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Encephale. 2018 Oct 13. pii: S0013-7006(18)30166-0. doi: 10.1016/j.encep.2018.07.007. [Epub ahead of print]

[The 10-year findings from the FondaMental Academic Center of Expertise for Schizophrenia (FACE-SZ): Review and recommendations for clinical practice].

[Article in French]

Author information

1
Fondation FondaMental, 94000 Créteil, France; Inserm U955, translational psychiatry team, 94000 Créteil, France; Pôle de psychiatrie des hôpitaux universitaires Henri-Mondor, DHU Pe-PSY, Paris Est University, 94000 Créteil, France. Electronic address: franck.schurhoff@inserm.fr.
2
Fondation FondaMental, 94000 Créteil, France.
3
Fondation FondaMental, 94000 Créteil, France; Inserm U1114, fédération de médecine translationnelle de Strasbourg, hôpitaux universitaires de Strasbourg, université de Strasbourg, 67000 Strasbourg, France.
4
Fondation FondaMental, 94000 Créteil, France; Inserm U955, translational psychiatry team, 94000 Créteil, France; Pôle de psychiatrie des hôpitaux universitaires Henri-Mondor, DHU Pe-PSY, Paris Est University, 94000 Créteil, France.
5
Fondation FondaMental, 94000 Créteil, France; UMR_S 1136, institut Pierre Louis d'épidémiologie et de santé publique, Sorbonne universités, UPMC université Paris 06, 75013 Paris, France.
6
Fondation FondaMental, 94000 Créteil, France; Pôle psychiatrie universitaire, CHU Sainte-Marguerite, 13274 Marseille cedex 09, France.
7
Fondation FondaMental, 94000 Créteil, France; Université de Bordeaux, centre hospitalier Charles Perrens, 33076 Bordeaux, France; CNRS UMR 5287-INCIA, 33000 Bordeaux, France.
8
Fondation FondaMental, 94000 Créteil, France; Université de Bordeaux, centre hospitalier Charles Perrens, 33076 Bordeaux, France; Inserm, neurocentre Magendie, physiopathologie de la plasticité neuronale, U862, 33000 Bordeaux, France.
9
Fondation FondaMental, 94000 Créteil, France; Inserm 1061, service universitaire de psychiatrie adulte, hôpital la Colombière, université Montpellier 1, CHRU Montpellier, 34090 Montpellier, France.
10
Fondation FondaMental, 94000 Créteil, France; EA 7280 faculté de médecine, université d'Auvergne, CHU, CMP B, BP 69, 63003 Clermont-Ferrand cedex 1, France.
11
Fondation FondaMental, 94000 Créteil, France; Université Claude Bernard Lyon 1/Centre Hospitalier Le Vinatier Pole Est, BP 300, 39-95 boulevard Pinel, 69678 Bron cedex, France.
12
Fondation FondaMental, 94000 Créteil, France; Inserm U894, department of psychiatry, faculté de médecine Louis Mourier, hospital, université Paris Diderot, Sorbonne Paris Cité, AP-HP, 92700 Colombes, France.
13
Fondation FondaMental, 94000 Créteil, France; Centre référent de réhabilitation psychosociale, centre hospitalier Alpes Isère, 38100 Grenoble, France.
14
Fondation FondaMental, 94000 Créteil, France; Pôle universitaire de psychiatrie, Assistance publique des Hôpitaux de Marseille (AP-HM), 13009 Marseille, France.
15
Fondation FondaMental, 94000 Créteil, France; Service de psychiatrie d'adulte, centre hospitalier de Versailles, UFR des sciences de la santé Simone Veil, université Versailles Saint-Quentin en Yvelines, 78000 Versailles, France.
16
Fondation Fondamental, Créteil, France; Inserm U955, équipe de psychiatrie translationnelle, 94000 Créteil, France; Pôle de Psychiatrie des Hôpitaux Universitaires Henri-Mondor, université Paris-Est Créteil, DHU Pe-PSY, 94000 Créteil, France.
17
Fondation Fondamental, Créteil, France; Pôle de psychiatrie générale et universitaire, centre hospitalier Charles Perrens, 33076 Bordeaux, France; Laboratoire de nutrition et de neurobiologie intégrée (UMR Inra 1286), université de Bordeaux, 33000 Bordeaux, France.
18
Fondation Fondamental, Créteil, France; EA 4047 HANDIReSP, service de psychiatrie d'adulte, centre hospitalier de Versailles, Le Chesnay, UFR des sciences de la santé Simone Veil, université Versailles Saint-Quentin en Yvelines, Versailles, France.
19
Fondation Fondamental, Créteil, France; Inserm U1114, fédération de médecine translationnelle de Strasbourg, hôpitaux universitaires de Strasbourg, université de Strasbourg, 67000 Strasbourg, France.
20
Fondation Fondamental, Créteil, France; EA 7280 faculté de médecine, université d'Auvergne, CHU, CMP B, BP 69, 63003 Clermont-Ferrand cedex 1, France.
21
Fondation Fondamental, Créteil, France; Inserm 1061, service universitaire de psychiatrie adulte, hôpital la Colombière, université Montpellier 1, CHU Montpellier, Montpellier, France.
22
Fondation Fondamental, Créteil, France; Inserm U1028, CNRS UMR5292, centre de recherche en neurosciences de Lyon, université Claude Bernard Lyon 1, Equipe PSYR2, centre hospitalier Le Vinatier, Pole Est, 95, boulevard Pinel, BP 30039, 69678 Bron cedex, France.
23
Fondation Fondamental, Créteil, France; Pôle de psychiatrie générale et universitaire, centre hospitalier Charles Perrens, 33076, France; CNRS UMR 5287-INCIA, université de Bordeaux, Bordeaux, France.
24
Centre référent de réhabilitation psychosociale, centre hospitalier Alpes Isère, Grenoble, France.
25
Fondation Fondamental, Créteil, France; Inserm U894, department of psychiatry, faculté de médecine, Louis Mourier Hospital, Colombes, université Paris Diderot, AP-HP, Sorbonne Paris Cité, France.
26
Fondation Fondamental, Créteil, France; Centre référent de réhabilitation psychosociale, centre hospitalier Alpes Isère, Grenoble, France.
27
Fondation Fondamental, Créteil, France; Pôle universitaire de psychiatrie, Assistance publique des Hôpitaux de Marseille (AP-HM), Marseille, France.
28
Fondation Fondamental, Créteil, France.
29
Fondation Fondamental, Créteil, France; CHU Carémeau, Nîmes, France.

Abstract

OBJECTIVES:

The present article is a synthesis of the first 10 years of follow-up of the FondaMental Academic Center of Expertise for Schizophrenia (FACE-SZ) cohort.

METHODS:

More than 700 community-dwelling stabilized subjects have been recruited and evaluated to date. The mean age was 32 years with 75 % males, the mean illness duration was 11 years, the mean age at illness onset was 21 years, the mean duration of untreated psychosis was 1.5 years and 55 % were current daily tobacco smokers.

RESULTS:

The major findings of the FACE-SZ cohort may be summarized as follows: the metabolic syndrome is twice more frequent in schizophrenia as compared to the general population and is not correctly assessed and treated; cognitive disturbances have been found in benzodiazepine consumers and in patients with chronic low-grade peripheral inflammation; major depressive disorder (MDD) is a common current comorbid condition in about 20% of the subjects at the evaluation. MDD is associated with impaired quality of life and with increased nicotine dependency in SZ daily tobacco smokers. Improving depression and negative symptoms may be the most effective strategies to improve quality of life in schizophrenia; the duration of untreated psychosis is much longer in cannabis smokers and in subjects with an age at illness onset<19 years. Adherence to treatment is diminished in subjects who report a subjective negative feeling after treatment intake independent of objective side effects (extrapyramidal syndrome and weight gain). Akathisia has been found in 18% of the subjects and has been associated with antipsychotic polytherapy.

CONCLUSIONS:

In the light of these results, some recommendations for clinical care may be suggested. The early detection of schizophrenia should be specifically increased in adolescents and/or cannabis smokers. All patients should be administered a comprehensive neuropsychological evaluation at the beginning of the illness and after stabilization under treatment. Improving metabolic parameters and lifestyle (diet and physical activity) should be reinforced. The benefit/risk ratio of benzodiazepine and antipsychotic polytherapy should be regularly reevaluated and withdrawn as soon as possible. If MDD remains underdiagnosed and undertreated, improving depression may strongly improve the quality of life of SZ subjects. In the end, Cognitive Remediation Therapy and anti-inflammatory strategies should be more frequently included in therapeutic strategies.

KEYWORDS:

Centre expert; Cognition; Depression; Dépression; Expert centre; Inflammation; Metabolic syndrome; Schizophrenia; Schizophrénie; Syndrome métabolique; Traitement; Treatment

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