Abstract
Employment rate in psychiatry is around 10 to 30%. Cognitive remediation (CR) associated with psychosocial rehabilitation shows good functional outcomes, with a high level of satisfaction in participants provided by tailored CR. However, few studies looked at the long-term outcome in participants who experienced such a program. This retrospective survey examines the outcome of persons having psychiatric diseases 2 to 9 years after being treated with a personalized CR program. The survey included 12 domains with questions relevant to work, studies, before CR (T1) and at the moment of the survey (T2), questions about housing, relatedness, familiar relationships and daily activities at T2. Finally, a narrative interview was included to express feelings of the participants about CR. Sixty-six participants completed the survey, and were treated with neurocognitive or social cognition programs. Their diagnosis was: schizophrenia (80.3%), neurodevelopment disorder (autism as well as genetic or metabolic disease with psychiatric expression) (15.2%) and bipolar disorder (4.5%). The comparison between T1 and T2 showed significant difference for job employment (P < 0.001), even for competitive jobs (p < 0.007), for performing studies (p = 0.033), for practicing a physical activity (0.033) or reading (0.002). Outcome was also examined in reference to the delay from CR to highlight changes in patient characteristics and service delivery over the years. Hence, the total sample was split in two subgroups: CR delivered in 2009–2013 (n = 37); CR delivered in 2014–2016 (n = 29). While in the former group more participants were working (p = 0.037), in the latter group, which was younger (p = 0.04), more participants were studying (p = 0.02). At T2, a majority of persons experienced no relapse, three years (79.1%) to 8 years (56.8%) after CR, when referring to the anamnesis. Concerning subjective perception of CR, participants expressed feelings concerning positive impact on clarity of thought, on cognitive functions, self-confidence, perceiving CR as an efficient help for work and studies. To conclude, even long years after a personalized CR program, good benefits in terms of employment or studies emerge when compared to the status before CR, with good determinants for recovery in terms of leisure or physical activity practice.
Highlights
Employment rate for people with severe mental illness is only around 10 to 30% [1,2,3]
The principle of CR2PR program insisted on the point that “cognitive remediation programs had to be delivered tied to overall recovery goals” to increase the impact on functional outcome [11, 22]
Three eligible persons for CR died by suicide, unrelated to the rehabilitation course, with two of them who experienced a CR program but died several years after
Summary
Employment rate for people with severe mental illness is only around 10 to 30% [1,2,3]. The literature mentions that poor cognitive functioning affects vocational outcomes in patients with severe mental illness, and even for those receiving vocational rehabilitation services [4,5,6,7,8,9]. Psychosocial rehabilitation includes psychosocial therapies such as psychoeducation, for users and care-givers, cognitive behavior therapy or psychosocial skills intervention. These therapies can facilitate the transfer of benefits acquired during CR programs to everyday life [19]. A CR program, called “Cognitive Remediation to Promote Recovery” (CR2PR), has been developed in 16 clinics in New York for patients with serious mental illness [21]. Medalia et al [19], as well as Seccomandi et al [23] suggested to provide a “personalized medicine’ with tailored medical intervention for CR, bringing an answer to the fact that around 25% of the patients do not improve after CR
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