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AbstractBackgroundPeople 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.MethodsRemedRehab 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.ResultsSeventy-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.ConclusionsParticipants 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. 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. [ABSTRACT FROM AUTHOR]

Résumé La sémiologie psychiatrique présente des fondements complexes à la fois sur le plan historique et théorique, imposant de questionner la méthode pour organiser des termes sémiologiques. Le recueil sémiologique actuel est principalement tourné vers des diagnostics épidémiologiques, fondés sur des listes de symptômes, dont l’objectif est surtout d’aboutir à un diagnostic « athéorique » plus que vers une compréhension de leurs mécanismes et une prise en charge individualisée. Serait-il possible alors d’envisager une sémiologie compréhensive et scientifique, à la fois fondée sur la nosographie actuelle, mais autorisant également une prise en charge personnalisée en psychiatrie ? Cet article propose d’y répondre en questionnant la place des sciences cognitives dans cette perspective, selon la distinction fondamentale de la cognition au sens du contenu de pensées, dans une première partie, au travers des thérapies cognitivo-comportementales, et du contenant ou processus de pensée, dans une deuxième partie, au travers de la remédiation cognitive. The psychiatric semiology presents complex historical and theoretical underpinnings that lead us to question the method to organize semiological terms. The current organization of semiology is mainly based on lists of symptoms in order to make diagnosis validated by international nosography and epidemiological approach. This “atheoretical” diagnosis approach lacks sometimes of accuracy to understand the mechanisms underlying the semiology and to develop individualized care support. We propose here to present a comprehensive and scientific semiology, based on the current nosology, but also allowing personalized care in psychiatry. This article highlights thus the role of cognitive science according to a fundamental distinction of cognition in two views. On one hand, cognition can be view as a content of thought in the context of cognitive behavioral therapies. On the other hand, cognition can be view as containing or thought processes in the context of cognitive remediation. Each of theses views highlight the role of cognitive science to develop a comprehensive, validated and personalized semiology in psychiatry. [ABSTRACT FROM AUTHOR]