), as well as in sub scores for each emotion except for joy. Scores for women were significantly higher than for men in the population without psychiatric diagnosis. The study also allowed the identification of cut-off scores; results below 2 standard deviations of the healthy control average (61.57%) pointed to a facial affect recognition deficit., Conclusion: The TREF appears to be a useful tool to identify facial affects recognition impairment in schizophrenia. Neuropsychologists, who have tried this task, have positive feedback. The TREF is easy to use (duration of about 15 minutes), easy to apply in subjects with attentional difficulties, and tests facial affects recognition at ecological intensity levels. These results have to be confirmed in the future with larger sample sizes, and in comparison with other tasks, evaluating the facial affects recognition processes., (Copyright © 2014 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

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.)

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.

The tendency to over-interpret events of daily life as resulting from voluntary or intentional actions is one of the key aspects of schizophrenia with persecutory delusions. Here, we ask whether this characteristic may emerge from the abnormal activity of a basic cognitive process found in healthy adults and children: the intentionality bias, which refers to the implicit and automatic inclination to interpret human actions as intentional (Rosset, 2008, Cognition 108, 771-780). In our experiment, patients with schizophrenia and healthy controls were shown sentences describing human actions in various linguistic contexts, and were asked to indicate whether the action was intentional or not. The results indicated that people with schizophrenia exhibited a striking bias to over attribute intentionality regardless of linguistic context, contrary to healthy controls who did not exhibit such a general intentionality bias. Moreover, this study provides some insight into the cognitive mechanisms underlying this bias: an inability to inhibit the automatic attribution of intentionality., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

People with schizophrenia are known to exhibit difficulties in the updating of their current belief states even in the light of disconfirmatory evidence. In the present study we tested the hypothesis that people with schizophrenia could also manifest perceptual inflexibility, or difficulties in the updating of their current sensory states. The presence of perceptual inflexibility might contribute both to the patients' altered perception of reality and the formation of some delusions as well as to their social cognition deficits. Here, we addressed this issue with a protocol of auditory hysteresis, a direct measure of sensory persistence, on a population of stabilized antipsychotic-treated schizophrenia patients and a sample of control subjects. Trials consisted of emotional signals (i.e., screams) and neutral signals (i.e., spectrally-rotated versions of the emotional stimuli) progressively emerging from white noise - Ascending Sequences - or progressively fading away in white noise - Descending Sequences. Results showed that patients presented significantly stronger hysteresis effects than control subjects, as evidenced by a higher rate of perceptual reports in Descending Sequences. The present study thus provides direct evidence of perceptual inflexibility in schizophrenia., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Recovery is partly defined by the patients' capacity to work, since doing well in a job favors hope and responsibilities' taking. Diminished job placement or tenure is linked with cognitive disorders, which impact directly and indirectly (through negative symptoms) functional outcomes. Attention, executive functions and working memory disorders can result in an alteration of the ability to manage the tasks required in the workplace. Executive function, working memory and social cognition disorders may also have an impact on behavior in relationships. Cognitive disorders do not automatically directly contribute to vocational outcome, yet their effects may be mediated by other variables such as symptoms, metacognition, social skills and intrinsic motivation. Then, since all these dimensions have to be taken into account, reducing the impact of cognitive troubles becomes a major challenge for the care of schizophrenia. Cognitive remediation is the more effective therapeutic tool to reduce cognitive dysfunctions. It rests in particular on the development of new strategies that allow taking concrete situations into account more efficiently. Cognitive remediation reduces the detrimental consequences of cognitive disorders and permits their compensation. It has emerged as an effective treatment, that improves not only cognitive abilities but also functioning, as it has been shown by numerous randomized controlled studies and several meta-analyses. The present article considers the effects on cognitive remediation on work function in schizophrenia. Several randomized controlled trials that compared supported employment alone versus supported employment associated with cognitive remediation showed significant improvement of employment rates in the latter condition. These results favor the use of cognitive remediation before job placement. The specific needs of the occupation that will be provided and the cognitive profile of the user should be taken into account., (Copyright © 2014. Published by Elsevier Masson SAS.)

Childhood schizophrenia is a rare but serious developmental disorder affecting most of the fields involved in the child's adaptive functioning: motor, emotional, cognitive, and social. The clinical expression of the disorder mainly depends on the child's age and the IQ level at the time the first clinical symptoms appear. The progression of childhood schizophrenia is generally poor, with different outcome studies suggesting a continuity of the process between childhood and adulthood. This stresses the importance of diagnosing the disorder early and initiating the adapted therapeutic measures as quickly as possible, including cognitive remediation (a new therapeutic tool to correct or anticipate cognitive disorders), which can prevent pejorative development., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Background: This study assesses the benefits of an individualized therapy (RECOS program) compared with the more general cognitive remediation therapy (CRT)., Methods: 138 participants took part with 65 randomized to CRT and 73 to RECOS. In the RECOS group, participants were directed towards one of five training modules (verbal memory, visuo-spatial memory and attention, working memory, selective attention or reasoning) corresponding to their key cognitive concern whereas the CRT group received a standard program. The main outcome was the total score on BADS (Behavioural Assessment of Dysexecutive Syndrome) and the secondary outcomes were: cognition (executive functions; selective attention; visuospatial memory and attention; verbal memory; working memory) and clinical measures (symptoms; insight; neurocognitive complaints; self-esteem). All outcomes were assessed at baseline (T1), week 12 (posttherapy, T2), and follow-up (week 36, i.e., 6months posttherapy, T3)., Results: No difference was shown for the main outcome. A significant improvement was found for BADS' profile score for RECOS at T2 and T3, and for CRT at T3. Change in BADS in the RECOS and CRT arms were not significantly different between T1 and T2 (+0.86, p=0.108), or between T1 and T3 (+0.36, p=0.540). Significant improvements were found in several secondary outcomes including cognition (executive functions, selective attention, verbal memory, and visuospatial abilities) and clinician measures (symptoms and awareness to be hampered by cognitive deficits in everyday) in both treatment arms following treatment. Self-esteem improved only in RECOS arm at T3, and working memory improved only in CRT arm at T2 and T3, but there were no differences in changes between arms., Conclusions: RECOS (specific remediation) and CRT (general remediation) globally showed similar efficacy in the present trial., (Copyright © 2013 Elsevier B.V. All rights reserved.)

The dominant cognitive model that accounts for the persistence of delusional beliefs in schizophrenia postulates that patients suffer from a general deficit in belief revision. It is generally assumed that this deficit is a consequence of impaired reasoning skills. However, the possibility that such inflexibility affects the entire system of a patient's beliefs has rarely been empirically tested. Using delusion-neutral material in a well-documented advice-taking task, the present study reports that patients with schizophrenia: 1) revise their beliefs, 2) take into account socially provided information to do so, 3) are not overconfident about their judgments, and 4) show less egocentric advice-discounting than controls. This study thus shows that delusional patients' difficulty in revising beliefs is more selective than had been previously assumed. The specificities of the task and the implications for a theory of delusion formation are discussed.

Background: In schizophrenia, disturbances of cognitive control have been associated with impaired functional specialization within the lateral prefrontal cortex (LPFC), but little is known about the functional interactions between specialized LPFC subregions. Here, we addressed this question with a recent model that describes the LPFC functioning as a cascade of control processes along a rostrocaudal axis, whereby anterior frontal regions influence the processing in posterior frontal regions to guide action selection on the basis of the temporal structure of information., Methods: We assessed effective connectivity within the rostrocaudal axis of the LPFC by means of functional magnetic resonance imaging in 15 schizophrenic patients and 14 matched healthy control subjects with structural equation modeling and psychophysiological interactions., Results: In healthy subjects, activity in the left caudal LPFC regions was under the influence of left rostral LPFC regions when controlling information conveyed by past events. By contrast, schizophrenic patients failed to demonstrate significant effective connectivity from rostral to caudal LPFC regions in both hemispheres., Conclusions: The hierarchical control along the rostrocaudal axis of the LPFC is impaired in schizophrenia. This provides the first evidence of a top-down functional disconnection within the LPFC in this disorder. This disruption of top-down connectivity from rostral to caudal LPFC regions observed in patients might affect their ability to select the appropriate sets of stimulus-response associations in the caudal LPFC on the basis of information conveyed by past events. This impaired hierarchical control within the LPFC could result from poorly encoded contextual information due to abnormal computations in the caudal LPFC., (Copyright © 2011 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.)

Patients with schizophrenia have pronounced deficits in face recognition memory that severely hamper their social skills. The functional mechanisms of these impairments remain unknown. According to the dual-process theory, recognition memory comprises two distinct components: recollection and familiarity. Studies using the Remember/Know procedure in patients with schizophrenia showed impairments in conscious recollection as measured by remember responses, but not in familiarity as measured by know responses. Unfortunately, none of these studies used face material. We investigated both recognition memory components using words and faces and the 'Remember/Know' procedure in 25 patients with schizophrenia and 24 control participants. In the same task, size congruency of stimuli was manipulated between the study and test phases to have a selective impact on know responses for faces. Patients reported fewer remember responses than controls. Size changes between the study and the test affected know responses in controls but not in patients. These results reveal that patients with schizophrenia are impaired in terms of their ability to recollect details about previously seen faces as they are for words., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Cognitive remediation is efficient to treat cognitive disorders associated with schizophrenia. Since (i) these disorders play a negative role in functional outcome and (ii) antipsychotics do not improve significantly cognition, cognitive remediation should be systematically used with patients with schizophrenia and after the first episode of psychosis. A comprehensive neuropsychological assessment, that precedes the beginning of cognitive remediation, allows targeting the most impaired cognitive domains. Cognitive remediation intervention takes place after symptoms stabilization. It needs also that the antipsychotic treatment was prescribed at minimal fully effective dose and that the patients have acquired a minimal understanding of their disease (i.e. after psychoeducation). Cognitive remediation programs that have been validated for schizophrenia (NEAR, CET, NET, IPT, CRT…) can be used after the first episode of psychosis., (Copyright © 2010 L'Encéphale. Published by Elsevier Masson SAS.. All rights reserved.)

Background: Cognitive impairments are a core feature in schizophrenia. They impact several cognitive abilities but most importantly attention, memory and executive functions, consequently leading to great difficulties in everyday life. Most schizophrenia patients need assurance and require assistance and help from care workers, family members and friends. Family members taking care of a patient have additional daily work burden, and suffer psychological anguish and anxiety. Therefore, improving cognitive functions in schizophrenia patients is essential for the well-being of patients and their relatives. Reducing these deficits may decrease the economic burden to the health care system through lower numbers of hospital admissions and shorter hospitalisation periods, for example. Cognitive rehabilitation was developed to address the limited benefits of conventional treatments on cognitive deficits through the use of assistive technology as a means of enhancing memory and executive skills in schizophrenia patients., Objective: To provide clinicians with comprehensive knowledge on cognitive trainings, programs of remediation, and cognitive assistive technologies., Method: Literature review. A search in the electronic databases (PubMed, EMBASE, Index Medicus) for recent articles in the last 10 years related to cognitive remediation published in any language using the words: cognitive and remediation or rehabilitation and schizophrenia, and a search for chapters in psychiatry and rehabilitation textbooks., Results: We found 392 articles and 112 review paper mainly in English. First, we identified cognitive remediation programs that were beneficial to schizophrenia patients. Programs available in French (IPT, RECOS, and RehaCom) and others (CET, NET, CRT, NEAR, APT and CAT) were identified. In addition, since memory and executive function impairments could be present in people without schizophrenia, we reviewed inventories of cognitive assistive technologies proven to enhance cognitive skills in other populations. Finally, we present a review of recent studies testing innovative devices developed to assist schizophrenia patients., Discussion: First, we found several cognitive programs proven to be effective with schizophrenia patients, but only three were validated in French. It could be useful to adapt other programs for French-speaking populations. Unfortunately, we found that very few of the existing cognitive assistive technologies are proposed to be used with schizophrenia patients. In fact, most of the available cognitive orthoses were tested primarily in people with neurological injuries (for example, various memory impairments caused by traumas), and in elderly illnesses (like Alzheimer disease). Devices for patients with mental deficits (e.g., mental retardation) were developed later, and only very recently explored for use in schizophrenia. As a result of an international collaboration between France and Canada, currently a tool called MOBUS is being tested. This technology aims at improving the autonomy of schizophrenia patients, by helping them plan and remember their daily activities. Furthermore, it encourages patient-caregiver communication, and permits monitoring patients' subjective reports of their symptoms. The use of cognitive assistive technologies is not meant to isolate patients by replacing the human element of relatives and caregivers by a machine. On the contrary, they offer a sense of security and they improve interpersonal relationships by permitting enhanced autonomy and greater self-confidence. Finally, a literature review of cognitive remediation in schizophrenia emphasizes the importance of a structured application of the technique in order for it to succeed. First, it is crucial to detect the impairments that will be targeted in each patient presenting a specific pattern of impairments. For this purpose, validated and customised neuropsychological tests are required. Then, cognitive remediation programs must be customised to each patient's needs in order to motivate the patient to participate. Finally, long-term effects must be assessed in order to verify whether reinforcement is needed. Following these steps, most of the studies show an improvement in the well-being of patients with schizophrenia. These recommendations are also suitable for the cognitive remediation programs, as for treatments with cognitive assistive devices. An important hurdle facing the advance of cognitive assistive technology programs is that different research groups work individually without a coordinated effort to improve and validate the existing programs., Conclusion: Schizophrenia treatments must take into account not only patients' symptoms, but also the associated cognitive deficits which constitute an important factor in their social problems. It has been shown that several cognitive remediation programs are efficient in schizophrenia. New technologies complement the benefits of such programs, and support pharmacological treatments and psychotherapies.

Contemporary experimental research has emphasised the role of centrally generated signals arising from premotor areas in voluntary muscular force perception. It is therefore generally accepted that judgements of force are based on a central sense, known as the sense of effort, rather than on a sense of intra-muscular tension. Interestingly, the concept of effort is also present in the classical philosophy: to the French philosopher Maine de Biran [Maine de Biran (1805). Mémoire sur la décomposition de la pensée (Tome III), Vrin, Paris (1963)], the sense of effort is the fundamental component of self-experience, the landmark of the exercise of the will. In the present review, after a presentation of the nature and neurophysiological bases of effort sensation, we will examine its possible involvement in the neurocognitive process of agency. We will further focus on delusions of alien control in schizophrenic patients. Experimental data suggest that these patients have an abnormal awareness of effort caused by cerebral anomalies in the frontal and parietal lobes.

First-rank symptoms of schizophrenia have been related to an impaired sense of agency (the sense of causing and controlling an action). The sense of agency is considered as one of the two components of self-recognition, the other component being the sense of body (awareness of one's body). The present study aimed at evaluating whether first-rank symptoms can be considered as a general impairment in self-recognition that will also concern the sense of body. A group of schizophrenic patients with first-rank symptoms, a group of schizophrenic patients without first-rank symptoms and a group of normal subjects were compared in a self-recognition task where they first had to execute hand movements simultaneously with the experimenter and subsequently to indicate the position either of their own or the experimenter's hand. The visualized locations of the hands could rotate by 0 degrees , 90 degrees , -90 degrees or 180 degrees from their real locations. This rotation allowed us to induce a distorted sense of body since there was a visual discontinuity between the patient's hand and the rest of his/her body. If patients present a perturbed sense of body we would expect a greater impairment in discriminating between their own hand and the experimenter's hand as the rotation values increased. This preliminary study shows that patients with first-rank symptoms are more impaired than normal subjects in distinguishing between their own hands and the experimenter's hands when the visualization of the locations of their hands were rotated respective to their real locations. However, both group of patients performed equally, thus showing that sense of body impairment is not specific to first-rank symptoms. These symptoms, compared to other symptoms of schizophrenia do not reflect general self-recognition impairment but rather a specific impairment of the sense of agency.

Cognitive remediation is a type of treatment added recently to the range of tools available to therapists. It includes a number of miscellaneous methods that aim to correct some of the cognitive impairments observed in schizophrenia. These cover the fields of target attention, memory and executive deficits, as well as impaired social cognition. Cognitive remediation acts as a complement to medication and psychological therapies, which constitute the core methods of treatment for schizophrenia. The present paper reviews the state of the art in cognitive remediation. The principle underlying this innovative therapeutic approach is the enhancement of the cognitive resources of patients with schizophrenia in order to improve their cognitive functions, social skills and in some cases alleviate some of the symptoms of the disease. Several programs developed within the past two decades (e.g., IPT, CRT, NEAR, CET, NET, CRT and CAT) are becoming more widely used. Their efficacy on neurocognition and on functional outcome has been demonstrated, with inconstant continuation of benefit after completion of treatment. The sustainability of the cognitive and functional improvements following completion of these programs has to be further studied. Other programs aimed at acting upon altered social cognition (one of the critical facets of schizophrenia) are still in the experimental stages, but the results obtained so far are encouraging. A preliminary study has also demonstrated the effectiveness of board games in improving cognitive functioning, which seems to be a highly promising therapeutic avenue owing to its ease of use.

This study investigated the processing of second-order relational face information in schizophrenia. Twenty-eight schizophrenic patients and 28 controls were asked to say whether the space between the eyes was the same in 2 side-by-side faces. The 2 faces were derived from the same original face, but the spacing between the eyes was either the same or differed by various distances. The results showed that schizophrenic patients needed a space that was twice as great as controls to see a difference. The authors conclude that schizophrenic patients have a deficit in processing second-order relational face information.

Introduction: Previous studies show that patients with schizophrenia have a deficit in facial emotion recognition. In the framework of emotion categorisation theories, the purpose of the present study was to test if this impairment could result from abnormal boundaries between emotions (whether these boundaries are shifted along continuums or are less sharpened)., Method: Twenty-six schizophrenic patients and the same number of healthy participants were required to perform a facial emotion recognition task and an emotion categorisation task with different emotion intensities obtained using morphing techniques., Results: The main results indicate that schizophrenic patients exhibited an emotion space with less sharpened categories which favoured confusion between different emotions and intrusions of other emotions. Moreover, correlations between different indices showed that the less sharpened the categories, the more frequent the intrusions and the less discriminable the facial emotions., Conclusion: We conclude that patients with schizophrenia process facial expressions in a less categorical way which involves impaired recognition of facial expressions. Such a specific impairment may favour false perceptions and lead to the settlement of delusional ideas.

Schizophrenia is characterized by an altered sense of the reality, associated with hallucinations and delusions. Some theories suggest that schizophrenia is related to a deficiency of the system that generates information about the sensory consequences of the actions realized by the subject. This system monitors the reafferent information resulting from an action and allows its anticipation. In the present study, we examined visual-event-related potentials (ERPs) generated by a sensorimotor task in 15 patients with schizophrenia and 15 normal controls. The visual feedback from hand movements performed by the subjects was experimentally distorted. Behavioral results showed that patients were impaired in recognizing their own movements. The ERP signal in patients also differed from those of control subjects. In patients, the ERP waveform was affected during the early part of the response (200 ms). This early effect in schizophrenic patients reveals a modified processing of the visual consequence of their actions.

The schizophrenia deficit in facial emotion recognition could be accounted for by a deficit in processing the configural information of the face. The present experiment was designed to further test this hypothesis by studying the face-inversion effect in a facial emotion recognition task. The ability of 26 schizophrenic patients and 26 control participants to recognize facial emotions on upright and upside-down faces was assessed. Participants were told to state whether faces expressed one of six possible emotions (happiness, anger, disgust, fear, sadness, neutrality) in two sessions, one with upright faces and the other with upside-down faces. Discriminability and the decision criterion were computed. The results indicated that the schizophrenic patients were impaired in upright facial emotion discrimination by comparison with the controls. They also exhibited an inversion effect similar to the controls. However, whereas controls tended to adopt a more conservative criterion for all emotions and a liberal criterion for neutrality when the faces were upside-down, schizophrenic patients presented a decision criterion pattern that was similar for the two orientations and similar to controls in upside-down emotion recognition. The lack of a decision criterion shift was associated with positive symptoms such as delusions, hallucinations, and bizarre behavior. Moreover, positive and negative symptoms were associated with inversion effect on discriminability; the more severe the symptoms, the weaker the inversion effect. We conclude that individuals with schizophrenia do process the configural information of the face. However, further investigations are needed to assert whether this information is of good quality in schizophrenia.