Towards an improved access to psychiatric rehabilitation: availability and effectiveness at 1-year follow-up of psychoeducation, cognitive remediation therapy, cognitive behaviour therapy and social skills training in the FondaMental Advanced Centers of Expertise-Schizophrenia (FACE-SZ) national cohort. Running title: Psychosocial therapies in schizophrenia PhD and the FACE-SZ (FondaMental Academic Centers of Expertise for Schizophrenia) group*

Julien Dubreucq (1, 2) , Bernard Ycart (3) , F. Gabayet (1, 2) , C. Perier (1, 2) , Agnès Hamon (3) , P. Llorca (4, 1) , L. Boyer (1, 5) , O. Godin (1, 6) , E. Bulzacka (7, 1) , M. Andrianarisoa (1, 7) , Bruno Aouizerate (1, 8) , F. Berna (4, 1) , L. Brunel (9, 10) , D. Capdevielle (1, 11) , I. Chereau (1, 4) , T. D’amato (1, 12) , C. Dubertret (1, 13) , C. Faget (1, 14) , J. Mallet (1, 13, 15) , D. Misdrahi (1, 8) , C. Passerieux (1, 16) , R. Rey (1, 12) , R. Richieri (17, 14) , A. Schandrin (1, 11) , F. Schürhoff (1, 10) , M. Urbach (1, 16) , P. Vidailhet (1, 18) , E. Giraud-Baro (19) , Guillaume Fond (20, 14, 5)

1 Fondation FondaMental [Créteil]
2 Centre Référent de Réhabilitation Psychosociale [CH Alpes Isère]
3 SVH - Statistique pour le Vivant et l’Homme
4 NPsy-Sydo - Neuro-Psycho Pharmacologie des Systèmes Dopimanégiques sous-corticaux
5 CEReSS - Centre d'études et de recherche sur les services de santé et la qualité de vie
6 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
7 IMRB - Institut Mondor de Recherche Biomédicale
8 SANPSY - Sommeil, Addiction et Neuropsychiatrie [Bordeaux]
9 IEM - Institut Européen des membranes
10 Inserm U955 - Molecular virology and immunology – Physiopathology and therapeutic of chronic viral hepatitis (Team 18)
11 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
12 UCBL - Université Claude Bernard Lyon 1
13 UPD7 - Université Paris Diderot - Paris 7
14 APHM - Assistance Publique - Hôpitaux de Marseille
15 AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)
16 UVSQ - Université de Versailles Saint-Quentin-en-Yvelines
17 Departement de Psychiatrie
18 UNISTRA - Université de Strasbourg
19 Réseau Handicap Psychique RéHPSY
20 AMU - Aix Marseille Université

Psychosocial Interventions (PIs) have shown positive effects on clinical and functional outcomes of schizophrenia (SZ) in randomized controlled trials. However their effectiveness and accessibility remain unclear to date in “real world” schizophrenia. The objectives of the present study were (i) to assess the proportion of SZ outpatients who benefited from PIs between 2010 and 2015 in France after an Expert Center Intervention in a national multicentric non-selected community-dwelling sample; (ii) to assess PIs’ effectiveness at 1-year follow-up. 183 SZ outpatients were recruited from FondaMental Advanced Centers of Expertise for Schizophrenia cohort. Baseline and 1-year evaluations included sociodemographic data, current treatments, illness characteristics and standardized scales for clinical severity, adherence to treatment, quality of life, a large cognitive battery, and daily functioning assessment. Only 7 (3.8%) received a PI before the evaluation, and 64 (35%) have received at least one PI during the 1-year follow-up. Having had at least one PI during the follow-up has been associated in multivariate analyses with significantly higher improvement in positive and negative symptoms (respectively p =0.031; p = 0.011), mental flexibility (TMT B, p = 0.029; C-VF, p = 0.02) and global functioning (p =0.042). CBT and SST were associated with higher cognitive improvements, while CRT was associated with clinical improvement. These results have not been demonstrated before and suggest that the effect of each PI is larger than its initial target. The present study has confirmed the PIs’ effectiveness in a large sample of community-dwelling SZ outpatients at 1 year follow-up. Efforts to improve access to PI should be reinforced in public health policies.

Keywords: Rehabilitation; Psychosocial interventions; Effectiveness; Functioning; Schizophrenia

Domains: Life Sciences [q-bio]; Human health and pathology; Psychiatrics and mental health

Julien Dubreucq, Bernard Ycart, F. Gabayet, C. Perier, Agnès Hamon, et al.. Towards an improved access to psychiatric rehabilitation: availability and effectiveness at 1-year follow-up of psychoeducation, cognitive remediation therapy, cognitive behaviour therapy and social skills training in the FondaMental Advanced Centers of Expertise-Schizophrenia (FACE-SZ) national cohort. Running title: Psychosocial therapies in schizophrenia PhD and the FACE-SZ (FondaMental Academic Centers of Expertise for Schizophrenia) group*. European Archives of Psychiatry and Clinical Neuroscience, 2019, 269 (5), pp.599-610. ⟨10.1007/s00406-019-01001-4⟩. ⟨hal-02473263⟩