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Eur Arch Psychiatry Clin Neurosci. 2019 Aug;269(5):599-610. doi: 10.1007/s00406-019-01001-4. Epub 2019 Apr 8.

Towards an improved access to psychiatric rehabilitation: availability and effectiveness at 1-year follow-up of psychoeducation, cognitive remediation therapy, cognitive behaviour therapy and social skills training in the FondaMental Advanced Centers of Expertise-Schizophrenia (FACE-SZ) national cohort.

Author information

1
Fondation FondaMental, Créteil, France. jdubreucq@ch-alpes-isere.fr.
2
Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France. jdubreucq@ch-alpes-isere.fr.
3
Réseau Handicap Psychique (GCSMS RéHPsy), 26 Avenue Marcellin Berthelot, 38100, Grenoble, France. jdubreucq@ch-alpes-isere.fr.
4
Laboratoire Jean Kuntzmann, CNRS UMR 5224, Université Grenoble-Alpes, Grenoble, France.
5
Fondation FondaMental, Créteil, France.
6
Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France.
7
CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69, 63003, Clermont- Ferrand Cedex 1, France.
8
School of Medicine, Aix-Marseille Univ, La Timone Medical Campus, EA 3279, Marseille, France.
9
CEReSS, Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005, Marseille, France.
10
Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, 75013, Paris, France.
11
INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, 75013, Paris, France.
12
Translational Psychiatry team, INSERM U955, Créteil, France.
13
Paris Est University, DHU Pe- PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France.
14
Centre Hospitalier Charles Perrens, 33076, Bordeaux, France.
15
Université de Bordeaux, Bordeaux, France.
16
Bordeaux Sleep Clinique, Research Unit, Pellegrin University Hospital, Bordeaux University, USR CNRS 3413 SANPSY, Bordeaux, 33000, France.
17
Inserm, Neurocentre Magendie, Physiopathologie de la Plasticité Neuronale, U862, 33000, Bordeaux, France.
18
Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, INSERM U1114, Strasbourg, France.
19
Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm, 1061, Montpellier, France.
20
Université Claude Bernard Lyon, 1/Centre Hospitalier Le Vinatier Pole Est BP 300 39-95 bd Pinel, 69678, Bron Cedex, France.
21
AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France.
22
Sorbonne Paris Cité, Faculté de médecine, Inserm U894, Université Paris Diderot, Paris, France.
23
Assistance Publique des Hôpitaux de Marseille (AP-HM), Pôle universitaire de psychiatrie, Marseille, France.
24
CNRS UMR 5287-INCIA, Talence, France.
25
Service de psychiatrie d'adulte, UFR des Sciences de la Santé Simone Veil, Centre Hospitalier de Versailles, Université Versailles Saint-Quentin en Yvelines, Versailles, France.
26
Réseau Handicap Psychique (GCSMS RéHPsy), 26 Avenue Marcellin Berthelot, 38100, Grenoble, France.

Abstract

Psychosocial Interventions (PIs) have shown positive effects on clinical and functional outcomes of schizophrenia (SZ) in randomized controlled trials. However their effectiveness and accessibility remain unclear to date in "real world" schizophrenia. The objectives of the present study were (i) to assess the proportion of SZ outpatients who benefited from PIs between 2010 and 2015 in France after an Expert Center Intervention in a national multicentric non-selected community-dwelling sample; (ii) to assess PIs' effectiveness at 1-year follow-up. 183 SZ outpatients were recruited from FondaMental Advanced Centers of Expertise for Schizophrenia cohort. Baseline and 1-year evaluations included sociodemographic data, current treatments, illness characteristics and standardized scales for clinical severity, adherence to treatment, quality of life, a large cognitive battery, and daily functioning assessment. Only 7 (3.8%) received a PI before the evaluation, and 64 (35%) have received at least one PI during the 1-year follow-up. Having had at least one PI during the follow-up has been associated in multivariate analyses with significantly higher improvement in positive and negative symptoms (respectively p =0.031; p = 0.011), mental flexibility (TMT B, p = 0.029; C-VF, p = 0.02) and global functioning (p =0.042). CBT and SST were associated with higher cognitive improvements, while CRT was associated with clinical improvement. These results have not been demonstrated before and suggest that the effect of each PI is larger than its initial target. The present study has confirmed the PIs' effectiveness in a large sample of community-dwelling SZ outpatients at 1 year follow-up. Efforts to improve access to PI should be reinforced in public health policies.

KEYWORDS:

Effectiveness; Functioning; Psychosocial interventions; Rehabilitation; Schizophrenia

PMID:
30963264
DOI:
10.1007/s00406-019-01001-4

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