Il est reconnu aujourd’hui que le trouble des fonctions neurocognitives peut concerner jusqu’à 80 % des patients dans la schizophrénie, engendrant une altération plus ou moins marquée des capacités de traitement de l’information. Celle-ci a pour conséquence une détérioration du fonctionnement cognitif et social, source d’un handicap important. La remédiation cognitive est une approche rééducative récente en psychiatrie qui vise à réduire l’impact de ces perturbations et à améliorer le fonctionnement cognitif et métacognitif du sujet. Il est nécessaire au préalable d’évaluer quantitativement et qualitativement ces déficits avec des tests neurocognitifs précisant son profil. À la suite de cette évaluation, les résultats sont restitués au patient afin notamment de présenter l’intérêt d’une aide rééducative adaptée. Nous avons pu cliniquement observer que, bien au-delà d’une simple information, cette rencontre avec le sujet lors du retour des résultats de l’évaluation neurocognitive pouvait avoir un effet bénéfique tant sur la perception que le patient a de lui-même et de sa maladie que sur la connaissance et l’acceptation de cette dernière. Nous avons également pu noter l’influence positive sur les capacités d’insight et le renforcement de l’alliance thérapeutique. L’objet de cet article est d’analyser, en s’appuyant sur des exemples cliniques, la fonction thérapeutique potentielle chez le patient schizophrène du retour des résultats de l’évaluation neurocognitive.

It is now recognized that neurocognitive dysfunctions can affect up to 80% of patients with schizophrenia, causing a more or less marked change in their ability to deal with information. As a result, patients show deterioration in cognitive and social functioning, which has a debilitating effect. Cognitive remediation is a new reeducative approach in psychiatry, which aims to reduce the impact of these disruptions and improve cognitive and metacognitive functioning in the subject. First of all, it is necessary to quantitatively and qualitatively assess these deficits with neurocognitive tests specifying their profile. Following this evaluation, the results are returned to the patient to present the value of appropriate rehabilitative assistance.

From clinical examples, the authors describe that, apart from informing patients, this encounter with the subject to return neurocognitive test results can have various beneficial effects: dedramatization and “decatastrophization” of beliefs about the illness in favor of objectivation of neurocognitive dysfunctions. Linking problems experienced by the patient with the neurological disruptions allows a more easily accessible and less stigmatizing approach and validates the benefit of drug therapy and cognitive remediation. Highlighting the psychoeducative aspect by improving knowledge and understanding, ultimately leads to greater acceptance of the illness and treatment. “Normalization” of the perception of the condition through a possible dialectic between subjective experience of the illness and objectified problems. Strengthening the feeling of control over the disease in the subject. This facilitates the therapeutic or acceptance approach. Increasing insight skills and reinforcing therapeutic alliance. Consideration of neurocognitive alternatives at the origin of difficulties perceived by the subject. Possibility of helping the patient improve compliance as proposed by Amador with a motivational approach.

Currently, in our daily practice of psychiatry, we do not have imagery which could help support our clinical diagnosis of psychosis. The patient interprets the practitioner’s speech through their own perception of their psychic disorders, which is sometimes highly altered due to impaired insight. Neurocognitive assessment is one of the few additional tests that may objectify and quantify, at least partially, cognitive dysfunction in patients with schizophrenia. It defines a cognitive profile and targets neurocognitive deficits in order to individualize the program of cognitive remediation in relation to patient complaints. It also adjusts the actions of psychoeducation and symptom control training in view of psychosocial rehabilitation. Furthermore, it provides us with valuable information about the realistic prospects for social and professional reintegration. These neurocognitive anomalies are closely correlated with cognitive dysfunction in our patients and with their inconvenience in day-to-day life. It is sometimes possible to rebuild a relationship, the start of a therapeutic connection with the patient by addressing their daily difficulties caused by cognitive dysfunction, which they register more easily than psychiatric diagnosis. Discussing their illness in terms of attention disorders, memory problems or social cognitive difficulties with the patient relates more closely to their daily experience, is initially less stigmatizing, makes it easier to help them take ownership of their illness and encourages them to commit to cognitive remediation actions or psychosocial rehabilitation.

The authors described psychoeducative functions and psychotherapeutic potential of returning the results of the neurocognitive assessment to the patient. It allows the schizophrenic patient to better understand their illness and the symptoms that affect them daily and even to dedramatize certain beliefs. It offers them the opportunity to put their subjective experience into words and reclaim part of their illness, making it less stigmatizing and, therefore, more acceptable. It can help therapeutic alliance and work on insight; act as mediator between the patient and/or their family and caregiver; and, finally, facilitate access to further cognitive remediation or psychosocial rehabilitation work.