Psychosocial Rehabilitation Resource Center (CRR) and Reference Center (SUR-CL3R), Le Vinatier Hospital, Lyon, France.
Psychosocial Rehabilitation Reference Centre, Alpes Isère Hospital, Grenoble, France.
Eur Psychiatry. 2021 Apr 15;64(1):e31. doi: 10.1192/j.eurpsy.2021.25.
People suffering from schizophrenia cannot easily access employment in European countries. Different types of vocational programs coexist in France: supported employment, sheltered employment (ShE), and hybrid vocational programs. It is now acknowledged that the frequent cognitive impairments constitute a major obstacle to employment for people with schizophrenia. However, cognitive remediation (CR) is an evidence-based nonpharmacological treatment for these neurocognitive deficits.
RemedRehab was a multicentric randomized comparative open trial in parallel groups conducted in eight centers in France between 2013 and 2018. Participants were recruited into ShE firms before their insertion in employment (preparation phase). They were randomly assigned to cognitive training Cognitive Remediation for Schizophrenia (RECOS) or Treatment As Usual (TAU). The aim of the study was to compare with the benefits of the RECOS program on access to employment and work attendance for people with schizophrenia, measured by the ratio: number of hours worked on number of hours stipulated in the contract.
Seventy-nine patients were included in the study between October 2018 and September 2019. Fifty-three patients completed the study. Hours worked / planned hours equal to 1 or greater than 1 were significantly higher in the RECOS group than in the TAU group.
Participants benefited from a RECOS individualized CR program allows a better rate of work attendance in ShE, compared to the ones benefited from TAU. Traditional vocational rehabilitation enhanced with individualized CR in a population of patients with schizophrenia is efficient on work attendance during the first months of work integration.
在欧洲国家，精神分裂症患者很难找到工作。法国存在着不同类型的职业项目：支持性就业、庇护性就业（ShE）和混合职业项目。现在人们已经认识到，频繁的认知障碍是精神分裂症患者就业的主要障碍。然而，认知矫正（CR）是一种针对这些神经认知缺陷的基于证据的非药物治疗方法。
RemedRehab 是一项在法国 8 个中心于 2013 年至 2018 年进行的多中心随机对照开放试验，采用平行组设计。参与者在被安置到工作岗位之前（准备阶段）被招募到 ShE 公司。他们被随机分配到认知训练认知矫正治疗精神分裂症（RECOS）或常规治疗（TAU）组。该研究的目的是比较 RECOS 方案对精神分裂症患者就业和工作出勤的益处，通过工作时间与合同规定时间的比值来衡量。
2018 年 10 月至 2019 年 9 月期间，共有 79 名患者入组研究，其中 53 名患者完成了研究。RECOS 组的工作时间/计划时间等于或大于 1 的比例明显高于 TAU 组。
与接受常规治疗的患者相比，接受个体化 CR 方案的 RECOS 治疗的患者在 ShE 中的工作出勤率更高。在精神分裂症患者人群中，将传统的职业康复与个体化 CR 相结合，可以在工作融合的头几个月内提高工作出勤效率。
