Search

Resume Les therapies psychosociales completent la pharmacotherapie en psychiatrie et repondent a la complexite des besoins d’un individu. Elles sont proposees apres une evaluation multidisciplinaire, et declinees des la phase aigue en un parcours de soin personnalise qui mene vers l’inclusion sociale et le retablissement. La remediation cognitive (RC) en est une illustration, s’appuyant sur les points forts et les faiblesses cognitives d’une personne ayant un handicap psychique, apportant des strategies destinees a ameliorer la cognition, a acquerir autonomie ainsi qu’insertion sociale et professionnelle. Les programmes de RC sont choisis d’apres le profil cognitif du patient et fonction de son projet de rehabilitation, apres une evaluation clinique, neuropsychologique et fonctionnelle. Y sont eventuellement adjoints des techniques de transfert au quotidien pour des personnes a faible autonomie. Ces parcours de RC s’inscrivent au sein d’un modele de soins, le modele « tremplin », rampe de lancement qui mene « en fondu enchaine » a la concretisation du projet de la personne. Les therapies psychosociales sont dispensees par des soignants formes auxquels s’adjoignent aux equipes de nouveaux metiers du soin : job coach pour l’emploi accompagne en milieu ordinaire, case manager pour coordonner parcours de vie et de soin de la personne dans son environnement. Ces nouvelles pratiques en psychiatrie peuvent etre declinees a l’echelle d’un territoire avec des orientations nouvelles pour les hopitaux de jour, qui deviennent de veritables « sas de transition » vers l’inclusion sociale de patients a parcours complexes, ou pour les foyers de post cure qui peuvent cibler l’acquisition de l’autonomie. A long terme, et plusieurs annees apres une RC personnalisee et envisagee dans un parcours de rehabilitation, notre equipe constate une meilleure insertion professionnelle ainsi que plus de retour aux etudes, un taux moindre de rechutes et plus de determinants du retablissement, a savoir plus de pratique d’activite physique ou de loisirs, avec un ressenti positif de cette periode pour les patients. En France, la promotion recente de ces therapies psychosociales par nos tutelles devrait permettre une couverture de proximite sur l’ensemble du territoire national pour une psychiatrie plus ethique et plus humaniste.

Resume La remediation cognitive (RC) est une approche breve et focalisee favorisant un meilleur fonctionnement neuropsychologique et une meilleure qualite de vie. Les processus neuropsychologiques cibles concernent les fonctions executives ; l’attention et la cognition sociale. En intervention precoce la RC vise a eviter un surhandicap chez les enfants et les adolescents presentant un trouble du neurodeveloppement en prevenant aussi des complications emotionnelles et/ou comportementales associees. Elle complete les prises en charge habituelles ou les optimise. Concernant la cognition sociale, elle favorise le developpement de la theorie de l’esprit et protege d’une faiblesse de l’inhibition comportementale. Facteur de rehabilitation chez les adultes, la RC est facteur d’inclusion chez les plus jeunes et favorise le maintien dans leur environnement ecologique. Nous proposons le programme de remediation cognitive NEAR (Neuropsychological Educational Approach to Remediation), developpe depuis 2002 par Alice Medalia, a des collegiens avec trouble du spectre de l’autisme (TSA) ou Trouble deficit de l’attention avec ou sans hyperactivite (TDA/H). Outil therapeutique attractif pour les plus jeunes il a fait preuve de son interet chez les adultes ; integre la metacognition et optimise la generalisation dans la vie quotidienne. La realisation d’un bilan medical et neuropsychologique au C3RP-Enfants/Adolescents (Centre referent en remediation cognitive et rehabilitation psycho-sociale) est un prerequis et les benefices sont evalues au terme du programme. Dans une etude de faisabilite, les jeunes ont temoigne se sentir plus motives, confiants et competents. La RC semble representer une nouvelle ressource therapeutique pour les plus jeunes dont l’efficience reste a evaluer scientifiquement.

Resume Objectifs Les troubles du spectre autistique (TSA) s’accompagnent souvent de signes moteurs, mais leur etude objective reste relativement recente. De plus, les anomalies de la motricite manuelle persisteraient avec l’âge, limitant les competences fonctionnelles et la qualite de vie. Cet article fait une revue et une analyse de la litterature portant sur les aspects sensori-moteurs et la motricite manuelle dans les TSA. Methodes Nous avons entrepris une recherche Medline de tous les articles parus depuis l’an 2000 dont le titre, le resume ou les mots-clefs contenaient la racine autis* et l’un ou l’autre des termes suivants : hand, manual, finger, dexterity, prehension, grip ou grasp. Trente-trois articles ont ete retenus. Resultats L’anomalie elementaire serait un deficit dans les capacites d’integration sensori-motrice pendant le mouvement pour predire des signaux d’erreur et ainsi permettre des corrections par feedforward. Ces alterations sont aussi retrouvees dans les tâches de dexterite manuelle et persistent de facon significative jusqu’a l’âge adulte. Le substratum neurologique sous-tendant ces anomalies serait une hypoconnectivite par retard de maturation des faisceaux cortico-cerebelleux retrouve dans l’autisme et globalement dans les troubles du neurodeveloppement. Conclusion Malgre un debut de convergence vers l’hypothese d’un deficit d’integration sensori-motrice, on ne dispose toujours pas d’un modele physiopathologique commun aux deficits sensori-moteurs de l’autisme. Une description plus fine de ces signes moteurs et une meilleure comprehension des mecanismes cerebraux sous-jacents permettraient une prise en charge plus adaptee pour cette population aux troubles du neurodeveloppement si singuliers.

The interactions between cognitive and sensorimotor impairments in schizophrenia remain largely unexplored. Using behavioural and neurophysiological techniques, Carment et al. show that inefficient attentional processing contributes to impaired sensorimotor control and altered task-related modulation of cortical excitability and inhibition in schizophrenia., Impairments in attentional, working memory and sensorimotor processing have been consistently reported in schizophrenia. However, the interaction between cognitive and sensorimotor impairments and the underlying neural mechanisms remains largely uncharted. We hypothesized that altered attentional processing in patients with schizophrenia, probed through saccadic inhibition, would partly explain impaired sensorimotor control and would be reflected as altered task-dependent modulation of cortical excitability and inhibition. Twenty-five stabilized patients with schizophrenia, 17 unaffected siblings and 25 healthy control subjects were recruited. Subjects performed visuomotor grip force-tracking alone (single-task condition) and with increased cognitive load (dual-task condition). In the dual-task condition, two types of trials were randomly presented: trials with visual distractors (requiring inhibition of saccades) or trials with addition of numbers (requiring saccades and addition). Both dual-task trial types required divided visual attention to the force-tracking target and to the distractor or number. Gaze was measured during force-tracking tasks, and task-dependent modulation of cortical excitability and inhibition were assessed using transcranial magnetic stimulation. In the single-task, patients with schizophrenia showed increased force-tracking error. In dual-task distraction trials, force-tracking error increased further in patients, but not in the other two groups. Patients inhibited fewer saccades to distractors, and the capacity to inhibit saccades explained group differences in force-tracking performance. Cortical excitability at rest was not different between groups and increased for all groups during single-task force-tracking, although, to a greater extent in patients (80%) compared to controls (40%). Compared to single-task force-tracking, the dual-task increased cortical excitability in control subjects, whereas patients showed decreased excitability. Again, the group differences in cortical excitability were no longer significant when failure to inhibit saccades was included as a covariate. Cortical inhibition was reduced in patients in all conditions, and only healthy controls increased inhibition in the dual-task. Siblings had similar force-tracking and gaze performance as controls but showed altered task-related modulation of cortical excitability and inhibition in dual-task conditions. In patients, neuropsychological scores of attention correlated with visuomotor performance and with task-dependant modulation of cortical excitability. Disorganization symptoms were greatest in patients with weakest task-dependent modulation of cortical excitability. This study provides insights into neurobiological mechanisms of impaired sensorimotor control in schizophrenia showing that deficient divided visual attention contributes to impaired visuomotor performance and is reflected in impaired modulation of cortical excitability and inhibition. In siblings, altered modulation of cortical excitability and inhibition is consistent with a genetic risk for cortical abnormality.

Resume Introduction Les deficits cognitifs associes aux troubles du spectre de l’autisme (TSA) concernent notamment les fonctions executives. La remediation cognitive est une strategie therapeutique qui vise a pallier ces deficits cognitifs. L’objectif de notre travail etait d’evaluer l’efficacite du programme de remediation cognitive CRT (Cognitive Remediation Therapy) sur la flexibilite cognitive, l’inhibition et les resultats scolaires chez des enfants et adolescents presentant un TSA. Methodes Etude transversale portant sur des enfants et adolescents presentant un TSA, selon les criteres du DSM-5. Le programme de remediation cognitive CRT a ete conduit a raison d’une seance par semaine de 45 minutes chacune. Les patients ont ete evalues avant le debut de l’intervention et une semaine apres sa fin. Les parametres evalues ont ete l’intelligence, la flexibilite, l’inhibition, ainsi que les resultats scolaires. Resultats Parmi les 25 patients inclus, 16 ont accompli le bilan neuropsychologique en post-CRT, constituant ainsi notre echantillon final. La moyenne d’âge etait de 10,87 ans. Le nombre moyen de seances effectuees etait de 22,38. En post-CRT, les patients ont presente une amelioration des scores de flexibilite phonemique (p = 0,032) et semantique en categorie « animaux » (p = 0,045), ainsi qu’une amelioration au niveau de l’inhibition evaluee par le Colors and Animals Attention Test (p = 0,279). Une amelioration significative des resultats scolaires (p = 0,001) a ete egalement notee. Conclusion La remediation cognitive est une modalite de prise en charge, qui peut s’averer prometteuse dans la prise en charge des enfants avec TSA.

Interactions between social cognition and symptoms of schizophrenia have been investigated, but mostly component by component. Here we tested the assumption that two categories of deficits exist depending on clinical profiles, one corresponding to a defect in social cognition – “under-social cognition” – and one corresponding to excessive attributions leading to social cognitive impairments – “over-social cognition”. To conduct the investigation, we performed a Hierarchical Clustering Analysis using positive and negative symptoms in seventy patients with schizophrenia and we compared the clusters obtained to a group of healthy controls on social cognitive measures. We distinguished two social cognitive profiles based on prevailing symptoms for emotion processes and Theory of Mind. Actually, patients with negative symptoms showed lower performances in emotion recognition task than both those with positive symptoms and controls. Concerning Theory of Mind, patients with positive symptoms had a significant tendency to make over interpretative errors than both patients with negative symptoms and controls. For other processes assessed, further explorations are needed. Actually, concerning social perception and knowledge both patients' groups presented significant impairments compared to controls. Assessment of attribution bias showed that patients in the positive group presented a significant hostility bias and a higher intentionality score compared to healthy controls. These results favor the existence of different categories of impairments depending more on the clinical characteristics of patients than on nosographical categories, but further investigations are now necessary to specify these profiles. It nevertheless showed the importance of assessing symptoms in relationship with cognitive functioning. Keywords: Social cognition, Schizophrenia, Symptoms, Emotion, Theory of mind, Attribution style

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.

Background: Schizophrenia is a heterogeneous neurodevelopmental disease involving cognitive and motor impairments. Motor dysfunctions, such as eye movements or neurological soft signs, are proposed as endophenotypic markers. Methods: Supervised machine-learning methods (Support Vector Machines) applied on oculomotor performances using comprehensive testing with prosaccades, antisaccades, memory-guided saccade tasks and smooth pursuit, as well as neurological soft signs assessment, was used to discriminate patients with schizophrenia (SZ, N=53), full siblings of patients (FS, N=45) and healthy volunteers (C, N=48). 80% of patients were used in a training/validation set and 20% on a test set. The discrimination was measured using the classification error (rate of misclassified patients).Results: The most reliable classification was between C and SZ, with only 15% and 12% of error rates for validation and test, whereas the SZ vs. FS classification provided the highest error rates (32% of error rate in both validation and test). Interestingly, neurological soft signs were selected as the best predictor, together with a combination of measures, for the two classifications: C vs. SZ, SZ vs. FS. In addition, memory-guided saccades were consistently selected among the best two multimodal features for the classifications involving the control group (C vs. SZ or FS). Conclusions: Taken together, these results emphasize the importance of neurological soft signs and sensitive oculomotor parameters, especially memory-guided saccades. This classification provides promising avenues for improving early detection of / early intervention in psychosis.

Background Neural information processing is subject to noise and this leads to variability in neural firing and behavior. Schizophrenia has been associated with both more variable motor control and impaired cortical inhibition, which is crucial for excitatory/inhibitory balance in neural commands. Hypothesis In this study, we hypothesized that impaired intracortical inhibition in motor cortex would contribute to task-related motor noise in schizophrenia. Methods We measured variability of force and of electromyographic (EMG) activity in upper limb and hand muscles during a visuomotor grip force-tracking paradigm in patients with schizophrenia (N = 25), in unaffected siblings (N = 17) and in healthy control participants (N = 25). Task-dependent primary motor cortex (M1) excitability and inhibition were assessed using transcranial magnetic stimulation (TMS). Results During force maintenance patients with schizophrenia showed increased variability in force and EMG, despite similar mean force and EMG magnitudes. Compared to healthy controls, patients with schizophrenia also showed increased M1 excitability and reduced cortical inhibition during grip-force tracking. EMG variability and force variability correlated negatively to cortical inhibition in patients with schizophrenia. EMG variability also correlated positively to negative symptoms. Siblings had similar variability and cortical inhibition compared to controls. Increased EMG and force variability indicate enhanced motor noise in schizophrenia, which relates to reduced motor cortex inhibition. Conclusion The findings suggest that excessive motor noise in schizophrenia may arise from an imbalance of M1 excitation/inhibition of GABAergic origin. Thus, higher motor noise may provide a useful marker of impaired cortical inhibition in schizophrenia.

Cognitive dysfunctions associated with Autism spectrum disorder (ASD) are nowadays highlighted. These cognitive impairments include mainly executive dysfunctioning and are linked with academic difficulties, thus representing one of the treatment targets. Cognitive remediation therapy (CRT) is a new promising program aiming to remediate cognitive impairments by targeting executive functions. It attempts to teach information processing strategies through guided mental exercises.To assess the effectiveness of the cognitive remediation program CRT (Cognitive Remediation Therapy) on executive abilities and school results, in children and adolescents with ASD.Cross-sectional study involving children and adolescents with ASD according to DSM-5. The CRT program was conducted individually at the rate of one session per week of 45 minutes each. Outcome measures were intellectual abilities, cognitive flexibility, working memory and school performance.Of the 25/24 patients included, 16 had reached the end of the program. Their average age was 10.87 years. The mean number of sessions performed was 22.38. After completion of CRT, patients showed significant improvement on intellectual abilities (p10-3), phonemic fluency (p=0.032), « animal » category of semantic fluency (p=0.045), working memory (p=0.001 for forward digit-span and p=0.006 for backward digit span) and school results (p=0.001). Patients made more repetitive and intrusive errors in semantic fluency with significant increase in the "clothes" semantic category (p=0.019).Cognitive remediation enhances cognition directly and positively acts on clinical course. It appears to be a relevant new method in the management of ASD. Yet, further research is required in order to confirm the efficiency of this treatment and to better define its optimal settings.

Although various psychiatric disorders present with social-cognitive impairment, a measure assessing social-cognitive processes implicitly and reliably, with high selectivity and with enough signal-to-noise ratio (SNR) for individual evaluation of any population at any age, is lacking. Here we isolate a neural marker quantifying impaired visual coding of facial expression in individuals with 22q11.2 deletion syndrome (22q11DS) using frequency-tagging with electroencephalography (EEG). Twenty-two 22q11DS participants and 22 healthy controls were presented with changes of facial expression displayed at low, moderate, and high intensities every five cycles in a stream of one neutral face repeating 6 times per second (i.e., at a 6 Hz base rate). The brain response to expression changes tagged at the 1.2 Hz (i.e., 6 Hz/5) predefined frequency was isolated over occipito-temporal regions in both groups of participants for moderate- and high-intensity facial expressions. Neural sensitivity to facial expression was reduced by about 36% in 22q11DS, revealing impaired visual coding of emotional facial signals. The significance of the expression-change response was estimated for each single participant thanks to the high SNR of the approach. Further analyses revealed the high reliability of the response and its immunity from other neurocognitive skills. Interestingly, response magnitude was associated with the severity of positive symptoms, pointing to a potential endophenotype for psychosis risk. Overall, the present study reveals an objective, selective, reliable, and behavior-free signature of impaired visual coding of facial expression implicitly quantified from brain activity with high SNR. This novel tool opens avenues for clinical practice, providing a potential early biomarker for later psychosis onset and offering an alternative for individual assessment of social-cognitive functioning in even difficult-to-test participants.

Resume La remediation cognitive (RC) vise a reduire des deficits cognitifs et fournir des strategies palliatives en vue d’une reinsertion de patients avec handicap psychique. Elle s’inscrit dans un parcours de soin personnalise et necessite une evaluation et une prise en charge multidisciplinaires, incluant eventuellement d’autres therapies psychosociales. Cette etude, realisee en 2016, a pour ambition d’etablir un etat des lieux de l’accessibilite et de la pratique de la RC en Ile-de-France, pour promouvoir un acces large en systematisant l’integration de la RC dans un parcours global et coherent. Si la RC est proposee par pres de 58 % des structures ayant repondu a l’enquete, sa mise en œuvre gagnerait a etre amelioree : elle s’inscrit a 58 % dans un projet de rehabilitation precis et l’evaluation multidisciplinaire avant/apres est realisee a 51 % en psychiatrie adulte et 20 % en psychiatrie infanto-juvenile (PIJ), peut-etre du fait d’un manque de personnel qualifie (neuropsychologues). Les programmes utilises en PIJ sont peu specifiques. La capacite d’accueil, encore faible, devrait etre majoree par des programmes de groupe. Malgre un manque de connaissance a combler, il ressort un interet important pour la RC avec une volonte exprimee par douze structures a se former. Les autres therapies psychosociales, bien que mieux connues, gagneraient a etre plus souvent proposees et labellisees par l’ARS. Nos resultats confirment une rarete de l’offre de soin en psychiatrie dans le 77, le 91 et 93. Quatre unites de rehabilitation dans le 77 et trois dans le 91 sont en formation. Trois structures dans le 77 et deux dans le 91 souhaitent se former. Les soutenir est d’autant plus important que la bonne pratique de la RC a un effet direct sur les benefices en termes de couts societaux. Depuis, dans toute l’IDF, huit structures ont depose un projet de plateforme de RC et Rehabilitation.

Resume Les personnes a ultra haut risque de developper une psychose ou presentant un premier episode psychotique presentent tres precocement un deficit neurocognitif et de cognition sociale. L’enjeu pour les inserer au plus vite dans la vie sociale et professionnelle est crucial. Des prises en charge specifiques doivent etre developpees actuellement en France pour ces adolescents ou jeunes adultes, tant pour la remediation cognitive, que pour la psychoeducation. Mais d’autres dimensions psychosociales comme l’activite physique adaptee ou le soutien a l’emploi s’averent indispensables. Ces jeunes, souvent hyperconnectes, sont une population difficile a fideliser et a integrer dans une demarche de soin. Les centres de detection precoce doivent creer un maillage territorial et sectoriel coordonne avec des structures medicosociales specifiques mettant l’accent sur des acteurs du soins et du social indispensables comme les case managers ou les soutiens a l’emploi.

L’education therapeutique (ETP) a prouve son efficacite pour ameliorer l’observance medicamenteuse et diminuer les rehospitalisations des sujets souffrant de schizophrenie. Cependant, moins de 10 % des secteurs psychiatriques proposent des programmes agrees par les agences regionales de sante. Un des facteurs limitant la diffusion de cette pratique serait le manque de donnees sur son impact reel pour la perception subjective des patients de leur qualite de vie. Nous proposons donc d’evaluer l’impact d’un programme agree d’ETP sur la qualite de vie objective et subjective de sujets souffrants de schizophrenie et de verifier son benefice sur la compliance therapeutique. Ceci, au moyen d’une etude clinique retrospective de type quasi experimentale avant/apres, ouverte et non controlee. Quatorze patients souffrant de schizophrenie ont participe a un programme d’ETP en groupe, qui comportait 15 seances sur huit mois. Les qualites de vie objective et subjective, ainsi que la compliance medicamenteuse ont ete evaluees respectivement par les echelles GAF, SQoL et MARS. La moyenne de participation etait de 11,6 seances sur 15. La comparaison des echelles GAF et SQoL avant et apres programme montre une amelioration modeste mais significative de la qualite de vie objective et du bien-etre psychologique. Nous retrouvons une majoration significative du score de l’echelle MARS. Cette premiere etude francaise sur un programme d’ETP agree montre un impact indubitable de l’ETP sur la qualite de vie objective, le bien-etre psychologique et la compliance medicamenteuse. A moyen et long terme, il serait interessant de reevaluer ces benefices pour le patient, d’une part, et de quantifier ces benefices d’un point de vue socio-economique d’autre part. [resume d'auteur]

Cognitive disorders are currently considered as central components of disorders found in schizophrenia and are a major handicap for patients day to day. These disorders appear before the first psychotic episode, in the prodromal phase, during which time the symptoms are below the threshold for psychosis. People with these symptoms are considered as presenting an at-risk mental state (or at ultra-high risk, UHR of psychosis) and their risk for psychotic transition is between 20% and 40% within one year. Despite a number of studies, the chronology in which cognitive disorders appear in relation to the psychotic symptoms has not clearly been established and the study of the links between cognition and symptoms could improve our understanding of psychotic disorders. The detection of certain cognitive disorders before the onset of psychotic disorders could help improve early detection. We carried out a systematic analysis of the literature exploring cognitive disorders found in subjects with UHR for psychosis. The objective of most studies was to establish the predictive value for psychotic transition. Nevertheless study results have shown little consensus. Faced with this heterogeneity of results from past studies, we carried out a critical analysis of the literature and suggest areas of reflection for future research.

Resume Objectifs Adaptation et validation en population generale et clinique chez l’enfant d’une echelle de signes neurologiques mineurs (SNM) : l’echelle de Krebs et al. (2000). Methodes Apres une etude preliminaire qui a examine 42 enfants, des modifications ont ete apportees pour permettre une adaptation a l’enfant et faciliter sa pratique en particulier chez les enfants atteints de troubles du spectre autistique (TSA). Une etude de validation a ete menee en examinant les proprietes psychometriques de l’echelle chez 86 enfants âges de 6 a 12 ans dont 26 enfants atteints de TSA et 60 enfants au developpement normal. Resultats L’adaptation de l’echelle a consiste en une modification de l’ordre des items, en une utilisation de supports concrets pour l’evaluation de la lateralite, et en l’elimination de l’item praxie constructive. La coherence interne etait bonne avec un alpha de Cronbach de 0,87. La fiabilite interjuge donnait un coefficient de correlation intraclasse de 0,91. L’analyse en composantes principales rapportait cinq facteurs representant 62,96 % de la variance totale. L’evaluation des SNM a montre des differences significatives entre patients et temoins pour le score total de SNM ( p = 0,000) et dans differents sous-scores. Conclusion La validite de l’echelle est confirmee pour l’evaluation des SNM chez les enfants, en particulier pour les enfants atteints de TSA.

Schizophrenia is a neurodevelopmental disease with cognitive and motor impairments. Motor dysfunctions, such as eye movements or Neurological Soft Signs (NSS), are proposed as endophenotypic markers. Antisaccade (AS) and memory-guided saccades (MGS), two markers of inhibitory control mechanism, are altered in both patients with schizophrenia and their relatives, although these tools may have different sensitivities. Recently, emphasis has been put on identifying markers predictive of psychosis transition in subjects with ultra-high-risk psychosis in order to develop targeted prevention. This study investigates AS and MGS in 46 patients with schizophrenia, 23 ultra-high-risk subjects, and 39 full siblings compared to 47 healthy volunteers. NSS were assessed as a marker of abnormal neurodevelopment. The results revealed more errors in MGS in patients, ultra-high-risk subjects and siblings, than in controls, and more specifically ultra-high-risk subjects with high NSS scores. By contrast, the error rate in AS was significantly higher only in patients with schizophrenia compared to controls. These findings suggest that MGS could be more accurate to detect deficient inhibitory processes as a marker of vulnerability before the onset of schizophrenia. The use of the different paradigms (AS, MGS) revealed distinct profiles depending on the stage of the disease, indicating that some alterations could be pure endophenotypic markers of vulnerability for schizophrenia, while others could be markers of the disease progression.

Little is known about the respective effects of depression and cognitive impairment on quality of life among older adults with schizophrenia spectrum disorder.We used data from the Cohort of individuals with Schizophrenia Aged 55-years or more (CSA) study, a large multicenter sample of older adults with schizophrenia or schizoaffective disorder (N = 353). Quality of life (QoL), depression and cognitive impairment were assessed using the Quality of Life Scale (QLS), the Center of Epidemiologic Studies Depression scale and the Mini-Mental State Examination, respectively. We used structural equation modeling to examine the shared and specific effects of depression and cognitive impairment on QoL, while adjusting for sociodemographic characteristics, general medical conditions, psychotropic medications and the duration of the disorder.Depression and cognitive impairment were positively associated (r = 0.24, p 0.01) and both independently and negatively impacted on QoL (standardized β = -0.41 and β = -0.32, both p 0.01) and on each QLS quality-of-life domains, except for depression on instrumental role and cognitive impairment on interpersonal relations in the sensitivity analyses excluding respondents with any missing data. Effects of depression and cognitive impairment on QoL were not due to specific depressive symptoms or specific cognitive domains, but rather mediated through two broad dimensions representing the shared effects across all depressive symptoms and all cognitive deficits, respectively.Because of the cross-sectional design of this study, measures of association do not imply causal associations.Mechanisms underlying these two broad dimensions should be considered as important potential targets to improve quality of life of this vulnerable population.

International audience; Difficulties in social cognition are present both in persons with schizophrenia (SCZ) and persons with autism spectrum disorders (ASD). However, qualitative similarities and differences in this field remain unclear. The aim of this study was to explore attribution of intentionality in patients with recent onset SCZ in comparison to patients with high functioning ASD, and to explore relationships between alterations in attribution and clinical profile. Animated shapes are a non-verbal Theory of Mind (ToM) task involving the interpretation of geometric figure interactions in three conditions: random, goal-directed and ToM. We compared 51 young adults with SCZ, 32 with ASD and 23 healthy controls (HC) matched for age and gender. In random, goal-directed and ToM conditions, persons with SCZ attributed less intentionality with less appropriate answers than HC, while the same anomalies were only found in the ToM condition in persons with ASD. In SCZ, thought and langage disorganization and earlier age at onset were correlated with intentionality score in the random condition. Moreover, a mixed ToM impairment was found in SCZ, combining undermentalizing (for movements involving a mental state) similar to what was found in ASD, and overmentalizing (for random movements), related to dizorganization and precocity of the first psychotic episode. In the frame of the hypothesis of a continuum, these results underline both similarities and differences between autism and schizophrenia.

In the last half century, a large body of research literature has concentrated on oculomotor function in psychiatric syndromes and especially schizophrenia spectrum disorders. The emerging picture from these studies is that specific deficits measured in specific oculomotor function tasks such as smooth eye pursuit, antisaccades and memory saccades are evident in patients with psychosis and probably to a lesser degree in their first degree relatives. Such oculomotor function deficits have helped develop a better understanding of the genetic and neurobiological substrate of psychiatric syndromes, bearing in mind that these functions have a complex genetic and neurobiological substrate that remains to be fully understood. Some of these functions such as visually guided and predictive saccades are sensitive to medication status and the natural course of psychiatric syndromes. This fact could potentially lead to the future development of oculomotor biological markers for treatment response and outcome predictions in these syndromes.

The ability to infer from uncertain information is impaired in schizophrenia and is associated with hallucinations and false beliefs. The accumulation of information is a key process for generating a predictive internal model, which statistically estimates an outcome from a specific situation. This study examines if updating the predictive model by the accumulation of information in absence of feedback is impaired in schizophrenia. We explored the implicit adaptation to the probability of being instructed to perform a movement (33%-Go, 50%-Go, or 66%-Go) in a Go/NoGo task in terms of reaction times (RTs), electromyographic activity, and corticospinal excitability (CSE) of primary motor cortex (M1). CSE was assessed at two time points to evaluate prediction of the upcoming instruction based on previously accumulated information: at rest (preceding the warning signal) and at the Go/NoGo signal onset. Three groups were compared: patients with schizophrenia (n = 20), unaffected siblings (n = 16), and healthy controls (n = 20). Controls and siblings showed earlier movement onset and increased CSE with higher Go probability. CSE adaptation seemed long-lasting, because the two CSE measures, at least 1500 ms apart, strongly correlated. Patients with schizophrenia failed to show movement onset (RT) adaptation and modulation of CSE. In contrast, all groups decreased movement duration with increasing Go probability. Modulation of CSE in the anticipatory phase of the potential movement reflected the estimation of upcoming response probability in unaffected controls and siblings. Impaired modulation of CSE supports the hypothesis that implicit adaptation to probabilistic context is altered in schizophrenia.

ObjectiveWe examined Theory of Mind (ToM) abilities in adolescents with early-onset schizophrenia (EOS) and their correlation with clinical findings and Executive Functions (EF).MethodsThe 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).ResultsAdolescents 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 (pp=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.ConclusionOur results confirm previous findings of ToM deficits in adult individuals with schizophrenia and attest the severity of these deficits in patients with EOS.

The neuropeptide oxytocin (OT) is an evolutionary highly conserved molecule that plays a part in the regulation of complex social cognition and behaviours. From a pathophysiological point of view, several studies have evidenced dysfunctions of the oxytocinergic system in autism spectrum disorders (ASD): a lowering of plasma OT and genetic or epigenetic anomalies of the OT receptor. Therefore, some authors have hypothesized that an abnormality in the OT neurotransmission may account for several features of autism and that a treatment restoring a normal OT pathway functioning could improve social abilities. OT administration has thus been used in clinical trials, especially in groups of subjects suffering from autism. Some studies found that OT decreased repetitive behaviours, enhanced emotional understanding of speech intonation, improved performance of the Reading the Mind in the Eyes Test and reinforced cooperation. Nevertheless, the findings of the OT administration studies on clinical samples show great diversity. The context, the personality and childhood experiences of the subject could be moderators influencing the effect of exogenous OT. Besides, three mechanisms could play a part in the action of OT on ASD social symptoms: anxiety reduction (with a lowering in the hypothalamic-pituitary-adrenal axis responsiveness and in the amygdale reactivity to social stimuli), increased affiliative motivation (involving the dopaminergic pathway and several regions of the social brain) and enhanced perceptual selectivity and social stimuli salience. To conclude, OT could be a promising molecule used as a treatment to promote social behaviours, helping individuals with ASD to develop new relationships. OT could be administered during a cognitive-behavioural therapy to reinforce the efficacy of such procedures. More studies are needed, on larger samples, to investigate the safety and efficacy of OT administration and to specify optimal dosages and characteristics of patients who may benefit from this treatment.

Resume Veritables enjeux de sante publique, les adolescents et adultes avec deficience intellectuelle souffrent aujourd’hui de « surhandicaps », par des accompagnements parfois peu favorables a l’autonomisation et a de nouveaux apprentissages, indispensables a la vie en communaute. Leurs limites cognitives, en particulier au niveau des fonctions executives, seraient un frein a leur participation aux activites de vie quotidienne, par des difficultes de planification, d’anticipation, de flexibilite et de memoire de travail. Ces fonctions mentales superieures peuvent etre exercees a l’aide de programmes tels que la CRT (Cognitive Remediation Therapy – Wykes and Reeder 2005) developpes dans d’autres pathologies, a la condition de les adapter a l’âge de developpement de la personne. Les benefices attendus par ce type d’accompagnement sont l’amelioration de l’autonomie, une meilleure participation aux activites de vie quotidienne et une estime de soi accrue, en resume toutes les modalites necessaires a une meilleure qualite de vie.

Attention-Deficit Hyperactivity Disorder (ADHD) is associated with neuropsychological deficits including executive and attentional impairments. The cognitive remediation therapy is a new promising technique designed to improve the neurocognitive abilities damaged in ADHD.Adapt and apply the cognitive remediation program CRT (Cognitive Remediation Therapy) for children and adolescents with ADHD and to evaluate its effectiveness on attentional and executive abilities.Children and adolescents with ADHD, diagnosed using the K-SADS-PL questionnaire was involved in the study. The CRT program was administered for an average period of fourteen weeks with a rate of one session per week of 40 minutes each. The Attentional Network Test was administered prior to the intervention and one week after.Of the 30 patients included, 14 had reached the end of the program. Among them, nine patients passed the attentional test post CRT, thus constituting our final sample. Their average age was 9 years. The mean number of sessions performed was 14.5. Post CRT, the mean of patient's response time was found to be shorter (p=0,004) and the frequency of omissions errors was also lesser than that found at the initial assessment. Patients also committed fewer errors in incongruent situations in post program, with a significant improvement of the conflict effect (p= 0.009) signing a better executive control.Cognitive remediation is a promising new modality in the treatment of ADHD. Further research is needed to better document its effects and the optimal conditions required for setting it up.

Theory of Mind (ToM) is compromised in schizophrenia, and responsible for social disability. We aim to study the correlation between ToM deficits and Executive Functions (EF), using the Faux Pas Test (FPT) for ToM evaluation, Behavioral Assessment of the Dysexecutive Syndrome (BADS) and Wisconsin Card Sorting Test (WCST) for EF assessment. Two groups of patients with schizophrenia were included: 22 young (18-35 years-old) and 18 middle-aged (>50 years-old) Patients, compared to age-matched Controls. We found worst FPT performances in both groups of patients, but with a more generalized pattern of dysfunction in the middle-aged patient group. This group had worse EF scores than both controls and younger patients. The association of EF with FPT items was uneven. In young patients only empathy (Q6) remained significant after controlling for EF and level of education, while in middle-aged patients faux pas explanation (Q4), false belief (Q5) and total scores remained significant. In young patients only affective TOM was impaired. No correlation was found with clinical symptoms, nor age at onset of the disease. We conclude that ToM deficit arises early during the course of the illness (already present in young patients), increases in middle-aged patients, and relates only partially with EF.

Resume But Les objectifs de notre etude etaient de determiner la prevalence, les scores et la nature des signes neurologiques mineurs (SNM) chez des adolescents presentant une schizophrenie a debut precoce et de rechercher les correlations entre ces marqueurs et les caracteristiques demographiques, cliniques et therapeutiques des patients. Methodologie Il s’agit d’une etude cas-temoins portant sur 12 patients apparies par âge et par niveau scolaire a 12 temoins sains sans antecedents personnels, ni familiaux psychiatriques. La procedure d’evaluation a consiste en la passation des echelles cliniques des symptomes positifs et negatifs (PANSS), et de l’echelle des SNM de Krebs et al. (2000). Resultats L’âge moyen de notre population etait de 14,7 ans. La prevalence des SNM etait de 100 % avec un score total moyen de 29,3 ± 4,1 contre 7 ± 1,3 chez les temoins. Des correlations negatives entre l’âge et le score total des SNM (p = 0,05) et celui de l’integration sensorielle (p = 0,04) ont ete trouvees. Aucune correlation n’a ete trouvee entre les differents scores de l’echelle des SNM et les caracteristiques cliniques et therapeutiques des patients. Conclusion La prevalence et les scores eleves des SNM chez les jeunes atteints de schizophrenie precoce traduiraient l’existence d’anomalies structurelles cerebrales, elles-memes sequelles de perturbations du developpement neurologique precoce, ce qui serait en faveur de l’hypothese neurodeveloppementale pour cette pathologie.

The hypothesis of cerebral plasticity in psychiatric disorders has encouraged clinicians to develop cognitive remediation therapy (CRT), a new therapeutic approach based on attention, memory, planning, and mental flexibility tasks. The first cognitive remediation programs were developed and validated for adults with schizophrenia and were shown to have a positive impact on executive functions as well as on quality of life. In children and adolescents, researchers emphasized the existence of executive dysfunction in neurodevelopmental disorders such as autistic spectrum disorder, attention deficit disorder, and eating disorders. For these disorders, neuropsychological studies suggest that memory, planning, attention and mental flexibility are impaired. Despite the paucity of studies on cognitive remediation (CR) in children, preliminary results have suggested, as in adults with schizophrenia, good compliance and optimization of executive functioning. Consequently, programs dedicated to young subjects were developed in English-speaking countries, and the Department of Child and Adolescent Psychiatry of Sainte Anne Hospital (Paris) developed a new CR program for children with attention deficit disorder, academic problems, or eating disorders. These programs complete the field of CRT proposed by Sainte Anne Hospital's Remediation and Psychosocial Rehabilitation Reference Center, initially designed for adults with schizophrenia. Our team used and adapted validated tools such as Delahunty and Wykes's CRT program (translated and validated in French by Amado and Franck) and Lindvall and Lask's CRT Resource Pack. One program was developed for an adolescent with anorexia nervosa and applied to the subject and her family, but the purpose of this paper is to present a CR approach for children with attention deficit disorder or academic disorder, a 6-month program based on paper-pencil tasks and board and card games. The team was trained in different kinds of cognitive remediation, and the program was applied by a clinical nurse with the supervision of a child and adolescent psychiatrist and the department's neuropsychologists. Paper-pencil tasks were adapted from the CRT program for adults; the card and board games used were geometric figures, illusions, Rush Hour(®), Set(®), Jungle Speed(®), Color Addict(®), etc. These games are available in stores and the program can be applied at home, which helps families set aside their preoccupations with their child's academic performance. Diagnostic and neuropsychological evaluations were done before the beginning of the therapy and repeated at the end of the 6-month program. This program does not ignore the metapsychological impact of the therapy, and work on self-esteem is also done. The presence of the therapist is necessary, which seems better than a computer program, which cannot encourage the young subject in the same personalized and empathetic way. We therefore conducted the first clinical feasibility trial of cognitive remediation in young subjects and present a clinical case of a 6-year-old boy with attention deficit disorder and academic disorder. The results of neuropsychological evaluations before and after therapy suggest improvement in executive functions and better self-esteem. Satisfaction for the boy and his family was high. Even if these results need to be replicated, cognitive remediation appears to be a new therapeutic tool, complementary to classical approaches used in childhood psychiatric disorders. The Department of Child and Adolescent Psychiatry will submit this program to a research program conducted by the National Health Department to study the impact of this approach in a controlled study.