Antoinette Prouteau

Self-assessed cognitive dysfunction and objective performance in outpatients with schizophrenia participating in a rehabilitation program

OBJECTIVE To explore the pattern of associations between self-assessed and objective neuropsychological performance in a sample of outpatients with schizophrenia participating in a rehabilitation program. METHOD The Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS) [Compr. Psychiatry 44 (2003) 331] was used to assess cognitive complaints in 73 subjects with schizophrenia. Visuo-spatial tests of the Cambridge Neuropsychological Test Automated Battery (CANTAB) [Cogn. Neuropsychiatry 3 (1998) 45] were administered as objective measures. RESULTS Cognitive complaints in several cognitive domains were mainly correlated with a true difficulty in memory. Higher SSTICS attention scores, i.e. increased complaints, were associated with poorer CANTAB explicit visual memory and planning performances. Higher SSTICS executive functioning scores were associated with poorer CANTAB explicit visual memory scores. CONCLUSION These findings suggest that outpatients with schizophrenia express some cognitive difficulties. However, the cognitive nature of these subjective complaints does not strictly correspond with objective performances. These results also suggest that theoretical constructs of cognitive functions do not always have ecological validity. Thus, subjective cognitive complaints should be taken into account in assessment of patient well-being, but cannot be used as a substitute to objective cognitive measures. The simultaneous use of subjective and objective measures of cognitive dysfunction may provide a more complete picture of individual rehabilitation targets in patients with schizophrenia.

CANTAB explicit memory is less impaired in addicted schizophrenia patients

It has been suggested that in order to sustain the lifestyle of substance abuse, addicted schizophrenia patients would have less negative symptoms, better social skills, and less cognitive impairments. Mounting evidence supports the first two assumptions, but data lack regarding cognition in dual diagnosis schizophrenia. Seventy-six schizophrenia outpatients (DSM-IV) were divided into two groups: with (n = 44) and without (n = 32) a substance use disorder. Motor speed and visuo-spatial explicit memory were investigated using CANTAB. As expected, dual diagnosis patients showed a better cognitive performance. Our results suggest either that substance abuse relieves the cognitive deficits of schizophrenia or that the patients with less cognitive deficits are more prone to substance abuse.

Self-perceived cognitive deficits and occupational outcome in persons with schizophrenia

A two-year prospective follow-up study was used to explore whether self-perceived cognitive deficits (SPCD) predict occupational outcome in persons with schizophrenia. Cognitive complaints were assessed using the Scale to Investigate Cognition in Schizophrenia (SSTICS) in persons with schizophrenia requesting disability status. A higher level of SPCD was associated with better occupational outcome, independently from other characteristics. Persons with better social functioning may have a higher level of metacognition allowing a greater awareness of their cognitive difficulties. Measures of cognitive complaints should be complemented by objective testing to assess potential for vocational rehabilitation.

Cognitive insight in schizophrenia: the missing link between insight and neurocognitive complaint?

Abstract The aim of this study was to explore the associations between cognitive insight, clinical insight, and neurocognitive complaint in a sample of 54 outpatients with schizophrenia spectrum disorders. Cognitive insight assessed using the Beck Cognitive Insight Scale (BCIS) was not associated with clinical insight assessed using the Scale to Assess Unawareness of Mental Disorder. Associations were found between the BCIS scores and the neurocognitive complaints assessed using the Subjective Scale to Investigate Cognition in Schizophrenia. A high level of neurocognitive complaints was positively associated with self-reflectiveness and negatively associated with self-certainty about beliefs and judgments. These results provide further support for the construct validity of the BCIS. The data also suggest that cognitive insight and neurocognitive complaint are close constructs that should be differentiated from awareness of having a mental illness.

Neurocognitive insight and executive functioning in schizophrenia.

Introduction. This study explored whether integrity of executive functioning is required for good neurocognitive insight (NI) in subjects with schizophrenia. Methods. NI was measured by subtracting executive difficulties (errors in the Modified Card Sorting Task) from executive cognitive complaints (Subjective Scale to Investigate Cognition in Schizophrenia) in 40 outpatients with schizophrenia and 42 normal controls. The schizophrenia sample was a priori divided into two subgroups on the basis of executive level. Multivariate analyses were conducted to compare groups and to control for potential confounding factors. Results. Only the schizophrenia dysexecutive subgroup had a poorer NI compared to normal controls. Group differences remained significant after adjustment for potential confounding factors (education, depression, anxiety and self-esteem). Conclusion. These results provide support for the hypothesis that executive dysfunctioning is a limiting factor for NI, independently from depressive and anxiety symptoms.

Associations between self-esteem, anxiety and depression and metacognitive awareness or metacognitive knowledge

This study explored in a non-clinical sample the associations between self-esteem, anxiety and depression symptoms and metacognitive awareness or metacognitive knowledge. Higher metacognitive awareness scores measured during the neuropsychological tasks were positively associated with higher depression scores in the social cognition test. Metacognitive knowledge score measured independently of ongoing neuropsychological tasks was positively associated with lower self-esteem, higher anxiety (state or trait) and depression scores.

Profiles of Relationships Between Subjective and Objective Cognition in Schizophrenia: Associations With Quality of Life, Stigmatization, and Mood Factors

Justification: Recent studies showed that neurocognitive insight difficulties occur in subjects with schizophrenia. However, little is known about the different profiles of neurocognitive insight, their relations with neurocognitive functioning, and their specific links with mood factors and outcomes. Aim: The study explored profiles of relationships between objective and subjective cognition in persons with schizophrenia spectrum disorders (SSD) and associations with quality of life (QoL), stigmatization, and mood factors. Method: Participants were 69 outpatients with an SSD. Cluster analysis (Ward method) was performed to explore profiles of interactions between subjective complaints and objective cognitive performances. Analyses of variance (ANOVAs) were then conducted to compare groups on anxiety and depression levels, stigmatization, and QoL. Results: Cluster analysis produced 3 groups: high cognitive impairment/moderate cognitive complaints (N = 26), good cognitive functioning/moderate cognitive complaints (N = 22), and moderate cognitive impairment/high cognitive complaints (N = 21). The second group has higher objective QoL, and the third group has higher levels of anxiety, depression, and stigmatization. Our results show that (a) not all patients with SSD have neurocognitive insight difficulties, (b) relation between objective and subjective cognition is not linear, and (c) differences between profiles may have theoretical and clinical implications.

Challenging behaviour following traumatic brain injury: Symptoms and assessments

injury hindering family, work and social relationship. Care management of these symptoms at hospital, in medico-social facilities or at home faces the diversity and the low efficiency of usual treatments. The French Physical and Rehabilitation Medicine Society (SOFMER) proposed to elaborate good practice recommendations under the aegis of the French High Health Authority (HAS). On the basis of a systematic and critical review of the literature, performed by four project-managers, recommendations have been proposed by a working group composed of 23 experts. A reading group will give his opinion before the final validation in the context of the on-going HAS label process.

Support disorders after traumatic brain injury, guidelines: Medications

Support disorders after traumatic brain injury, guidelines: Medications D. Plantier *, J. Luaute , L. Wiart , A. Stefan , J. Hamonet , A. Arnould , S. Aubert , J.-M. Beis , L. Blais , M.-C. Cazals , J.-M. Destaillats , E. Durand , P. Fayol , C. Fieyre , L. Jagot, C. Lermuzeaux , J.-M. Lucas , D. Malauzat , N. Montrobert , J.-A. Preziosi , A. Prouteau , I. Richard , L. Tell b a CHU de Lyon, hopital Renee-Sabran, boulevard Edouard-Herriot, 83400 Hyeres Les Palmiers, France CHU de Lyon, Lyon, France c CHU de Bordeaux, Bordeaux, France d CHU de Nantes, Nantes, France CHU de Limoges, Limoges, France APHP, Garches, France g UNAFTC, France h CHU de Nancy, Nancy, France Maison du Douglas, Mercœur, France Hopitaux Saint-Maurice, France k CH Esquirol, Limoges, France MDPH, Paris, France Universite de Nantes, Nantes, France n Institut Marcel-Riviere MGEN, France o Centre medical de l’Argentiere, Aveize, France Marseille, France Universite de Bordeaux, Bordeaux, France r CHU d’Angers, Angers, France *Corresponding author. E-mail address: david.plantier@chu-lyon.fr

Troubles du comportement après traumatisme crânien : quelles stratégies thérapeutiques ?

CO14-003-f Techniques de soins et interventions non médicamenteuses pour la prise en charge des troubles du comportement de la personne victime d’un traumatisme crânien grave. Revue de la littérature L. Wiart *, J. Luauté , C. Lermuzeaux , L. Tell , A. Stefan , I. Richard , A. Prouteau , J. Preziosi , D. Malauzat , N. Montrobert , L. Jagot , J. Hamonet , C. Fieyre , J.-M. Lucas , J.-M. Destaillats , M.-C. Cazals , A. Arnould , J.-M. Beis , S. Aubert , E. Durand , P. Fayol , D. Plantier , L. Blais k a CHU de Bordeaux, place Amélie-Rabat-Léon, 33071 Bordeaux, France b CHU de Lyon, Lyon, France c Institut Marcel-Rivière, La Verrière, France d CHU de Nantes, France e CHU d’Angers, France f Marseille, France g CHU de Limoges, Limoges, France h Centre médical de l’Argentière, Aveize, France i Université de Nantes, France j MDPH, Paris, France k Maison du Douglas, Mercœur, France l Hôpital de Jonzac, France m UNAFTC, France n APHP, Garches, France o UGECAM, Nancy, France p Hôpitaux de Saint-Maurice, Paris q HCL, Ghiens, France *Auteur correspondant. Adresse e-mail : lwiart001@cegetel.rss.fr