Effet de l’Integrated Psychological Treatment chez des patients souffrant de schizophrénie hospitalisés au Liban - 03/03/15
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Résumé |
L’objectif de cette étude conduite dans des conditions naturelles est de tester l’efficacité de l’Integrated Psychological Treatment (IPT) en association avec un traitement pharmacologique. Deux groupes (expérimental et témoin) de 36 individus souffrant de schizophrénie chronique et hospitalisés à l’hôpital psychiatrique de La Croix (Beyrouth, Liban) depuis plus de sept ans ont été recrutés. Le groupe expérimental recevait le programme thérapeutique pendant un an et demi à raison d’une séance par semaine. Les patients du groupe témoin ne suivaient pas le programme mais gardaient leur traitement habituel. Les résultats montrent, pour le groupe témoin, une stagnation ou une détérioration significative des performances cognitives (test de Stroop), ainsi qu’une augmentation des troubles du cours de la pensée et de l’alogie. Pour les patients du groupe expérimental, une amélioration significative et généralisée du fonctionnement cognitif est rapportée (mémoire et fonctions exécutives), ainsi qu’une réduction significative des symptômes positifs et négatifs. Cette étude est l’une des premières à prouver l’efficacité de l’IPT pour des patients sévèrement malades, puisque institutionnalisés depuis de nombreuses années. Nos résultats montrent donc que l’IPT peut bénéficier à des patients, même après de nombreuses années de chronicité de la maladie et leur permettre d’acquérir des compétences indispensables à un bon fonctionnement dans la vie quotidienne.
Le texte complet de cet article est disponible en PDF.Summary |
Introduction |
The knowledge about cognitive dysfunction and schizophrenia treatment has made considerable progress over the last decade. Cognitive impairments have been recognized as responsible for the majority of these patients’ functional deficits. Despite growing efforts to develop drugs aimed at decreasing cognitive impairments, results are still disappointing. These disturbances, however, are accessible to different therapeutic approaches: Cognitive-Behavioral Therapy (CBT), Cognitive Remediation (CR, Psychosocial Rehabilitation PsR), Integrated Psychological Treatment Program (IPT), among others. IPT has been validated in French and is an efficient treatment for the management of the typical deficits in patients with schizophrenia (Roger et al., 2011). This therapeutic program is composed of 6 sub-programs, the first three, “cognitive differentiation”, “social perception” and “verbal communication” aim at working on cognitive deficits. The other 3 sub-programs, “social skills”, “emotion management”, and “problem solving” aim at the acquisition of skills to manage interpersonal problems, emotional experiences, and social difficulties.
Method |
The aim of this naturalistic study was to test the efficacy of Brenner's IPT in combination with antipsychotic medication. Two groups (experimental and control groups, respectively), each composed of 36 women and men meeting DSM-IV-R criteria for schizophrenia, hospitalized at Hôpital Psychiatrique de La Croix (Beirut, Lebanon) for at least 7 years were compared. The experimental group was treated with the IPT program once a week during 18 months. The patients in the control group received their usual treatment. A test battery comprising cognitive tasks and clinical scales related to the evaluation of each therapeutic sub-program was administrated to the participants at the beginning and at the end of the therapy. The comparison of results gave the opportunity to test the impact of the IPT program compared to the control (treatment as usual).
Results |
In the control group, the results demonstrated significant deterioration of executive functioning (Stroop Test P<0.002, Tower of London Test P<0.002), as well as an increase in thought disorders and alogia (all P<0.002). The results of the experimental group showed significant and generalized improvements in cognitive (verbal and non verbal memory, executive functions, concentration, all P<0.002) and social functioning, along with a decrease of both positive and negative symptoms (all P<0.002) following therapy.
Discussion |
Cognitive impairments are considered as one of the core deficits in patients with schizophrenia. They induce major disturbance in psychosocial functioning, inhibit professional and scholarly achievement, and diminish subjective quality of life. The results of this study demonstrate that IPT showed better efficacy than usual treatment to improve cognitive deficits in patients with schizophrenia. This program also produces a decrease in positive and, most importantly, negative symptoms of schizophrenia as well as improvement in social adaptation. The current pharmacological treatments for schizophrenia are only moderately effective against these symptoms. IPT should be considered as a relevant add-on therapy to manage persistent and enduring symptoms of schizophrenia. Moreover, the current study is among the first to demonstrate the effectiveness of IPT in severely ill patients, since they are hospitalized for several years. The results show that the IPT is beneficial for patients with a high level of symptoms suffering from severe chronicity. These patients were able to learn and use skills essential to a good functioning in daily life. To improve efficacy over positive symptoms such as delusions or hallucinations, IPT can be efficiently associated with cognitive therapy (Tarrier et al., 2004).
Limits |
In the control group, a decrease of executive functioning and a worsening of thought disorders and alogia were found. This finding should prompt caution in interpreting the results demonstrating cognitive improvement in the experimental group.
Le texte complet de cet article est disponible en PDF.Mots clés : Schizophrénie, Déficits cognitifs, Remédiation cognitive, Fonctionnement social
Keywords : Schizophrenia, Cognitive impairments, Cognitive remediation, Social functioning
Plan
Vol 25 - N° 1
P. 21-28 - mars 2015 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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