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Centres Experts Schizophrénie, un outil pour le soin et la recherche : retour sur 10 ans d’expérience

F. Schürhoff 1 Guillaume Fond 2, 3 F. Berna 4 E. Bulzacka 5 O. Godin 1 L. Boyer 6 D. Misdrahi 1 M. Andrianarisoa 1 L. Brunel 7 N. Coulon B. Aouizerate 1 Delphine Capdevielle 8, 9 I. Chereau 1 T. D’amato 1 C. Dubertret 1 J. Dubreucq 1 C. Faget 1 F. Gabayet 1 J. Mallet 10 R. Rey 1 C. Lançon 11 C. Passerieux 1 A. Schandrin 8, 9 N. Bazin 12 O. Blanc I. Chéreau-Boudet 13 G. Chesnoy-Servanin J.M. Danion 14 A. Deloge C. Delorme 15 H. Denizot 1 J.M. Dorey 16 C. Fluttaz S. Fonteneau E. Giraud-Baro M. Jarroir D. Lacelle H. Laouamri 1 M. Leboyer 1 T. Le Gloahec Y. Le Strat 17 P.M. Llorca 4 E. Metairie I. Offerlin-Meyer P. Peri S. Pires 18 C. Portalier L. Ramet C. Roman A. Tessier 19 A.M. Tronche M. Urbach 1 F. Vaillant 20 A. Vehier P. Vidailhet 1 E. Vila 1, 21 H. Yazbek A. Zinetti-Bertschy
Abstract : Objectives The present article is a synthesis of the first 10 years of follow-up of the FondaMental Academic Center of Expertise for Schizophrenia (FACE-SZ) cohort. Methods More than 700 community-dwelling stabilized subjects have been recruited and evaluated to date. The mean age was 32 years with 75 % males, the mean illness duration was 11 years, the mean age at illness onset was 21 years, the mean duration of untreated psychosis was 1.5 years and 55 % were current daily tobacco smokers. Results The major findings of the FACE-SZ cohort may be summarized as follows: the metabolic syndrome is twice more frequent in schizophrenia as compared to the general population and is not correctly assessed and treated; cognitive disturbances have been found in benzodiazepine consumers and in patients with chronic low-grade peripheral inflammation; major depressive disorder (MDD) is a common current comorbid condition in about 20% of the subjects at the evaluation. MDD is associated with impaired quality of life and with increased nicotine dependency in SZ daily tobacco smokers. Improving depression and negative symptoms may be the most effective strategies to improve quality of life in schizophrenia; the duration of untreated psychosis is much longer in cannabis smokers and in subjects with an age at illness onset < 19 years. Adherence to treatment is diminished in subjects who report a subjective negative feeling after treatment intake independent of objective side effects (extrapyramidal syndrome and weight gain). Akathisia has been found in 18% of the subjects and has been associated with antipsychotic polytherapy. Conclusions In the light of these results, some recommendations for clinical care may be suggested. The early detection of schizophrenia should be specifically increased in adolescents and/or cannabis smokers. All patients should be administered a comprehensive neuropsychological evaluation at the beginning of the illness and after stabilization under treatment. Improving metabolic parameters and lifestyle (diet and physical activity) should be reinforced. The benefit/risk ratio of benzodiazepine and antipsychotic polytherapy should be regularly reevaluated and withdrawn as soon as possible. If MDD remains underdiagnosed and undertreated, improving depression may strongly improve the quality of life of SZ subjects. In the end, Cognitive Remediation Therapy and anti-inflammatory strategies should be more frequently included in therapeutic strategies.
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Submitted on : Monday, February 10, 2020 - 6:45:54 PM
Last modification on : Saturday, September 19, 2020 - 3:47:32 AM

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F. Schürhoff, Guillaume Fond, F. Berna, E. Bulzacka, O. Godin, et al.. Centres Experts Schizophrénie, un outil pour le soin et la recherche : retour sur 10 ans d’expérience. L'Encéphale, Elsevier Masson, 2019, 45 (1), pp.9-14. ⟨10.1016/j.encep.2018.07.007⟩. ⟨hal-02473618⟩

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