Franck N
Centre référent lyonnais en réhabilitation et en remédiation cognitive (CL3R), centre hospitalier Le Vinatier, UMR 5229, CNRS, université Lyon-1, 98, rue Boileau, 69006 Lyon, France.
Encephale. 2014 Jun;40 Suppl 2:S75-80. doi: 10.1016/j.encep.2014.04.004. Epub 2014 Jun 13.
Recovery is partly defined by the patients' capacity to work, since doing well in a job favors hope and responsibilities' taking. Diminished job placement or tenure is linked with cognitive disorders, which impact directly and indirectly (through negative symptoms) functional outcomes. Attention, executive functions and working memory disorders can result in an alteration of the ability to manage the tasks required in the workplace. Executive function, working memory and social cognition disorders may also have an impact on behavior in relationships. Cognitive disorders do not automatically directly contribute to vocational outcome, yet their effects may be mediated by other variables such as symptoms, metacognition, social skills and intrinsic motivation. Then, since all these dimensions have to be taken into account, reducing the impact of cognitive troubles becomes a major challenge for the care of schizophrenia. Cognitive remediation is the more effective therapeutic tool to reduce cognitive dysfunctions. It rests in particular on the development of new strategies that allow taking concrete situations into account more efficiently. Cognitive remediation reduces the detrimental consequences of cognitive disorders and permits their compensation. It has emerged as an effective treatment, that improves not only cognitive abilities but also functioning, as it has been shown by numerous randomized controlled studies and several meta-analyses. The present article considers the effects on cognitive remediation on work function in schizophrenia. Several randomized controlled trials that compared supported employment alone versus supported employment associated with cognitive remediation showed significant improvement of employment rates in the latter condition. These results favor the use of cognitive remediation before job placement. The specific needs of the occupation that will be provided and the cognitive profile of the user should be taken into account.
康复部分由患者的工作能力来定义，因为工作表现良好有利于激发希望并承担责任。就业安置减少或任期缩短与认知障碍有关，认知障碍会直接和间接（通过阴性症状）影响功能结局。注意力、执行功能和工作记忆障碍可能导致在工作场所管理所需任务的能力发生改变。执行功能、工作记忆和社会认知障碍也可能对人际关系中的行为产生影响。认知障碍不会自动直接导致职业结局，但它们的影响可能由其他变量介导，如症状、元认知、社交技能和内在动机。那么，由于所有这些方面都必须考虑在内，减少认知问题的影响就成为精神分裂症治疗的一项重大挑战。认知康复是减少认知功能障碍更有效的治疗工具。它尤其依赖于开发新策略，以便更有效地考虑具体情况。认知康复减少了认知障碍的有害后果并使其得到代偿。它已成为一种有效的治疗方法，不仅能提高认知能力，还能改善功能，众多随机对照研究和多项荟萃分析都已证明了这一点。本文探讨了认知康复对精神分裂症患者工作功能的影响。几项随机对照试验比较了单纯支持性就业与支持性就业加认知康复的效果，结果显示后者的就业率有显著提高。这些结果支持在就业安置前使用认知康复。应考虑将提供的职业的具体需求和使用者的认知概况。
