Les troubles cognitifs associés à la schizophrénie (TCAS) impactent fortement le fonctionnement social, professionnel et la qualité de vie. Malgré des recommandations internationales et d’interventions validées, notamment la remédiation cognitive, leur repérage et leur prise en charge restent limités en pratique clinique. Cette étude vise à explorer les représentations, les pratiques et les besoins des professionnels de santé concernant les TCAS en France.

Une enquête nationale a été réalisée via un questionnaire anonymisé en ligne, diffusé entre juillet et octobre 2023 auprès des membres de l’Association française de psychiatrie biologique et neuropsychopharmacologie et de leurs collaborateurs. Le questionnaire concernait leurs pratiques d’évaluation et de prise en charge des troubles cognitifs, les freins et leurs besoins pour un meilleur traitement.

Cent quatre soignants ont participé (69 % psychiatres ; majoritairement hospitaliers). Parmi eux, 89 % considèrent l’évaluation cognitive importante dans la schizophrénie, mais seulement la moitié ont les moyens d’assurer l’évaluation et 36,5 % déclarent pouvoir proposer de la remédiation cognitive. Les freins principaux rapportés sont le manque de ressources humaines (64 %), les effets des antipsychotiques (56 %) et l’absence d’outils facilement applicables (53 %). Les moyens d’évaluation rapportés sont très hétérogènes. La majorité des cliniciens (77 %) estiment que les troubles évoluent de manière défavorable, et seulement 7 % anticipent une amélioration possible. Les répondants demandent majoritairement des formations (78 %) et un déploiement de la remédiation cognitive (66 %) s’appuyant sur des recommandations et des dispositifs opérationnels pour faciliter l’implémentation.

Un écart existe entre les données probantes disponibles et la pratique clinique. Le besoin majeur exprimé par les professionnels porte sur la structuration d’un parcours d’évaluation et de prise en charge des TCAS, intégrant des outils simples et des formations spécifiques dans une approche de réhabilitation psychosociale orientée rétablissement.

Cognitive impairment associated with schizophrenia (CIAS) is a core dimension of the disorder and a major determinant of global functioning, work and social autonomy, and quality of life. Cognitive deficits are present in roughly 75–85% of individuals with schizophrenia and affect multiple domains, including processing speed, working memory, executive functions and social cognition. Despite robust international evidence supporting cognitive remediation and psychosocial rehabilitation, CIAS remains insufficiently assessed and managed in routine psychiatric practice. Barriers include limited time and human resources, lack of training and the absence of tools that are easily deployable in clinical settings. This national survey aimed to describe clinicians’ representations, evaluation practices, therapeutic strategies and perceived needs regarding CIAS in France.

We conducted a national cross-sectional survey using an anonymous online questionnaire (Google Forms) distributed between July and October 2023 to members of the French Association of Biological Psychiatry and Neuropsychopharmacology (AFPBN) and their collaborators. The target population included psychiatrists, psychologists, neuropsychologists, general practitioners and nurses involved in the care of individuals with schizophrenia. The questionnaire explored: (i) the perceived relevance of cognitive assessment; (ii) tools and methods used to evaluate cognition; (iii) care strategies and access to cognitive remediation; and (iv) perceived barriers and needs for improving management. Quantitative data were analysed descriptively; qualitative responses were coded thematically.

A total of 104 responses were analysed. Most respondents were psychiatrists (69%) working in public hospital settings. Cognitive assessment was considered clinically relevant by 89% of participants, yet only about half reported having the resources to perform it over time, and 36.5% declared using cognitive remediation. Reported barriers included insufficient time and human resources (64%), difficulty implementing available tools in routine care (53%), cognitive side effects of antipsychotic treatments (56%) and clinical instability (32%). Clinicians frequently associated CIAS with negative symptoms (88%) and reported a major impact on social (51%) and occupational functioning (48%), whereas repercussions on autonomy and everyday life were less frequently mentioned, and the notion of personal recovery was almost never spontaneously cited. Overall, 77% of respondents reported that cognitive deficits worsen over time, either progressively or in an episodic manner, and only 7% believed improvement was possible. Professionals expressed a need for dedicated training (78%) and for wider implementation of cognitive remediation (66%), supported by clear clinical recommendations and practical operational tools to facilitate real-world implementation.

This study highlights a clear disconnect between evidence-based recommendations and real-world clinical practice in France. CIAS is widely recognised as clinically relevant and functionally disabling, but its evaluation and treatment remain inconsistent, fragmented and often pessimistically appraised. The results underline the need for structured and scalable cognitive pathways integrating brief pragmatic assessments, training of multidisciplinary teams in cognitive remediation, and cognitive interventions embedded within psychosocial rehabilitation and personal recovery frameworks. Providing clinicians with national guidelines, standardised tools and accessible interventions appears crucial to reduce the treatment gap and promote functional recovery.