Abstract
BackgroundCognitive remediation is a key tool in rehabilitation programs but not sufficient recovery. Meta-analyses in cognitive remediation insist on combinating programs in schizophrenia (Wykes and al.,2012; Lindenmayer and al., 2013). Futhermore, other subjective and clinical factors must be taking account in order to create a personalized rehabilitation program facilitating skills transfer in an ecological context. CRISALID (Center of cognitive rehabilitation and cognitive remediation), Clermont de l’Oise psychiatric department (Hauts de France area, France) offers an integrative care program, COMBIMod; it combines several modules of therapeutic education and of cognitive remediation, after an individual assessment, clinical, cognitive and functional (quantitative and qualitative) of each patient. A personalized and contractualized project of rehabilitation is then created with all the care partners around the patient. Objectives are: first to present COMBIMod with the description of each integrative education therapeutic programs based on cognitive deficits; then to proceed to a statistical neuropsychological comparative analysis. We postulate that using an integrative and ecological approach including remediation cognitive technics and ecological psychoeducation programs, can improve cognitive deficits.MethodsFirst, we described all the steps to enter COMBIMOD program since the global personalized assessments to the creation of an individualized program including cognitive remediation (Neurocognition and Social-cognition) and therapeutics education programs (MODip, MODen). We illustrated this program with patients verbatim. Then, we recruited 15 stabilized patients with schizophrenia according to DSM-IV-TR criteria. All the patients were assessed using neuropsychological tests at the baseline and after completed the program. We used Wilcoxon test analysis with level of significancy < 0,05.ResultsWe found significant improvement in some visuospacial memory test (p< 0,02) and executive functions (semantic verbal fluency: p<0,02; alphabetical verbal fluency: p<0,01; TMTB: p<0,003). Verbatim show some impact on the daily living and cognitive perceptions of the patient.DiscussionThese preliminary results confirm the importance of an integrative rehabilitation program including personalized assessments, motivation working, mixed cognitive remediation and psychoeducation programs. In order to facilitate ecological skills transfer, rehabilitation program should focus on subjective and will assessments. Further studies must be conducted in a larger cohort to better understand recovery
Highlights
Negative, cognitive and depressive symptoms, as well as physical comorbidities, have a great impact on the real-world functioning in patients with schizophrenia (SZ) (1, 2, 3)
Distributions for the observed outcomes=0 had the peaks at the part of the estimate probabilities < 0.5, while those for observed outcomes=1 were relatively uniform, lacking the peaks at the part of estimated probabilities >0.5. These results indicate that the classification was less accurate in patients who exceeded the criteria compared to those who did not
Overall, estimation was more accurate at higher criteria, yielding 80–87% accuracy at 20 or 30 hours/week criteria (c.f., 67–70% at 0 or 10 hours/week criteria)
Summary
Deficits in social cognition and on social perception tasks are well studied and widely found in populations with schizophrenia. The present study examines the effectiveness of a novel, adaptive virtual reality simulated social exposure training intervention (see Bekele et al, 2016) in both decreasing feelings of loneliness and improving social cognitive function in individuals with schizophrenia. The present study attempts to enhance social cognitive and interpersonal abilities of individuals with schizophrenia while decreasing loneliness by strengthening social bonds and skills using a virtual reality training game. We find that following 10 sessions of VR social training, accuracy on measures of social cognition is improved significantly, loneliness is reduced non-significantly. These initial results demonstrate potential feasibility of a novel VR social skills training game for improving social experience for patients with schizophrenia
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