Remédiation cognitive de la schizophrénie. Présentation du programme RECOS

Effect of non-pharmacological interventions on source memory processes in the early course of psychosis: A systematic review

People with a psychotic disorder suffer from major cognitive impairments which prevent their functional recovery. Source memory impairments have been shown to be associated with psychotic symptoms and even to precede their onset. Source memory has thus been hypothesized as a cognitive precursor of psychosis. However, few interventions targeting source memory are included in current therapeutic approaches for early psychosis.

AIM

This systematic review aimed to identify non-pharmacological interventions for early psychosis which have impacted source memory processes.

METHODS

Studies were selected from nine databases when they included: (a) a non-pharmacological intervention involving a sample of patients with early-onset psychotic disorder or subclinical psychotic symptoms; and (b) effects on source memory processes, measured directly or inferred through an episodic memory task.

RESULTS

Thirteen studies were identified, including two cognitive remediation programs and one repetitive transcranial magnetic stimulation treatment that reported beneficial effects on source memory.

CONCLUSIONS

Relevant intervention strategies for source memory impairments were identified. This review points up a need to further develop interventions targeting theoretically defined source memory concepts and assess their effects with specific and valid tasks. Recommendations regarding underlying mechanisms which could have a beneficial impact on source memory may provide guidance for the future development of early psychosis interventions.

Cognitive remediation: a promising tool for the treatment of schizophrenia

Cognitive remediation is a type of treatment added recently to the range of tools available to therapists. It includes a number of miscellaneous methods that aim to correct some of the cognitive impairments observed in schizophrenia. These cover the fields of target attention, memory and executive deficits, as well as impaired social cognition. Cognitive remediation acts as a complement to medication and psychological therapies, which constitute the core methods of treatment for schizophrenia. The present paper reviews the state of the art in cognitive remediation. The principle underlying this innovative therapeutic approach is the enhancement of the cognitive resources of patients with schizophrenia in order to improve their cognitive functions, social skills and in some cases alleviate some of the symptoms of the disease. Several programs developed within the past two decades (e.g., IPT, CRT, NEAR, CET, NET, CRT and CAT) are becoming more widely used. Their efficacy on neurocognition and on functional outcome has been demonstrated, with inconstant continuation of benefit after completion of treatment. The sustainability of the cognitive and functional improvements following completion of these programs has to be further studied. Other programs aimed at acting upon altered social cognition (one of the critical facets of schizophrenia) are still in the experimental stages, but the results obtained so far are encouraging. A preliminary study has also demonstrated the effectiveness of board games in improving cognitive functioning, which seems to be a highly promising therapeutic avenue owing to its ease of use.