La pathologie schizophrénique entraîne non seulement une altération des fonctions psychiques (due à la symptomatologie positive et/ou négative), mais aussi des difficultés sur le plan cognitif (mémoire, attention, fonctions exécutives et habiletés sociales). De plus, 40 à 60 % des patients souffrent de surpoids ou d’obésité (mauvaise hygiène de vie, troubles du comportement alimentaire et prise de psychotropes). L’ensemble de ces difficultés handicape les patients et entrave leur accès à l’autonomie. Dans ce contexte, la création d’un outil thérapeutique – qui pourrait avoir des effets sur certaines fonctions cognitives – prend tout son sens. Ainsi, MODen est un outil d’éducation thérapeutique qui pourrait améliorer les fonctions cognitives et la symptomatologie de l’individu en prenant comme support « l’équilibre alimentaire ». Dans ce programme, les patients encadrés par deux thérapeutes se réunissent une fois par semaine pour une durée de 2 à 4 heures pendant 16 semaines. Sont abordées, les notions d’équilibre nutritionnel, l’organisation des repas ainsi que la réalisation de 4 repas. Nous avons réalisé une étude pilote sur 8 patients souffrant de schizophrénie. Bien que l’amélioration au score total de la PANSS ne soit que tendancielle (0,07), deux des sous-scores de cette échelle se distinguent de manière significative : les symptômes négatifs et la désorganisation (respectivement, p<0,02 ; p<0,02). Une amélioration tendancielle au score de la BECS (p<0,08) est également observée. Ces premiers résultats ainsi que les qualités écologiques de cet outil thérapeutique pourraient constituer un outil de choix dans la prise en charge des personnes souffrant de schizophrénie.

Schizophrenia causes psychological difficulties (with positive and/or negative symptoms) as well as cognitive disabilities (attention, memory, executive functions and social cognition). Moreover, 40 to 60% of patients suffer from an excess of weight or obesity (due to bad eating habits, eating disorders or medication). All these difficulties impair their autonomy and their insertion into the society. In this context, setting-up a therapeutic tool, which may have cognitive benefits seems relevant. Thus, MODen is a therapeutic educational tool whose aim is to improve cognitive functions and the symptoms by using “nutritional balance” as an aid.

In this treatment program, two therapists lead a group of 5 to 8 patients which group meets once a week during two to four hours for 16 weeks, divided in 4 cycles. The first three weeks of each cycle consists of theoretical instruction: patients talk about their eating habits, information is given about nutritional balance and preparation of meals. In the different cycles, flexibility, planning, memory and attention are trained. For instance, the work on categorisation of foods and nutritional balance allow enhancing flexibility abilities. Writing down the lists of different ingredients needed for one week's meals and preparation of meals train planning abilities. MODen also takes into account ecological issues such as the limited budget of patients to do their shopping (this budget is around 4 euros per meal in France). The budget is also linked to planning abilities and reasoning. Finally, during the last session of each cycle the group prepares a meal (from the shopping to cooking). This last session is all about sharing and social cognition abilities. By the end of the program, patients will have prepared four meals together. Also “homework” has to be done each week in order to facilitate memorisation of what has been learned during the last session and to prepare the beginning of the next session.

In a pilot study with 8 patients with schizophrenia (DSM-IV), improvements in PANSS negative symptoms and disorganization (respectively P<0.02; P<0.02) were observed. An underlying improvement at BECS scores was also observed (P<0.08). Regarding those preliminary results as well as the ecological qualities of this program, this therapeutic tool could be relevant in the treatment of patients with schizophrenia.