La schizophrénie est associée à des troubles cognitifs et sociaux variés qui handicapent fortement les patients dans leur vie quotidienne. Le traitement de la schizophrénie repose sur une approche biopsychosociale qui comporte l’utilisation d’antipsychotiques, associés à un programme de remédiation cognitive. Le programme intégratif de thérapies psychologiques (IPT) a la particularité d’associer une approche psychosociale à la remédiation cognitive. Ce programme se compose de six sous-programmes. Chaque sous-programme est subdivisé en plusieurs étapes. Les interventions thérapeutiques se situent sur un axe qui procède du cognitif vers le social, du simple vers le complexe et d’un style d’animation directif vers la discussion ouverte centrée.

Quarante-huit patients répondant au diagnostic de schizophrénie ont été évalués à l’aide de la Brief Cognitive Rating Scale et de la Morning Rehabilitation Status Scale.

L’évaluation après trois mois montre une amélioration des troubles cognitifs. Il n’existait pas de différences significatives quant aux performances sociales étant donné que le groupe expérimental n’a pas encore suivi tous les modules d’entraînement des habiletés sociales.

L’IPT semble constituer une intervention thérapeutique efficace, en association avec les antipsychotiques. Ce programme permet ainsi aux patients souffrant de schizophrénie une adaptation socioprofessionnelle et par conséquent une qualité de vie satisfaisante.

Schizophrenia is associated with various cognitive and social disorders, which severely affect patients’ daily life. The treatment of schizophrenia is based on a biopsychosocial approach involving the use of antipsychotics associated with a cognitive remediation program. The Integrated Psychological Treatment Program (IPT) developed by Brenner’s team, has the distinction of associating a psychosocial approach with cognitive remediation. This program is composed of six sub-programs and each sub-program is subdivided into several stages. The first three sub-programs: cognitive differentiation, social perception and verbal communication are aimed at structured training using specific exercises which target particular cognitive deficits. In this way, the IPT program seeks to reduce the cognitive factors of vulnerability that often represent stresses adding to the demands of everyday life. The other three sub-programs, called social skills, emotion management and problem solving, train and develop the skills of managing emotional and relationship experiences as well as personal and social difficulties in a more constructive way in people with schizophrenia. As for the whole program, each sub-program is constructed so that the difficulties gradually increase for both the individual and the group. Materials, exercises and situational tasks become increasingly complex. The overall therapeutic context moves from being very task-oriented to highlighting interactions within the group. At the same time the directive attitude of the therapist gives way to a more withdrawn and permissive style. The exercises in the sub-programs therefore follow a gradual process, starting with neutral and objective therapeutic material, which should not present an emotional charge to the patient. Steadily, emotive content is introduced and the issues addressed become more personalized.

Forty-eight patients hospitalized at L’Hôpital Psychiatrique de la Croix (Jal-Eddib, Lebanon) for between 1 and 7years and diagnosed with schizophrenia (paranoid schizophrenia or schizoaffective disorder) were assessed with the help of the Brief Cognitive Rating Scale (BCRS) and the Morning Rehabilitation Status Scale (MRSS). The patients were separated into two matched groups. 14.5% were divorced, 85.5% were single. 41.5% had primary level education and 58.5% had a higher level of education. There were no significant differences between the two groups in terms of age, economic status, length of stay and frequency of hospital discharges.

After 3months, assessment showed an improvement in cognitive disorders, notably in concentration, memory of recent events, orientation, past memory and autonomy. This improvement on the BCRS scale is explained by the fact that the experimental group followed the first three sub-programs which restores cognitive functioning. There were no significant differences in social performance as the experimental group had not yet completed all modules on social skills training. With regard to the control group, the subjects had almost the same scores in T0 (assessment during the first meeting) as in T1 (assessment three months into the program) on the BCRS and MRSS scales.

IPT appears to be an effective therapeutic intervention, in combination with antipsychotics. This program allows patients suffering from schizophrenia to integrate socially and professionally and, therefore, experience a satisfying quality of life. This program is therefore particularly interesting in the framework of internal and external hospital services which work with stabilized patients committed to the reintegration process.