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Dubreucq J, Plasse J, Gabayet F, Faraldo M, Blanc O, Chereau I, Cervello S, Couhet G, Demily C, Guillard-Bouhet N, Gouache B, Jaafari N, Legrand G, Legros-Lafarge E, Pommier R, Quilès C, Straub D, Verdoux H, Vignaga F, Massoubre C, Franck N. Stigma resistance is associated with advanced stages of personal recovery in serious mental illness patients enrolled in psychiatric rehabilitation. Psychol Med 2022; 52:2155-2165. [PMID: 33196405 DOI: 10.1017/s0033291720004055] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Stigma resistance (SR) is defined as one's ability to deflect or challenge stigmatizing beliefs. SR is positively associated with patient's outcomes in serious mental illness (SMI). SR appears as a promising target for psychiatric rehabilitation as it might facilitate personal recovery. OBJECTIVES The objectives of the present study are: (i) to assess the frequency of SR in a multicentric non-selected psychiatric rehabilitation SMI sample; (ii) to investigate the correlates of high SR. METHODS A total of 693 outpatients with SMI were recruited from the French National Centers of Reference for Psychiatric Rehabilitation cohort (REHABase). Evaluation included standardized scales for clinical severity, quality of life, satisfaction with life, wellbeing, and personal recovery and a large cognitive battery. SR was measured using internalized stigma of mental illness - SR subscale. RESULTS Elevated SR was associated with a preserved executive functioning, a lower insight into illness and all recovery-related outcomes in the univariate analyses. In the multivariate analysis adjusted by age, gender and self-stigma, elevated SR was best predicted by the later stages of personal recovery [rebuilding; p = 0.004, OR = 2.89 (1.36-4.88); growth; p = 0.005, OR = 2.79 (1.30-4.43)). No moderating effects of age and education were found. CONCLUSION The present study has indicated the importance of addressing SR in patients enrolled in psychiatric rehabilitation. Recovery-oriented psychoeducation, metacognitive therapies and family interventions might improve SR and protect against insight-related depression. The effectiveness of psychiatric rehabilitation on SR and the potential mediating effects of changes in SR on treatment outcomes should be further investigated in longitudinal studies.
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Affiliation(s)
- J Dubreucq
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, France
- Centre référent de réhabilitation psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France
- Fondation FondaMental, Créteil, France
- Réseau Handicap Psychique, Grenoble, France
| | - J Plasse
- Centre ressource de réhabilitation psychosociale et de remédiation cognitive, Hôpital Le Vinatier, UMR 5229, CNRS & Université Lyon 1, Université de Lyon, France
- Centre référent lyonnais de réhabilitation psychosociale CL3R, centre hospitalier Le Vinatier, Lyon, France
| | - F Gabayet
- Centre référent de réhabilitation psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France
- Fondation FondaMental, Créteil, France
| | - M Faraldo
- Centre référent de réhabilitation psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France
- Fondation FondaMental, Créteil, France
| | - O Blanc
- CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003 Clermont-Ferrand Cedex 1, France
| | - I Chereau
- Fondation FondaMental, Créteil, France
- CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003 Clermont-Ferrand Cedex 1, France
| | - S Cervello
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, France
- Centre ressource de réhabilitation psychosociale et de remédiation cognitive, Hôpital Le Vinatier, UMR 5229, CNRS & Université Lyon 1, Université de Lyon, France
- Centre référent lyonnais de réhabilitation psychosociale CL3R, centre hospitalier Le Vinatier, Lyon, France
| | - G Couhet
- Centre référent de réhabilitation psychosociale C2RP Nouvelle-Aquitaine Sud, Pôle de réhabilitation psychosociale, Centre de la Tour de Gassies, Bruges, France
| | - C Demily
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, France
- Centre de référence maladies rares Génopsy, pôle ADIS, centre hospitalier Le Vinatier, UMR 5229, CNRS & Université Lyon 1, Université de Lyon, France
| | | | - B Gouache
- Centre référent de réhabilitation psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France
| | - N Jaafari
- CREATIV & URC Pierre Deniker, CH Laborit, Poitiers, France
| | - G Legrand
- Centre Hospitalier Sainte Marie de Clermont Ferrand, 33 rue Gabriel Péri, CS 9912, 63037 Clermont-Ferrand Cedex 1, France
| | - E Legros-Lafarge
- Centre Référent de Réhabilitation Psychosociale de Limoges C2RL, CH Esquirol, Limoges, France
| | - R Pommier
- REHALise, CHU de Saint-Etienne, France
| | - C Quilès
- Centre référent de réhabilitation psychosociale C2RP Nouvelle Aquitaine Sud, Pôle universitaire de psychiatrie adulte, centre hospitalier Charles Perrens, Bordeaux& Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France
| | - D Straub
- Centre de Réhabilitation Psychosociale, Centre Hospitalier de Roanne, France
| | - H Verdoux
- Centre référent de réhabilitation psychosociale C2RP Nouvelle Aquitaine Sud, Pôle universitaire de psychiatrie adulte, centre hospitalier Charles Perrens, Bordeaux& Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France
| | - F Vignaga
- Dispositif de Soins de Réhabilitation Psychosociale, Centre Psychothérapeutique de l'Ain, France
| | | | - N Franck
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, France
- Centre ressource de réhabilitation psychosociale et de remédiation cognitive, Hôpital Le Vinatier, UMR 5229, CNRS & Université Lyon 1, Université de Lyon, France
- Centre référent lyonnais de réhabilitation psychosociale CL3R, centre hospitalier Le Vinatier, Lyon, France
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2
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Dubreucq J, Gabayet F, Godin O, Andre M, Aouizerate B, Capdevielle D, Chereau I, Clauss-Kobayashi J, Coulon N, D’Amato T, Dorey JM, Dubertret C, Faraldo M, Laouamri H, Leigner S, Lancon C, Leboyer M, Llorca PM, Mallet J, Misdrahi D, Passerieux C, Rey R, Pignon B, Schorr B, Urbach M, Schürhoff F, Szoke A, Fond G, Berna F. Overlap and Mutual Distinctions Between Clinical Recovery and Personal Recovery in People With Schizophrenia in a One-Year Study. Schizophr Bull 2021; 48:382-394. [PMID: 34718808 PMCID: PMC8886587 DOI: 10.1093/schbul/sbab114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Recovery is a multidimensional construct that can be defined either from a clinical perspective or from a consumer-focused one, as a self-broadening process aimed at living a meaningful life beyond mental illness. We aimed to longitudinally examine the overlap and mutual distinctions between clinical and personal recovery. Of 1239 people with schizophrenia consecutively recruited from the FondaMental Advanced Centers of Expertise for SZ network, the 507 present at one-year did not differ from those lost to follow-up. Clinical recovery was defined as the combination of clinical remission and functional remission. Personal recovery was defined as being in the rebuilding or in the growth stage of the Stages of Recovery Instrument (STORI). Full recovery was defined as the combination of clinical recovery and personal recovery. First, we examined the factors at baseline associated with each aspect of recovery. Then, we conducted multivariable models on the correlates of stable clinical recovery, stable personal recovery, and stable full recovery after one year. At baseline, clinical recovery and personal recovery were characterized by distinct patterns of outcome (i.e. better objective outcomes but no difference in subjective outcomes for clinical recovery, the opposite pattern for personal recovery, and better overall outcomes for full recovery). We found that clinical recovery and personal recovery predicted each other over time (baseline personal recovery for stable clinical recovery at one year; P = .026, OR = 4.94 [1.30-23.0]; baseline clinical recovery for stable personal recovery at one year; P = .016, OR = 3.64 [1.31-11.2]). In short, given the interaction but also the degree of difference between clinical recovery and personal recovery, psychosocial treatment should target, beyond clinical recovery, subjective aspects such as personal recovery and depression to reach full recovery.
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Affiliation(s)
- Julien Dubreucq
- Fondation FondaMental, Créteil, France,Centre Référent de Réhabilitation psychosociale et de Remédiation cognitive (C3R), CH Alpes Isère, Saint Egrève, France,To whom correspondence should be addressed to: Centre Référent de Réhabilitation psychosociale et de Remédiation Cognitive (C3R), CH Alpes Isère, 8 place du Conseil National de la Résistance, 38400 Saint Martin d’Hères, France; tel: (33 4) 56 58 88 00, e-mail:
| | - Franck Gabayet
- Fondation FondaMental, Créteil, France,Centre Référent de Réhabilitation psychosociale et de Remédiation cognitive (C3R), CH Alpes Isère, Saint Egrève, France
| | - Ophélia Godin
- Fondation FondaMental, Créteil, France,Univ Paris Est Créteil, INSERM U955, IMRB, Translational Neuro-Psychiatry, Créteil, France
| | - Myrtille Andre
- Fondation FondaMental, Créteil, France,IGF, University of Montpellier, CNRS, INSERM, Montpellier, France,Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHU Montpellier, France
| | - Bruno Aouizerate
- Fondation FondaMental, Créteil, France,Centre Hospitalier Charles Perrens, Université de Bordeaux, Bordeaux, France,INRA, NutriNeuro, University of Bordeaux, Bordeaux, France
| | - Delphine Capdevielle
- Fondation FondaMental, Créteil, France,IGF, University of Montpellier, CNRS, INSERM, Montpellier, France,Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHU Montpellier, France
| | - Isabelle Chereau
- Fondation FondaMental, Créteil, France,Université Clermont Auvergne, CMP-B CHU, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France
| | - Julie Clauss-Kobayashi
- Fondation FondaMental, Créteil, France,Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Nathalie Coulon
- Fondation FondaMental, Créteil, France,Centre Référent de Réhabilitation psychosociale et de Remédiation cognitive (C3R), CH Alpes Isère, Saint Egrève, France
| | - Thierry D’Amato
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, PSYR2 team, Lyon, France,Centre Hospitalier le Vinatier, Centre Expert Dépression Résistante, Lyon, France
| | - Jean-Michel Dorey
- INSERM U1028, CNRS, UMR 5292, Lyon Neuroscience Research Center, EDUWELL Team, Lyon 2 University, Lyon, France,Centre Hospitalier le Vinatier, Pôle PsyPA, Lyon, France
| | - Caroline Dubertret
- Fondation FondaMental, Créteil, France,AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, Service de Psychiatrie et Addictologie. Hôpital Louis Mourier, Colombes, France,Université de Paris INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
| | - Mégane Faraldo
- Fondation FondaMental, Créteil, France,Centre Référent de Réhabilitation psychosociale et de Remédiation cognitive (C3R), CH Alpes Isère, Saint Egrève, France
| | | | - Sylvain Leigner
- Fondation FondaMental, Créteil, France,Centre Référent de Réhabilitation psychosociale et de Remédiation cognitive (C3R), CH Alpes Isère, Saint Egrève, France
| | - Christophe Lancon
- Fondation FondaMental, Créteil, France,AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, Service de Psychiatrie et Addictologie. Hôpital Louis Mourier, Colombes, France,Université de Paris INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
| | - Marion Leboyer
- Fondation FondaMental, Créteil, France,Univ Paris Est Créteil, INSERM U955, IMRB, Translational Neuro-Psychiatry, Créteil, France,AP-HP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d’Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Paris, France
| | - Pierre-Michel Llorca
- Fondation FondaMental, Créteil, France,Université Clermont Auvergne, CMP-B CHU, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France
| | - Jasmina Mallet
- Fondation FondaMental, Créteil, France,AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, Service de Psychiatrie et Addictologie. Hôpital Louis Mourier, Colombes, France,Université de Paris INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
| | - David Misdrahi
- Fondation FondaMental, Créteil, France,Pôle de psychiatrie Générale et Universitaire, Centre Hospitalier Charles Perrens, Université de Bordeaux, CNRS UMR 5287-INCIA, Bordeaux, France
| | - Christine Passerieux
- Fondation FondaMental, Créteil, France,Service Universitaire de Psychiatrie d’Adultes et d’Addictologie, Centre Hospitalier de Versailles, Le Chesnay, France,DisAP-DevPsy-CESP, INSERM UMR1018, Université Paris-Saclay, Université Versailles Saint-Quentin-En-Yvelines, Villejuif, France
| | - Romain Rey
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, PSYR2 team, Lyon, France,Centre Hospitalier le Vinatier, Centre Expert Dépression Résistante, Lyon, France
| | - Baptiste Pignon
- Fondation FondaMental, Créteil, France,Univ Paris Est Créteil, INSERM U955, IMRB, Translational Neuro-Psychiatry, Créteil, France,AP-HP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d’Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Paris, France
| | - Benoit Schorr
- Fondation FondaMental, Créteil, France,Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Mathieu Urbach
- Fondation FondaMental, Créteil, France,Service Universitaire de Psychiatrie d’Adultes et d’Addictologie, Centre Hospitalier de Versailles, Le Chesnay, France,DisAP-DevPsy-CESP, INSERM UMR1018, Université Paris-Saclay, Université Versailles Saint-Quentin-En-Yvelines, Villejuif, France
| | - Franck Schürhoff
- Fondation FondaMental, Créteil, France,Univ Paris Est Créteil, INSERM U955, IMRB, Translational Neuro-Psychiatry, Créteil, France,AP-HP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d’Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Paris, France
| | - Andrei Szoke
- Fondation FondaMental, Créteil, France,Univ Paris Est Créteil, INSERM U955, IMRB, Translational Neuro-Psychiatry, Créteil, France,AP-HP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d’Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Paris, France
| | | | - Guillaume Fond
- Fondation FondaMental, Créteil, France,AP-HM, Aix-Marseille Univ, School of medicine—La Timone Medical Campus, EA 3279: CEReSS—Health Service Research and Quality of Life Center, Marseille, France
| | - Fabrice Berna
- Fondation FondaMental, Créteil, France,Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
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3
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Dubreucq J, Faraldo M, Abbes M, Ycart B, Richard-Lepouriel H, Favre S, Jermann F, Attal J, Bakri M, Cohen T, Cervello C, Chereau I, Cognard C, De Clercq M, Douasbin A, Giordana JY, Giraud-Baro E, Guillard-Bouhet N, Legros-Lafarge E, Polosan M, Pouchon A, Rolland M, Rainteau N, Roussel C, Wangermez C, Yanos PT, Lysaker PH, Franck N. Narrative enhancement and cognitive therapy (NECT) to improve social functioning in people with serious mental illness: study protocol for a stepped-wedge cluster randomized controlled trial. Trials 2021; 22:124. [PMID: 33557924 PMCID: PMC7869198 DOI: 10.1186/s13063-021-05067-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 01/20/2021] [Indexed: 12/03/2022] Open
Abstract
Background Self-stigma is highly prevalent in serious mental illness (SMI) and is associated with poorer clinical and functional outcomes. Narrative enhancement and cognitive therapy (NECT) is a group-based intervention combining psychoeducation, cognitive restructuring and story-telling exercises to reduce self-stigma and its impact on recovery-related outcomes. Despite evidence of its effectiveness on self-stigma in schizophrenia-related disorders, it is unclear whether NECT can impact social functioning. Methods This is a 12-centre stepped-wedge cluster randomized controlled trial of NECT effectiveness on social functioning in SMI, compared to treatment as usual. One hundred and twenty participants diagnosed with schizophrenia, bipolar disorder or borderline personality disorder will be recruited across the 12 sites. The 12 centres participating to the study will be randomized into two groups: one group (group 1) receiving the intervention at the beginning of the study (T0) and one group (group 2) being a control group for the first 6 months and receiving the intervention after (T1). Outcomes will be compared in both groups at T0 and T1, and 6-month and 12-month outcomes for groups 1 and 2 will be measured without a control group at T2 (to evaluate the stability of the effects over time). Evaluations will be conducted by assessors blind to treatment allocation. The primary outcome is personal and social performance compared across randomization groups. Secondary outcomes include self-stigma, self-esteem, wellbeing, quality of life, illness severity, depressive symptoms and personal recovery. Discussion NECT is a promising intervention for reducing self-stigma and improving recovery-related outcomes in SMI. If shown to be effective in this trial, it is likely that NECT will be implemented in psychiatric rehabilitation services with subsequent implications for routine clinical practice. Trial registration ClinicalTrials.gov NCT03972735. Trial registration date 31 May 2019.
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Affiliation(s)
- J Dubreucq
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, Lyon, France. .,Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, 1 place du Conseil National de la Résistance, 38400 Saint Martin d'Hères, Grenoble, France. .,Fondation FondaMental, Créteil, France. .,Réseau Handicap Psychique, Grenoble, France.
| | - M Faraldo
- Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, 1 place du Conseil National de la Résistance, 38400 Saint Martin d'Hères, Grenoble, France.,Fondation FondaMental, Créteil, France
| | - M Abbes
- Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, 1 place du Conseil National de la Résistance, 38400 Saint Martin d'Hères, Grenoble, France.,Fondation FondaMental, Créteil, France
| | - B Ycart
- Laboratoire Jean Kuntzmann, CNRS UMR 5224, Université Grenoble-Alpes, Grenoble, France
| | - H Richard-Lepouriel
- Department of Psychiatry, Mood disorders Unit, Geneva University Hospital, 20bis rue de Lausanne, CH-1201, Geneva, Switzerland
| | - S Favre
- Department of Psychiatry, Mood disorders Unit, Geneva University Hospital, 20bis rue de Lausanne, CH-1201, Geneva, Switzerland
| | - F Jermann
- Department of Psychiatry, Mood disorders Unit, Geneva University Hospital, 20bis rue de Lausanne, CH-1201, Geneva, Switzerland
| | - J Attal
- Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm, 1061, Montpellier, France
| | - M Bakri
- Centre de Réhabilitation Psychosociale et de Remédiation Cognitive (C2R), CH Drôme Vivarais, Montéléger, France
| | - T Cohen
- Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, 1 place du Conseil National de la Résistance, 38400 Saint Martin d'Hères, Grenoble, France.,Fondation FondaMental, Créteil, France
| | - C Cervello
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive, Centre Hospitalier Le Vinatier, Bron, France.,Centre Référent Lyonnais de Réhabilitation Psychosociale et de Remédiation Cognitive (CL3R), Centre Hospitalier Le Vinatier, Bron, France
| | - I Chereau
- Fondation FondaMental, Créteil, France.,CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003, Clermont-Ferrand Cedex 1, France
| | - C Cognard
- Unité Ariane de rehabilitation psychosociale, EPSM, Caen, France
| | - M De Clercq
- Centre Départemental de Réhabilitation Psychosociale des Glières, 219 chemin des bois des Fornets, 74800, La Roche sur Foron, France
| | - A Douasbin
- Unité Ariane de rehabilitation psychosociale, EPSM, Caen, France
| | - J Y Giordana
- Centre Hospitalier Sainte Marie de Nice, 87 Avenue Joseph Raybaud, 06100, Nice, France
| | - E Giraud-Baro
- Clinique du Dauphiné- Groupe Sinoué, 252 Route de Saint-Nizier, 38180, Seyssins, France
| | | | - E Legros-Lafarge
- Centre Référent de Réhabilitation Psychosociale de Limoges C2RL, CH Esquirol, Limoges, France
| | - M Polosan
- Centre Expert Troubles Bipolaires, Service Universitaire de Psychiatrie, CHU de Grenoble et des Alpes, CS10217, F-38043, Grenoble, France
| | - A Pouchon
- Centre Expert Troubles Bipolaires, Service Universitaire de Psychiatrie, CHU de Grenoble et des Alpes, CS10217, F-38043, Grenoble, France
| | - M Rolland
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive, Centre Hospitalier Le Vinatier, Bron, France.,Centre Référent Lyonnais de Réhabilitation Psychosociale et de Remédiation Cognitive (CL3R), Centre Hospitalier Le Vinatier, Bron, France
| | - N Rainteau
- Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm, 1061, Montpellier, France
| | - C Roussel
- Centre Départemental de Réhabilitation Psychosociale des Glières, 219 chemin des bois des Fornets, 74800, La Roche sur Foron, France
| | - C Wangermez
- CREATIV & URC Pierre Deniker, CH Laborit, Poitiers, France
| | - P T Yanos
- John Jay College of Criminal Justice, City University of New York, New York, USA
| | - P H Lysaker
- Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, USA
| | - N Franck
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, Lyon, France.,Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive, Centre Hospitalier Le Vinatier, Bron, France.,Centre Référent Lyonnais de Réhabilitation Psychosociale et de Remédiation Cognitive (CL3R), Centre Hospitalier Le Vinatier, Bron, France
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4
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Dubreucq J, Plasse J, Gabayet F, Faraldo M, Blanc O, Chereau I, Cervello S, Couhet G, Demily C, Guillard-Bouhet N, Gouache B, Jaafari N, Legrand G, Legros-Lafarge E, Pommier R, Quilès C, Straub D, Verdoux H, Vignaga F, Massoubre C, Franck N. Self-stigma in serious mental illness and autism spectrum disorder: Results from the REHABase national psychiatric rehabilitation cohort. Eur Psychiatry 2020; 63:e13. [PMID: 32093806 PMCID: PMC7315867 DOI: 10.1192/j.eurpsy.2019.12] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background. Self-stigma
is a major issue in serious mental illness (SMI) and is negatively associated with patient outcomes. Most studies have been conducted in schizophrenia (SZ). Less is known about self-stigma in other SMI and autism spectrum disorder (ASD). The objectives of this study are: (i) to assess the frequency of self-stigma in a multicentric nonselected psychiatric rehabilitation SMI and ASD sample; and (ii) to investigate the correlates of elevated self-stigma in different SMI conditions and in ASD. Methods. A total of 738 SMI or ASD outpatients were recruited from the French National Centers of Reference for Psychiatric Rehabilitation cohort (REHABase). Evaluations included sociodemographic data, illness characteristics, and standardized scales for clinical severity, quality of life, satisfaction with life, wellbeing, personal recovery, a large cognitive battery, and daily functioning assessment. Results.
31.2% of the total sample had elevated self-stigma. The highest prevalence (43.8%) was found in borderline personality disorder and the lowest (22.2%) in ASD. In the multivariate analysis, elevated self-stigma was best predicted by early stages of personal recovery (moratorium, p = 0.001, OR = 4.0 [1.78–8.98]; awareness, p = 0.011, OR = 2.87 [1.28–6.44]), history of suicide attempt (p = 0.001, OR = 2.27 [1.37–3.76]), insight (p = 0.002, OR = 1.22 [1.08–1.38]), wellbeing (p = 0.037, OR = 0.77 [0.60–0.98]), and satisfaction with interpersonal relationships (p < 0.001, OR = 0.85 [0.78–0.93]). Conclusions. The present study has confirmed the importance of addressing self-stigma in SMI and ASD patients enrolled in psychiatric rehabilitation. The effectiveness of psychiatric rehabilitation on self-stigma and the potential mediating effects of changes in self-stigma on treatment outcomes should be further investigated.
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Affiliation(s)
- J Dubreucq
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, Lyon, France.,Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France.,Fondation FondaMental, Créteil, France.,Réseau Handicap Psychique, Grenoble, France
| | - J Plasse
- Centre Référent Lyonnais de Réhabilitation Psychosociale CL3R, Centre Hospitalier Le Vinatier, Lyon, France.,Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive, Hôpital Le Vinatier, UMR 5229, CNRS & Université Lyon 1, Université de Lyon, Lyon, France
| | - F Gabayet
- Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France.,Fondation FondaMental, Créteil, France
| | - M Faraldo
- Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France.,Fondation FondaMental, Créteil, France
| | - O Blanc
- Fondation FondaMental, Créteil, France.,CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003 Clermont-Ferrand Cedex 1, France
| | - I Chereau
- Fondation FondaMental, Créteil, France.,CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003 Clermont-Ferrand Cedex 1, France
| | - S Cervello
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, Lyon, France.,Centre Référent Lyonnais de Réhabilitation Psychosociale CL3R, Centre Hospitalier Le Vinatier, Lyon, France.,Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive, Hôpital Le Vinatier, UMR 5229, CNRS & Université Lyon 1, Université de Lyon, Lyon, France
| | - G Couhet
- Centre Référent de Réhabilitation Psychosociale C2RP Nouvelle-Aquitaine Sud, Pôle de Réhabilitation Psychosociale, Centre de la Tour de Gassies, Bruges, France
| | - C Demily
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, Lyon, France.,Centre de Référence Maladies Rares Génopsy, Centre Hospitalier Le Vinatier, UMR 5229, CNRS & Université Lyon 1, Université de Lyon, Lyon, France
| | | | - B Gouache
- Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France
| | - N Jaafari
- CREATIV & URC Pierre Deniker, CH Laborit, Poitiers, France
| | - G Legrand
- Centre Hospitalier Sainte Marie de Clermont Ferrand, 63037Clermont-Ferrand Cedex 1, France
| | - E Legros-Lafarge
- Centre Référent de Réhabilitation Psychosociale de Limoges C2RL, CH Esquirol, Limoges, France
| | - R Pommier
- REHALise, CHU de Saint-Etienne, Saint-Priest-en-Jarez, France
| | - C Quilès
- Centre Référent de Réhabilitation Psychosociale C2RP Nouvelle Aquitaine Sud, Pôle Universitaire de Psychiatrie Adulte, Centre Hospitalier Charles Perrens, Bordeaux & Univ. Bordeaux, INSERM, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, 33000Bordeaux, France
| | - D Straub
- Centre de Réhabilitation Psychosociale, Centre Hospitalier de Roanne, Roanne, France
| | - H Verdoux
- Centre Référent de Réhabilitation Psychosociale C2RP Nouvelle Aquitaine Sud, Pôle Universitaire de Psychiatrie Adulte, Centre Hospitalier Charles Perrens, Bordeaux & Univ. Bordeaux, INSERM, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, 33000Bordeaux, France
| | - F Vignaga
- Dispositif de Soins de Réhabilitation Psychosociale, Centre Psychothérapeutique de l'Ain, Bourg-en-Bresse, France
| | - C Massoubre
- REHALise, CHU de Saint-Etienne, Saint-Priest-en-Jarez, France
| | | | - N Franck
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, Lyon, France.,Centre Référent Lyonnais de Réhabilitation Psychosociale CL3R, Centre Hospitalier Le Vinatier, Lyon, France.,Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive, Hôpital Le Vinatier, UMR 5229, CNRS & Université Lyon 1, Université de Lyon, Lyon, France
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5
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Thiery JP, Sastre-Garau X, Vincent-Salomon B, Sigal-Zafrani X, Pierga JY, Decraene C, Meyniel JP, Gravier E, Asselain B, De Rycke Y, Hupe P, Barillot E, Ajaz S, Faraldo M, Deugnier MA, Glukhova M, Medina D. Challenges in the stratification of breast tumors for tailored therapies. Bull Cancer 2006; 93:E81-9. [PMID: 16935776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Studying the molecular stratification of breast carcinoma is a real challenge considering the extreme heterogeneity of these tumors. Many patients are now treated following recommendation established at several NIH and St Gallen consensus conferences. However a significant fraction of these breast cancer patients do not need adjuvant chemotherapies while other patients receive inefficacious therapies. High density gene expression arrays have been designed to attempt to establish expression profiles that could be used as prognostic indicators or as predictive markers for response to treatment. This review is intended to discuss the potential value of these new indicators, but also the current weaknesses of these new genomic and bioinformatic approaches. The combined analysis of transcriptomic and genomic alteration data from relatively large numbers of well annotated tumor specimens may offer an opportunity to overcome the current difficulties in validating recently published non overlapping gene lists as prognostic or therapeutic indicators. There is also hope for identifying and deciphering signal transduction pathways driving tumor progression with newly developed algorithms and semi quantitative parameters obtained in simplified in vitro or in vivo models for specific transduction pathways.
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MESH Headings
- Animals
- Antineoplastic Agents/therapeutic use
- Breast Neoplasms/classification
- Breast Neoplasms/drug therapy
- Breast Neoplasms/genetics
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/classification
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Intraductal, Noninfiltrating/classification
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Female
- Gene Expression Profiling
- Humans
- Mice
- Mice, Transgenic
- Models, Animal
- Mutation/genetics
- Neoplasm Metastasis
- Neoplasm Staging
- Neoplastic Stem Cells/pathology
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Affiliation(s)
- J-P Thiery
- Institut Curie, 26, rue d'Ulm, 75248 Paris Cedex 05.
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