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Background: History of childhood maltreatment is recognized as an important risk factor for the development of mental health and cognitive difficulties. Cognitive difficulties are associated with impairments in everyday functioning in different domains such as school or work. To date, no study has evaluated the feasibility and acceptability of cognitive remediation therapy (CRT) for teenagers with a history of childhood maltreatment. Objective: The objective was to assess the acceptability and feasibility of the CIRCuiTS program for teenagers in youth protection services and to explore the preliminary effect on clinical and neuropsychological outcomes. Methods: Ten participants were first assessed with clinical and neuropsychological measures. They then received a mean of 16 CRT sessions with the CIRCuiTS program adapted for teenagers. The same measures as a baseline were repeated directly after the end of treatment, as well as 3-months and 1-year post-treatment. Descriptive statistics were used to assess feasibility and acceptability, while the preliminary effect of CIRCuiTS was assessed with Reliable Change Indices (RCIs). Results: CIRCuiTS was considered acceptable by both participants and therapists for the attractiveness of the program, its easiness of use and understanding, and its cultural adaptability. However, the feasibility was limited, with only 50% of participants having completed CIRCuiTS. This was mostly explained by contextual factors. RCIs revealed significant improvements in several neuropsychological domains, as well as a decline in other domains. Conclusion: This pilot study highlights challenges that must be addressed to promote engagement with CRT for teenagers in the care of youth protection services.

Functional recovery is now a recognized treatment goal for schizophrenia. It is therefore important to better understand the cognitive and psychological factors that influence functioning. Theory of mind (ToM) deficits are common in schizophrenia and have been linked to greater impairments in functioning. The current study aimed to identify which specific areas of functioning are linked to ToM in a group of 54 patients with a recent-onset of a schizophrenia spectrum disorder.ToM was assessed with the Combined Stories Test (COST). Several areas of functioning were rated based on an extensive semi-structured interviews.Among the different areas of functioning that were examined, ToM showed a significant, positive relationship with ratings for productive activities (e.g. work or school) as well as with collaboration to psychiatric care.These results suggest that ToM can impair functioning especially in situations in which patients need to collaborate with others, including the interactions with the clinical team.

People with psychotic disorders are at higher risk of not completing an educational degree and tend to get low-wage jobs. We offered computer coding classes to 14 participants. The training was deemed feasible, acceptable, and appeared to increase their motivation for school or work, not only in computer-related domains.

Objective Treatment guidelines for the treatment of psychotic disorders suggest evidence-based interventions. These interventions target several domains such as self-management of clinical symptoms, social, familial and love relationships as well as cognitive functioning. However, these general guidelines do not provide specific evidence for people with a first-episode psychosis (FEP). The objective of this narrative and critical review is to present evidence supporting the interventions suggested by the treatment guidelines that were validated in people with a FEP, particularly those interventions validated in French. Method Based on the international and national treatment guidelines, a narrative and critical review of the scientific literature conducted in people with FEP and focusing on two recommended interventions for psychotic disorders, cognitive-behavioral therapy for psychosis (CBTp) and cognitive remediation (CR), was performed. Administration modalities adapted to the participant's profile are important to consider in this type of intervention. We thus explored two promising modalities in people with FEP, the group format and the use of digital technologies. Results Several studies support the use of CBTp in people with FEP, including one Quebec study. The effects of CR are less promising in people with FEP compared to those with a chronic evolution of their psychotic illness (e.g. schizophrenia). However, some limitations of the included studies are identified and the specific improvements in people with FEP are presented. Regarding the group format and the digital technologies, most interventions currently available need to be systematically validated, and the results need to be replicated by other groups of researchers to obtain evidence-based results. Conclusion This narrative and critical review of the literature highlights the evidence available for CBTp and CR in people with FEP. The group format used in several interventions with this population reveals encouraging results, while interventions using digital technologies have shown their acceptability and feasibility, but the efficacy remains to be assessed. In addition to contributing to symptomatic recovery, psychosocial interventions also support functional and personal recovery in people with FEP. Nonetheless, some limitations are observed regarding the accessibility of such interventions. While some interventions are currently not available in French, other available evidence-based interventions are not currently systematically used in clinical settings. These limitations call for the importance of developing an implementation science for these interventions to improve the transfer of results from research to clinical settings as well as a service organization model that promote or facilitate access to such interventions.

Introduction Socio-professional reintegration is an objective that is regularly sought-after by people in the early stages of a psychotic disorder. Despite this, employment rates are low for this population and high school dropout rates remind at a high level. Objectives and method This literature synthesis based on recent meta-analyses and studies aims at presenting the determinants of vocational and school integration for people in the early stages of a psychotic disorder. This will be followed by the presentation of the most studied supported employment and education programs, as well as by complementary interventions to support existing programs. In addition, key concepts are illustrated through clinical vignettes for this clientele. Results. Several barriers to socio-professional reintegration in this population could help explain the lower success rates when compared to the general population, including individual factors (e.g., past employment history, length of absence from the labour market, negative and cognitive symptoms, motivation) and environmental factors (e.g., availability of supported employment or education programs, competence of the employment specialist, social assistance benefits, employer attitude). The program that shows the most accumulated evidence is called Individual Placement and Support (IPS) and is frequently used in Quebec. IPS focuses on competitive job search, rapid placement in the labour market and collaboration between an employment specialist, the client, and the employer. Mowbray's supported education programs, as well as IPS adapted for education, help respond more specifically to the needs of people in the early stages of a psychotic disorder, who often wish to return to school. This article describes two clinical examples of programs offered in Quebec. Despite the interesting results provided by supported programs, socio-professional reintegration and maintaining employment remain difficult for people who are in the early stages of a psychotic disorder. Considering this, several researchers suggest that interventions for people with psychotic disorders should be more individualized, given the great heterogeneity associated with this condition. Combining interventions that are specific to each candidate's pre-existing individual deficits (e.g., cognitive remediation, cognitive-behavioural therapy, social skills training) appears to be an effective solution for optimizing the therapeutic response in supported employment or education programs. Conclusion This article highlights the issues related to the professional or academic reintegration of people in the early stages of a psychotic disorder, in order to guide practitioners in the field and to offer possible solutions to the current limitations of these programs in Quebec, including access to certain interventions.

BackgroundThe COVID-19 pandemic and the isolation measures taken to control it has caused important disruptions in economies and labour markets, changed the way we work and socialize, forced schools to close and healthcare and social services to reorganize in order to redirect resources on the pandemic response. This unprecedented crisis forces individuals to make considerable efforts to adapt and can have serious psychological and social consequences that are likely to persist once the pandemic has been contained and restrictive measures lifted. These impacts will be significant for vulnerable individuals and will most likely exacerbate existing social and gender health and social inequalities. This crisis also puts a toll on the capacity of our healthcare and social services structures to provide timely and adequate care. In order to minimize these consequences, there is an urgent need for high-quality, real-time information on the psychosocial impacts of the pandemic. The MAVIPAN (Ma vie et la pandémie/My life with the pandemic) study aims to document how individuals, families, healthcare workers, and health organisations that provide services are affected by the pandemic and how they adapt.MethodsThe MAVIPAN study is a 5-year longitudinal prospective cohort study that was launched on April 29th, 2020 in the province of Quebec which, at that time, was the epicenter of the pandemic in Canada. Quantitative data is collected through online questionnaires approximately 5 times a year depending on the pandemic evolution. Questionnaires include measures of health, social, behavioral and individual determinants as well as psychosocial impacts. Qualitative data will be collected with individual and group interviews that seek to deepen our understanding of coping strategies.DiscussionThe MAVIPAN study will support the healthcare and social services system response by providing the evidence base needed to identify those who are most affected by the pandemic and by guiding public health authorities’ decision making regarding intervention and resource allocation to mitigate these impacts. It is also a unique opportunity to advance our knowledge on coping mechanisms and adjustment strategies.Trial registrationNCT04575571 (retrospectively registered)

Schizophrenia is associated with major functioning difficulties. Theory of mind (ToM), the ability to infer the mental states of others, is an important determinant of functioning. However, the contribution of ToM to each specific domain of functioning remains to be better understood. The objectives of this meta-analysis were to document and compare the magnitude of the associations between ToM and (1) different domains of functioning (social functioning, productive activities, and instrumental activities of daily living), each assessed separately for functional performance and functional outcome and (2) different aspects of functioning (functional performance and functional outcome) in schizophrenia. Fifty-nine studies (N = 4369) published between 1980 and May 2019 targeting patients with schizophrenia or schizoaffective disorder aged between 18 and 65 years old were included. Studies were retrieved from seven databases. Correlations were extracted from the articles, transformed into effect sizes Zr and combined as weighted and unweighted means. The strength of the associations between the domains and aspects of functioning were compared using focused tests. A moderate association was observed between ToM and all domains of functioning, with a stronger association between ToM and productive activities compared with social functioning (only for functional outcome [χ2(2) = 6.43, P = 0.040]). Regarding the different aspects of functioning, a stronger association was observed between ToM and functional performance, compared with functional outcome, for overall functioning (χ2(1) = 13.77, P < 0.001) and social functioning (χ2(1) = 18.21, P < 0.001). The results highlight a stronger association of ToM with productive activities and with functional performance, which should be considered in future studies to improve functional recovery in schizophrenia.

International audience; Nicotine use, which is mostly done through smoking tobacco, is among the most burdensome comorbidities of schizophrenia. However, the ways in which nicotine affects the cognitive and early sensory alterations found in this illness are still debated. After conducting a systematic literature search, 29 studies were selected. These studies involve individuals with schizophrenia who underwent cognitive and/or early sensory function assessments after acute nicotine administration and include 560 schizophrenia subjects and 346 non-schizophrenia controls. The findings highlight that a single dose of nicotine can improve a range of cognitive functions in schizophrenia subjects, such as attention, working memory, and executive functions, with attention being the most responsive domain. In addition, nicotine can modulate early detection of changes in the sensory environment at both the auditory and visual levels. Nevertheless, effects vary strongly depending on the type of neuropsychological assessment and nicotine intake conditions used in each study. The current findings suggest the need to consider a potential decrease of cognitive and early sensory performance when patients with schizophrenia quit smoking.

Cognitive deficits are barriers to job acquisition or return to school, and can be reduced through Cognitive remediation therapy (CRT). The main goal of this multiple case study was to investigate the effect of personalized CRT on occupational status in three participants with a recent-onset psychosis. Two cases improved their occupational status at post-treatment, and showed improvements in cognitive, psychological, and/or clinical variables. This study suggests that personalized CRT may facilitate job acquisition or return to school. However, the different pathways showed by our cases indicate that personalized CRT may influence occupational status through multiple mechanisms, underlining the relevance of treatment personalization.

Previous meta-analyses have shown a moderate negative impact of maltreatment on the neuropsychological functioning of people with or without psychiatric disorders compared to healthy groups. The objectives of the present meta-analysis were to (1) investigate the impact of maltreatment on neuropsychological functioning of people with psychiatric disorders and to (2) evaluate the moderating effect of age, at the time of the cognitive assessment, on neuropsychological functioning.Seventeen studies published between 1970 and July 2017 were included.The results showed a negative impact of maltreatment with a small effect size (g = -0.25) on the neuropsychological performances in the group with psychiatric disorders with a history of exposure to childhood maltreatment compared to the group with psychiatric disorders without a history of exposure to childhood maltreatment. Cognitive domains that are significantly affected by maltreatment are: working memory (g = -0.56), verbal episodic memory (g = -0.39), intelligence (g = -0.27) and processing speed (g = -0.21). The impact of childhood maltreatment on the cognitive profile is greater in adults than young people.Clinicians should consider these common cognitive deficits using a transdiagnostic approach in cognitive interventions.

Working or studying is a common goal among people with recent-onset psychosis. Cognitive deficits have been reported to influence occupational outcome, but to date few studies have evaluated if cognitive deficits independently predict occupational outcome when taking into account other important determinants, such as self-esteem, motivation, length of time absent from employment/school, job/school search behaviours, subjective cognitive complaints and psychotic symptoms. Hence, this longitudinal study aimed to evaluate the role of cognition, as well as other key factors relevant to occupational outcome, to predict occupational status six months after baseline in people with recent-onset psychosis. A total of 27 participants receiving treatment in rehabilitation programs were included in the study. Neuropsychological, psychological, clinical and occupational measures were administered at baseline, and occupational status was collected six months later. Ordinal regression indicated that working memory and length of time absent from employment/school at baseline predicted 48.1% of the variance of occupational status at six months, with both variables showing a unique significant contribution to the model. These results suggest that working memory could be integrated in comprehensive models of occupational outcome in people with recent-onset psychosis. In addition, supported employment and education programs could target cognitive deficits and length of time absent from employment/school to help these individuals to acquire a job or return to school given their strong predictive value on occupational outcome. Keywords: Recent-onset psychosis, Cognition, Occupational outcome, Recovery, Rehabilitation program, Cognitive remediation

L’intervention cognitive est une pratique émergente de plus en plus utilisée par les professionnels en psychologie. Cependant, la place de l’intervention cognitive en psychologie demeure à l’heure actuelle assez ambiguë. L’Ordre des psychologues du Québec (OPQ) propose une définition de la psychothérapie dans laquelle le terme « cognition » apparaît. Cependant, cette définition ne permet ni de positionner l’intervention cognitive comme étant une psychothérapie, ni de l'insérer dans la liste des interventions non psychothérapeutiques. Le titre de psychothérapeute étant requis pour pratiquer la psychothérapie, ceci amène les psychologues à se questionner au sujet de l’intervention cognitive. Une proposition de définition de l’intervention cognitive et de réponse quant à sa réglementation est examinée dans une perspective neuropsychologique.

Objectifs Les guides de soins pour le traitement des troubles psychotiques recommandent plusieurs interventions basées sur les données probantes. Celles-ci ciblent différents domaines, incluant notamment l’autogestion des symptômes cliniques, les relations sociales, familiales et amoureuses ainsi que le fonctionnement cognitif. Toutefois, ces guides généraux ne soulignent pas les données probantes spécifiques aux personnes composant avec un premier épisode psychotique (PEP). L’objectif de cette revue narrative et critique est de présenter les données soutenant les interventions validées auprès des personnes composant avec un PEP, en considérant particulièrement les interventions validées en langue française.Méthode Suivant les guides cliniques internationaux et nationaux, une revue narrative et critique des écrits scientifiques réalisée chez les personnes composant avec un PEP et portant sur 2 interventions recommandées pour les troubles psychotiques, la thérapie cognitive-comportementale pour la psychose (TCCp) et la remédiation cognitive (RC), a été effectuée. Par ailleurs, l’engagement via des modalités d’administration adaptées au profil des participants étant central dans ce type d’intervention, nous avons exploré 2 modalités prometteuses dans le PEP, le format groupal et l’utilisation des technologies numériques.Résultats L’utilisation de la TCCp auprès des personnes composant avec un PEP est appuyée par plusieurs études, notamment une québécoise. Les bénéfices apportés par la RC semblent moindres pour les PEPs, comparativement aux stades ultérieurs des troubles psychotiques (p. ex. schizophrénie). Néanmoins, ces études présentent des limites et les personnes composant avec un PEP semblent pouvoir bénéficier de certains acquis spécifiques. Concernant les interventions groupales ainsi que les technologies numériques, la plupart des interventions actuellement disponibles nécessitent d’être validées de façon plus systématique, et répliquées par d’autres groupes de chercheurs afin d’obtenir un soutien empirique plus probant.Conclusion Cette revue narrative et critique souligne la validité empirique de la TCCp et de la RC chez les personnes composant avec un PEP. La modalité groupale, dispensée dans plusieurs interventions dédiées à cette population, présage des résultats encourageants, alors que les interventions utilisant les technologiques numériques, ayant montré leur acceptabilité et faisabilité, restent à valider en termes d’efficacité. En plus de contribuer au rétablissement symptomatique, les interventions psychosociales soutiennent le rétablissement fonctionnel et personnel des personnes composant avec un PEP. Malgré tout, des limites sont notées sur le plan de l’accessibilité à ces interventions. Alors que différentes interventions ne sont actuellement pas disponibles en français, certaines interventions probantes et disponibles ne sont pas appliquées de façon systématisée. Ces limites suggèrent l’importance de développer une science de la mise en oeuvre des interventions afin de favoriser le transfert des données issues de la recherche vers les milieux cliniques ainsi qu’une organisation des soins favorisant l’accès à des professionnels de la santé dédiés à ces approches., Objective Treatment guidelines for the treatment of psychotic disorders suggest evidence-based interventions. These interventions target several domains such as self-management of clinical symptoms, social, familial and love relationships as well as cognitive functioning. However, these general guidelines do not provide specific evidence for people with a first-episode psychosis (FEP). The objective of this narrative and critical review is to present evidence supporting the interventions suggested by the treatment guidelines that were validated in people with a FEP, particularly those interventions validated in French.Method Based on the international and national treatment guidelines, a narrative and critical review of the scientific literature conducted in people with FEP and focusing on two recommended interventions for psychotic disorders, cognitive-behavioral therapy for psychosis (CBTp) and cognitive remediation (CR), was performed. Administration modalities adapted to the participant’s profile are important to consider in this type of intervention. We thus explored two promising modalities in people with FEP, the group format and the use of digital technologies.Results Several studies support the use of CBTp in people with FEP, including one Quebec study. The effects of CR are less promising in people with FEP compared to those with a chronic evolution of their psychotic illness (e.g. schizophrenia). However, some limitations of the included studies are identified and the specific improvements in people with FEP are presented. Regarding the group format and the digital technologies, most interventions currently available need to be systematically validated, and the results need to be replicated by other groups of researchers to obtain evidence-based results.Conclusion This narrative and critical review of the literature highlights the evidence available for CBTp and CR in people with FEP. The group format used in several interventions with this population reveals encouraging results, while interventions using digital technologies have shown their acceptability and feasibility, but the efficacy remains to be assessed. In addition to contributing to symptomatic recovery, psychosocial interventions also support functional and personal recovery in people with FEP. Nonetheless, some limitations are observed regarding the accessibility of such interventions. While some interventions are currently not available in French, other available evidence-based interventions are not currently systematically used in clinical settings. These limitations call for the importance of developing an implementation science for these interventions to improve the transfer of results from research to clinical settings as well as a service organization model that promote or facilitate access to such interventions.

Background Deficits in theory of mind (ToM), the ability to infer the mental states of others, are common in psychotic disorders and are associated with functioning difficulties. While ToM is a social cognitive process, several neurocognitive processes are involved when inferring the mental states of others. A better understanding of the associations between ToM and neurocognitive domains could help better target treatment for ToM in schizophrenia. A recent meta-analysis has revealed that all neurocognitive domains are moderately associated with ToM in schizophrenia, but very few studies have looked at these associations in recent onset psychosis. These studies showed associations between ToM and speed of processing, episodic memory and executive functions although few neurocognitive domains have been assessed in each study. The aim of this study was to determine the associations between ToM and the key neurocognitive domains in recent onset psychosis. Methods These results are part of a larger study that aimed to determine the cognitive predictors of return to work or school in recent onset psychosis. Twenty-seven recent onset psychosis patients were recruited for this study, with a mean age of 24.9 years. The clinical assessment included the Combined Stories Test for ToM and the Matrics Consensus Cognitive Battery (MCCB) for neurocognition. The MCCB assesses the key cognitive domains relevant for schizophrenia, including attention/vigilance, speed of processing, working memory, verbal learning, visual learning, reasoning/problem solving and social cognition. Pearson correlations were conducted between the ToM scores of the Combined Stories Test and each neurocognitive domain of the MCCB. Results Correlations revealed a moderate to strong association between ToM and working memory (r = 0.443, p = 0.021), visual learning (r = 0.493, p = 0.009) and verbal learning (r = 0.443, p = 0.021). The correlations between ToM and attention/vigilance, speed of processing and reasoning/problem solving were not significant (p > 0.05). Discussion This is the first study that has assessed the associations between ToM and the neurocognitive domains of the MCCB in recent onset psychosis. This study did not show association between ToM and speed of processing nor executive functions, but rather with working memory and learning. These contradictory results could be explained by the large heterogeneity of tasks used across studies, particularly ToM tasks that often present with psychometric limitations such as ceiling effect. Learning processes highlighted here should be considered in the understanding of the therapeutic response following a cognitive remediation therapy for ToM in recent onset psychosis.

Background In recent decades, several meta-analyses have documented the severity of neurocognitive impairments in various domains and psychiatric disorders. There is also a growing body of literature on the common factors among psychiatric disorders (e.g., common psychological factors, neurobiological alterations or genetic variants). The first objective of this review was to investigate transdiagnostic neurocognitive impairments across several psychiatric disorders. The second objective was to document transdiagnostic neurocognitive impairments across the life span, to establish whether they are consistent across age. Methods A literature search was conducted in Pubmed, PsycINFO and Embase to identify all meta-analyses of neurocognitive deficits in psychiatry published prior to August, 2017. The following psychiatric disorders were considered: mood disorders, psychotic disorders, autism spectrum disorders, attention-deficit/hyperactivity disorder (ADHD), and anxiety disorders. The R-AMSTAR (Revised Assessment of Multiple Systematic Reviews) was used to assess methodological quality of all retrieved meta-analyses. The final selection included only the most rigorous meta-analyses. Results A total of 36 meta-analyses were included. They documented neurocognitive impairments in schizophrenia, autism spectrum disorder, ADHD, bipolar disorder, depression, obsessive-compulsive disorder, and posttraumatic stress disorder. Neurocognitive impairments were observed in the majority of psychiatric disorders, regardless of age group (childhood/adolescence, first episode, adulthood, elderly). Across all disorders, deficits in executive functions and in episodic memory were the most severe and the most frequently reported. Moreover, severe deficits in executive functions were frequently reported across age groups. Neurocognitive deficits were consistently more severe in schizophrenia compared to other psychiatric disorders, across all age groups. Discussion Neurocognitive impairments were observed in almost all disorders, in all age groups. Some neurocognitive impairments were more frequently reported across all disorders. Indeed, executive functions and episodic memory were severely impaired in almost every age group and psychiatric disorder considered in this review. Deficits in these two domains appear to be transdiagnostic and they remain relatively stable across the life span. Transdiagnostic factors could be key targets for transdiagnostic cognitive interventions in psychiatric populations. Neurobiological, neuropsychological, and genetic hypotheses of transdiagnostic neurocognitive impairments are discussed.

BACKGROUND: People with schizophrenia exhibit deficits in social and non-social cognition and these deficits are associated with difficulties in everyday functioning. The best cognitive predictor of functional difficulties in schizophrenia is theory of mind (ToM), the ability to infer the mental states of others. ToM is thus an important treatment target to promote functioning in schizophrenia. To improve ToM, it is however necessary to understand its underlying processes. Associations have been reported between ToM and different non-social cognitive abilities in several studies, but the cognitive processes that are most closely linked to ToM remain to be identified. The goal of this meta-analysis were: (1) to determine and compare the magnitude of the associations between ToM and each non-social cognition domain, and (2) to test the effect of different characteristics of the ToM tasks and of characteristics of the patient samples on the magnitude of the associations between ToM and non-social cognition. METHODS: The following inclusion criteria were used: 1) participants with a diagnosis of schizophrenia or schizoaffective disorder; 2) age 18–65; 3) publication in English, French or Spanish; 4) published or Epub before January 2018; 5) reporting a correlation between the performance on a ToM task and at least one non-social cognition task. Each correlation between a ToM task and a non-social cognition task was transformed into an effect size Zr and a weighted mean was calculated for the association between ToM and each cognitive domain. These associations were compared using focused test. RESULTS: A total of 86 studies (88 samples) were included (4 508 participants, 65% male, mean age 32.8 years). When all studies were combined regardless of the type of cognitive domain, a moderate association was observed (k=88, r=0.32). The associations between ToM and each cognitive domain were as follow: attention (k=17, r=0.27), working memory (k=27, r=0.29), episodic memory (k=24, r=0.28), speed of processing (k=24, r=0.26), language (k=31, r=0.36), visuospatial/problem solving (k=23, r=0.30), executive functions (k=61, r=0.29), early processing (k=6, r=0.32) and autobiographical memory (k=2, r=0.40). The comparison between the domains revealed no significant difference (χ2(8) =12.71, p = 0.122). The heterogeneity test was however significant for the executive function domain (χ2(60)=83.62, p=0.024), and we thus further compared the different executive functions together. This revealed that abstraction was more strongly associated with ToM than the other executive functions. For the effect of different characteristics of the ToM tasks, a significant effect was observed for visuospatial/problem solving and executive functions regarding the difference between ToM tasks (χ2(20) = 9.8, p = 0.040; χ2(64) = 22.5, p = 0.007), as well as for characteristics of the required answers including modality (i.e. verbal) (χ2(29) = 14.4, p = 0.001; χ2(77) = 19.4, p = 0.001) and type (i.e. multiple choices) (χ2(30) = 16.9, p = 0.001; χ2(84) = 21.7, p = 0.001). A significant effect was also observed for attention and episodic memory regarding the type of mental state (χ2(20) = 7.3, p = 0.026; χ2(30) = 9.2, p = 0.027). As for the characteristic of the sample, duration of illness (r = 0.27, p = 0.033), age at onset of the illness (r = 0.32, p = 0.035) and the total score on the PANSS (r = 0.52, p = 0.003) were significantly correlated to the strength of the association between ToM and non-social cognition. DISCUSSION: Non-social cognition deficits, particularly abstraction, and characteristics of ToM tasks should be considered when assessing and treating ToM deficits in people with schizophrenia in order to have a comprehensive understanding of ToM performance for each patient.

OBJECTIVE: Few studies have attempted to describe the range of cognitive impairments in individuals with psychiatric disorders who experienced maltreatment as children. The aims of this meta-analysis were to establish the impact of maltreatment and psychiatric disorders on cognition, and to examine the change in impact from childhood to adulthood. METHOD: Twelve publications from 1970 to 2013 were included, with the following inclusion criteria: (a) individuals with a psychiatric disorder who experienced maltreatment, (b) use of at least 1 standardized neuropsychological measure, and (c) use of a control group without any psychiatric disorder or mistreatment. The majority of studies (10/12) were about posttraumatic stress disorder. Several effect sizes were calculated (Hedge's g) according to the cognitive domains. RESULTS: The results of the meta-analysis demonstrate that the combination of psychiatric disorders and childhood maltreatment has a negative impact on global cognitive performance, with a moderate effect size (g = -0.59). The most affected cognitive domains for individuals aged 7- to 18-years-old were visual episodic memory (g = -0.97), executive functioning (g = -0.90), and intelligence (g = -0.68). For individuals over the age of 18-years-old, the most affected cognitive domains were verbal episodic memory (g = -0.77), visuospatial/problem solving (g = -0.73), and attention (g = -0.72). The impact of maltreatment and psychiatric disorders was greater in children than in adults (slope = 0.008, p CONCLUSION: The results suggest that exposure to maltreatment and the presence of psychiatric disorders have a broad impact on cognition, with specific neuropsychological profile. (PsycINFO Database Record Language: en

Cognitive remediation therapy is effective for improving cognition, symptoms and social functioning in individuals with schizophrenia; however, the impact on visual episodic memory remains unclear. The objectives of this feasibility study were: (1) to explore whether or not CIRCuiTS—a new computerised cognitive remediation therapy programme developed in England—improves visual episodic memory and other cognitive domains in young adults with early course schizophrenia; and (2) to evaluate acceptability of the CIRCuiTS programme in French-Canadians. Three participants with visual episodic memory impairments at baseline were recruited from clinical settings in Canada, and consented to participate. Neuropsychological, clinical and social functioning was evaluated at baseline and post-treatment. Intervention involved 40 sessions of cognitive remediation. First, the reliable change index (RCI) revealed that each participant demonstrated significant post-therapy change in episodic memory and in other cognitive domains. The response profile was characterised by the use of organisational strategies. Second, the treatment was considered acceptable to participants in terms of session frequency (number of sessions per week), intensity (hours per week; total hours), and number of missed sessions and total completed sessions. This preliminary study yielded encouraging data demonstrating the feasibility of the CIRCuiTS programme in French-Canadian young adults with schizophrenia.

Deficits in social cognition are common in psychiatric disorders. Validated social cognition measures with good psychometric properties are necessary to assess and target social cognitive deficits. Two recent social cognition tests, the Combined Stories Test (COST) and the Social Knowledge Test (SKT), respectively assess theory of mind and social knowledge. Previous studies have shown good psychometric properties for these tests, but the test-retest reliability has never been documented. The aim of this study was to evaluate the test-retest reliability and the inter-rater reliability of the COST and the SKT. The COST and the SKT were administered twice to a group of forty-two healthy adults, with a delay of approximately four weeks between the assessments. Excellent test-retest reliability was observed for the COST, and a good test-retest reliability was observed for the SKT. There was no evidence of practice effect. Furthermore, an excellent inter-rater reliability was observed for both tests. This study shows a good reliability of the COST and the SKT that adds to the good validity previously reported for these two tests. These good psychometrics properties thus support that the COST and the SKT are adequate measures for the assessment of social cognition.

Schizophrenia is associated with deficits in theory of mind (ToM) (i.e., the ability to infer the mental states of others) and cognition. Associations have often been reported between cognition and ToM, and ToM mediates the relationship between impaired cognition and impaired functioning in schizophrenia. Given that cognitive deficits could act as a limiting factor for ToM, this study investigated whether a cognitive remediation therapy (CRT) that targets nonsocial cognition and metacognition could improve ToM in schizophrenia. Four men with schizophrenia received CRT. Assessments of ToM, cognition, and metacognition were conducted at baseline and posttreatment as well as three months and 1 year later. Two patients reached a significant improvement in ToM immediately after treatment whereas at three months after treatment all four cases reached a significant improvement, which was maintained through 1 year after treatment for all three cases that remained in the study. Improvements in ToM were accompanied by significant improvements in the most severely impaired cognitive functions at baseline or by improvements in metacognition. This study establishes that a CRT program that does not explicitly target social abilities can improve ToM.

Cognitive remediation therapy for schizophrenia was developed to treat cognitive problems that affect functioning, but the treatment effects may depend on the type of trial methodology adopted. The present meta-analysis will determine the effects of treatment and whether study method or potential moderators influence the estimates.Electronic databases were searched up to June 2009 using variants of the key words "cognitive," "training," "remediation," "clinical trial," and "schizophrenia." Key researchers were contacted to ensure that all studies meeting the criteria were included. This produced 109 reports of 40 studies in which ≥70% of participants had a diagnosis of schizophrenia, all of whom received standard care. There was a comparison group and allocation procedure in these studies. Data were available to calculate effect sizes on cognition and/or functioning. Data were independently extracted by two reviewers with excellent reliability. Methodological moderators were extracted through the Clinical Trials Assessment Measure and verified by authors in 94% of cases.The meta-analysis (2,104 participants) yielded durable effects on global cognition and functioning. The symptom effect was small and disappeared at follow-up assessment. No treatment element (remediation approach, duration, computer use, etc.) was associated with cognitive outcome. Cognitive remediation therapy was more effective when patients were clinically stable. Significantly stronger effects on functioning were found when cognitive remediation therapy was provided together with other psychiatric rehabilitation, and a much larger effect was present when a strategic approach was adopted together with adjunctive rehabilitation. Despite variability in methodological rigor, this did not moderate any of the therapy effects, and even in the most rigorous studies there were similar small-to-moderate effects.Cognitive remediation benefits people with schizophrenia, and when combined with psychiatric rehabilitation, this benefit generalizes to functioning, relative to rehabilitation alone. These benefits cannot be attributed to poor study methods.

Objective: Memory deficits have been shown in patients affected by schizophrenia (SZ) and bipolar (BP)/mood disorder. We recently reported that young high-risk offspring of an affected parent were impaired in both verbal episodic memory (VEM) and visual episodic memory (VisEM). Understanding better the trajectory of memory impairments from childhood to adult clinical status in risk populations is crucial for early detection and prevention. In multigenerational families densely affected by SZ or BP, our aim was to compare the memory impairments observed in young nonaffected offspring with memory functioning in nonaffected adult relatives and patients. Methods: For 20 years, we followed up numerous kindreds in the Eastern Quebec population. After having characterized the Diagnostic and Statistical Manual of Mental Disorders phenotypes, we assessed cognition (N = 381) in 3 subsamples in these kindreds and in controls: 60 young offspring of a parent affected by SZ or BP, and in the adult generations, 92 nonaffected adult relatives and 40 patients affected by SZ or BP. VEM was assessed with the California Verbal Learning Test and VisEM with the Rey figures. Results: The VEM deficits observed in the offspring were also found in adult relatives and patients. In contrast, the VisEM impairments observed in the young offspring were present only in patients, not in the adult relatives. Conclusion: Implications for prevention and genetic mechanisms can be drawn from the observation that VEM and VisEM would show distinct generational trajectories and that the trajectory associated with VisEM may offer a better potential than VEM to predict future risk of developing the disease.

Cognitive dysfunctions in patients suffering from schizophrenia (SZ) are also found in their unaffected parents though to a lesser degree. According to several researchers, short-term memory (STM) deficits are a potential marker of vulnerability to SZ. However, the cognitive processes underlying the observed STM deficits remain underspecified in SZ (Lee & Park, 2005). In the present study, our goal was to pinpoint those processes at play in the manifestation of STM deficits by using the paradigm of the sandwich effect (e.g., Hitch, 1975) to manipulate information load (5 vs. 7 to-be-remembered items) and distraction (control vs. sandwich) in the verbal domain. Our study comprises four groups: patients with SZ (n = 25), their unaffected parents (n = 25), and their respective healthy controls. The pattern of results indicates a generalized dysfunction of STM in patients with SZ characterized by saturation and an increased susceptibility to distraction. The impact of saturation and distraction was also observed in unaffected parents of patients with SZ to a lesser degree. The methodological strategy adopted here allowed us to show that the dysfunction of STM is genuine, can be aggravated by deficits in selective attention, and is a good candidate for further research on genetic epidemiology.

Objective: Few studies have attempted to describe the range of cognitive impairments affecting people who have experienced child maltreatment. The aim of this meta-analysis was to examine the neuropsychological profile of these people and to determine the cognitive impacts of maltreatment from childhood to adulthood. Method: Fifty-two publications from 1970 to 2013 were included. Results: The affected cognitive domains were working memory (g = −.65), attention (g = −.63), intelligence (g = −.56) and speed of processing (g = −.49). The impact of maltreatment was greater in young children (g = −.71) and less pronounced in adults (g = −.26). Conclusions: These results suggest that exposure to maltreatment has an impact on specific cognitive processes, regardless of age.

Background: Several meta-analyses have been conducted to determine the magnitude of cognitive deficits in patients with schizophrenia. The effect of several key variables—such as age, gender, education, duration of illness, symptomatology, patient status, psychiatric comorbidity, publication year and sample size—has also been evaluated with moderator analysis to understand the nature of the deficit. One overlooked methodological aspect to consider is the potential influence of methodological quality of the meta-analysis in order to draw valid inferences. The main objective of this systematic review of meta-analysis was to evaluate the methodological quality of the meta-analyses evaluating cognition in schizophrenia.

The developmental aspects of cognitive structures from childhood until adulthood and across different levels of risk for psychopathology have been little studied. The aim of the current study was to explore the cognitive factorial structure in subsamples from highly familial and densely affected kindreds of schizophrenia and bipolar disorder – i.e. affected adult members, non-affected adult members and high-risk youth. The same neuropsychological battery was administered in a sample of 480 participants: schizophrenia and bipolar patients ( n =51), young high-risk offspring ( n =61), non-affected adult relatives of patients ( n =96), and controls ( n =272). Exploratory Factorial Analysis was performed in the control sample and yielded a 5-factor solution: verbal comprehension, processing speed/working memory, visual learning and memory, verbal learning and memory, reasoning and problem solving. Confirmatory factor analysis indicated that the hierarchical 5-factor solution was well suited for the young high-risk offspring, the non-affected adult relatives of patient and the patients. A hierarchical model with a " g " factor was a good fit for all subsamples. These results suggest that cognitive impairments may aggregate in highly familial individuals.

Background The purpose of this article was to conduct a review of the types of training offered to people with schizophrenia in order to help them develop strategies to cope with or compensate for neurocognitive or sociocognitive deficits. Methods We conducted a search of the literature using keywords such as “schizophrenia”, “training”, and “cognition” with the most popular databases of peer-reviewed journals. Results We reviewed 99 controlled studies in total (though nine did not have a control condition). We found that drill and practice training is used more often to retrain neurocognitive deficits while drill and strategy training is used more frequently in the context of sociocognitive remediation. Conclusions Hypotheses are suggested to better understand those results and future research is recommended to compare drill and strategy with drill and practice training for both social and neurocognitive deficits in schizophrenia.

It is now well established that cognitive impairments are evident in people with a diagnosis of schizophrenia as well as in their unaffected relatives. However, improving cognition is a relatively new interest in schizophrenia research which has developed over the past 15 years with new treatments and rigorous studies of efficacy. This relatively large body of work suggests that cognition can be improved significantly by cognitive remediation therapy and that these changes can impact on everyday functioning including work outcomes. There are a number of challenges for the future; not only to be clearer about the measurement of the success of programmes, but also to improve the delivery of this promising psychological treatment. Identifying mediator and moderator variables may help in the understanding of the active ingredients of therapy as well as the course of the clinical disorder.

Objective Neurocognitive dysfunctions analogous to those of adult patients have been detected in children at risk of schizophrenia and bipolar disorder. This led to the following developmental question: Do IQ and memory impairments exhibit different developmental courses from childhood to young adulthood in terms of stability or fluctuations? Methods In a high risk sample, we used a step by step sampling approach to narrow-down the early disease mechanisms. Upstream, we started with a 20-year follow-up of 48 densely affected multigenerational kindreds, including 1500 clinically characterized adult members. We then identified 400 adult members affected by a DSM-IV schizophrenia or bipolar disorder. Downstream, we finally focused on 65 offspring (of an affected parent) aged 7 to 22, who were administered a neuropsychological battery. We then constructed cross-sectional trajectories that were compared to those of controls. Results The childhood IQ deficit displayed a stability until young adulthood. The delay in visual memory exhibited a non-linear two-stage trajectory: a lagging period during childhood followed by a recuperation period from adolescence until adulthood, as supported by a significant Group x Age Periods interaction. No data suggested deterioration between 7 and 22. Conclusion In these offspring at genetic risk, the developmental trajectory of global IQ impairment may not apply to specific domains of cognition such as episodic memory. Different cognitive dysfunctions would mark different developmental courses. The shape of the trajectories might itself have a meaning and provide empirical leads for targeting the right dysfunction at the right time in future prevention research.

Source recognition memory deficits have repeatedly been observed in people with schizophrenia (SZ), and have also recently been observed in their first-degree relatives. These deficits have been hypothesized to result, at least in part, from impairments in the conscious recollection process. Although other processes are clearly also affected in SZ, it has been proposed that impairments in the conscious recollection process could be a parsimonious explanation for the source memory deficits observed in their relatives. Here, we tested 25 patients with SZ and 34 of their non-affected parents, as well as two groups of matched healthy controls, on a short-term associative memory task that shares the characteristics of standard source recognition tasks but minimizes the need for recollection of stored information from memory. This task was administered in order to determine if deficits can still be observed in these people when involvement of the conscious recollection process is minimized. We observed deficits on our short-term source memory task in people with SZ, but their first-degree relatives did not share this deficit. These results support the idea that multiple memory processes supporting associative/source memory are affected in SZ, whereas the source memory deficits previously observed in relatives of SZ seem specific to tasks that rely on the conscious recollection process.

Episodic memory deficits are present in patients with schizophrenia (SZ) and their unaffected relatives and could be considered as a cognitive indicator of genetic vulnerability to SZ. The present study, involving patients with SZ as well as their parents, used experimental tasks specifically designed to disentangle the contribution of familiarity and recollection processes to episodic memory. The performance of patients with SZ ( n =26) and their unaffected parents ( n =35) was compared with that of healthy control groups matched on socio-demographic variables (controls of patients, n =26; controls of parents, n =35) on two memory tasks assessing recollection and familiarity. The first task was designed to investigate item recognition and memory for item-spatial context associations whereas the second targeted item-item associations. The results revealed an overall episodic memory deficit in patients with SZ, encompassing both familiarity and recollection, while unaffected parents showed a dysfunction restricted to the recollection process. Our study highlights differences and similarities in the source of the episodic memory deficit found in patients with SZ and their unaffected parents, and it suggests that recollection could act as a cognitive endophenotype of SZ. The results also suggest that use of experimental tasks represents a promising method in the search of cognitive endophenotypes in SZ.

Memory deficits in patients with schizophrenia (SZ) are considered as a key feature of the clinical manifestations of the disease. In order to further examine the role and nature of memory deficits in SZ, the pattern of errors in verbal and spatial serial recall tasks committed by SZ patients was compared to that of healthy controls. We also tested the relationship between these memory errors and clinical symptoms.Twenty-seven outpatients with recent-onset SZ and 27 age and gender matched healthy controls had to remember sequences of items (digits or localisations) in a serial recall task. Clinical symptoms were assessed with the PANSS and the SAPS.The results indicate that the number of omissions, intrusions, and transpositions can differentiate patients with SZ from healthy controls. Intrusions and transpositions committed in the verbal domain were associated with the negative subscale of the PANSS. Transposition errors were associated with delusions whether the to-be-remembered information was verbal or spatial.The examination of the pattern of errors, in particular that of transpositions, is a more informative cognitive index than the mere analysis of overall performance, and provides a promising target for treatment.

Memory impairment is a core feature in schizophrenia (SZ). The aim of this study was to investigate short-term memory (STM) and its sensitivity to distraction with visual-spatial material. This study comprised 23 recent-onset SZ patients and 23 healthy controls. The degree of disruption upon recall from interleaving irrelevant items within a sequence of to-be-remembered items-the sandwich effect [Hitch, G. J. (1975). The role of attention in visual and auditory suffix effects. Memory and Cognition, 3, 501-505]-was examined. STM performance, whether in the presence or absence of distraction, was poorer and markedly more vulnerable to disruption in SZ. Our results suggest that processing spatial information in STM is susceptible to interference in SZ.

Michel Maziade, Nancie Rouleau, Chantal Merette, Marco Battaglia, Cecilia Marino, Valerie Jomphe, Elsa Gilbert, Caroline Cellard, Amelie Achim, Roch-Hugo Bouchard, Marie-Eve Paradis, Marc-Andre Roy Centre de recherche Universite, Laval Robert-Giffard, Quebec, Quebec, Canada; Ecole de psychologie, Universite Laval Quebec, Quebec, Canada; Academic Centre for the Study of Behavioural Plasticity, Vita-Salute San Raffaele University, Milan, Italy; Eugenio Medea Institute, Department of Child Psychiatry, Bosisio, Parini, Italy