La mémoire prospective est une fonction cognitive complexe sollicitée quotidiennement en particulier chez les personnes âgées qui sont, par exemple, fréquemment amenées à se souvenir de prendre un traitement médicamenteux. Cette thèse conduite dans une perspective différentielle était guidé par deux objectifs. Le premier était d’identifier les mécanismes cognitifs sous-tendant le déclin lié à l’âge à des tâches de laboratoire et à des tâches naturelles de mémoire prospective. Le second était d’étudier les possibilités d’amélioration de la mémoire prospective chez la personne âgée. Quatre études ont donc été conduites auprès de personnes âgées. Les deux premières études ont permis d’avoir une meilleure compréhension des effets du vieillissement sur la mémoire prospective en mettant en évidence le rôle médiateur de la mémoire rétrospective et du contrôle exécutif dans le déclin lié à l’âge de la mémoire prospective. La troisième étude a notamment montré que les personnes âgées semblent spontanément compenser certaines difficultés de mémoire prospective en ayant recours à des aides mnésiques externes. Ces trois études nous ont permis d’élaborer et de tester l’effet d’un programme d’intervention, visant à améliorer la mémoire prospective, basé sur le renforcement de la mémoire rétrospective, du contrôle exécutif et de certaines connaissances méta-mnésiques. Les résultats n’ont pas mis en évidence d’effet de l’intervention. Ces résultats suggèrent que des interventions individualisées ciblées sur des difficultés spécifiques seraient peut-être plus adaptées que des interventions destinées à améliorer le fonctionnement global de la mémoire prospective de la personne âgée / Prospective memory is a complex cognitive function requested to remember a planned action. For example, this function is particularly important in elderly people to remember taking medication at the appropriate time. Two key objectives were pursued in an interindividual differences approach. The first goal was to have a better understanding of prospective memory in aging people. Thus, we wanted to identify the cognitive mechanisms underlying the age-related decline in laboratory and naturalistic prospective memory tasks. The second goal was to estimate how prospective memory can be improved in elderly people. To that end, we performed four studies using samples of aging people. The results of the two first studies indicated that retrospective memory and executive control processes mediate the relation between age and prospective memory. In the third study, the results showed that elderly people compensated spontaneously some of their prospective memory problems using external memory aids. These studies allowed us to develop and to test a cognitive intervention program based on the reinforcement of retrospective memory, executive control processes, and metacognitive knowledge. The results indicated any effect of the intervention program on prospective memory performance. These suggest that individualized cognitive interventions focused on specific prospective memory problems would be more suitable than interventions designed to improve the global functioning of prospective memory in elderly people

Analgesic products can produce serious side effects. Because potent analgesics are not under medical surveillance but are available to the public without a medical prescription, any attempt to influence consumer behaviour in relation to these products must be via interventions at pharmacist level. The Australian government is now pressuring the pharmacy profession to monitor effectively the use of such non-prescription medication. The aim of this study was to train community pharmacists on brief intervention strategies for use in a pharmacy setting in relation to combination analgesic products. Focus groups showed that participants had concerns about adopting confrontational counselling styles, as they feared this would antagonise consumers leading to loss of patronage without having an impact on consumer behaviour. This concern was later reinforced by consumer interviews, which showed that a significant proportion of respondents thought that the use of non-prescription analgesics was their responsibility. A protocol for the sales of analgesic products was designed with these issues in mind. The transtheoretical model of change (TTM) and motivational interviewing were selected as theoretical frameworks, as they take into account differences among consumers in motivation and in intention to change behaviour and are congruent with pharmacists' concerns. Consumer-centred intervention strategies were tailored to the individual consumer according to his/her readiness to change. This approach was borrowed from the area of smoking secession in which it has been related to positive clinical outcomes. The assumption was made that TTM-based intervention would also be effective in a pharmacy setting in relation to analgesic products. In the initial pilot study, community pharmacists who simply attended a workshop in the cognitive-behavioural intervention strategies failed to incorporate the newly acquired skills to their practice and consequently lost their proficiency. In the subsequent pilot study, when the workshop was followed by ongoing on-site training with immediate feedback and coaching through the use of pseudo-patron visits, the investigator was able to shape community pharmacists' practice behaviour in relation to the monitoring of pharmacist only analgesic products. The methodology was then refined and in the final study trained pharmacists were significantly more likely than control pharmacists and baseline to engage in a number of behaviours related to the study intervention. These included handling the sales of pharmacist only analgesics themselves, identifying inappropriate use, assessing readiness to change, and delivering an intervention according to the consumer's readiness to change. The results suggested that in pharmacy practice post qualifying therapeutic skill transfer is not achieved by workshop presentation alone. Modelling of the desired behaviour involving reinforcement and feedback is necessary.

Analgesic products can produce serious side effects. Because potent analgesics are not under medical surveillance but are available to the public without a medical prescription, any attempt to influence consumer behaviour in relation to these products must be via interventions at pharmacist level. The Australian government is now pressuring the pharmacy profession to monitor effectively the use of such non-prescription medication. The aim of this study was to train community pharmacists on brief intervention strategies for use in a pharmacy setting in relation to combination analgesic products. Focus groups showed that participants had concerns about adopting confrontational counselling styles, as they feared this would antagonise consumers leading to loss of patronage without having an impact on consumer behaviour. This concern was later reinforced by consumer interviews, which showed that a significant proportion of respondents thought that the use of non-prescription analgesics was their responsibility. A protocol for the sales of analgesic products was designed with these issues in mind. The transtheoretical model of change (TTM) and motivational interviewing were selected as theoretical frameworks, as they take into account differences among consumers in motivation and in intention to change behaviour and are congruent with pharmacists' concerns. Consumer-centred intervention strategies were tailored to the individual consumer according to his/her readiness to change. This approach was borrowed from the area of smoking secession in which it has been related to positive clinical outcomes. The assumption was made that TTM-based intervention would also be effective in a pharmacy setting in relation to analgesic products. In the initial pilot study, community pharmacists who simply attended a workshop in the cognitive-behavioural intervention strategies failed to incorporate the newly acquired skills to their practice and consequently lost their proficiency. In the subsequent pilot study, when the workshop was followed by ongoing on-site training with immediate feedback and coaching through the use of pseudo-patron visits, the investigator was able to shape community pharmacists' practice behaviour in relation to the monitoring of pharmacist only analgesic products. The methodology was then refined and in the final study trained pharmacists were significantly more likely than control pharmacists and baseline to engage in a number of behaviours related to the study intervention. These included handling the sales of pharmacist only analgesics themselves, identifying inappropriate use, assessing readiness to change, and delivering an intervention according to the consumer's readiness to change. The results suggested that in pharmacy practice post qualifying therapeutic skill transfer is not achieved by workshop presentation alone. Modelling of the desired behaviour involving reinforcement and feedback is necessary.

La mémoire prospective est une fonction cognitive complexe sollicitée quotidiennement en particulier chez les personnes âgées qui sont, par exemple, fréquemment amenées à se souvenir de prendre un traitement médicamenteux. Cette thèse conduite dans une perspective différentielle était guidé par deux objectifs. Le premier était d'identifier les mécanismes cognitifs sous-tendant le déclin lié à l'âge à des tâches de laboratoire et à des tâches naturelles de mémoire prospective. Le second était d'étudier les possibilités d'amélioration de la mémoire prospective chez la personne âgée. Quatre études ont donc été conduites auprès de personnes âgées. Les deux premières études ont permis d'avoir une meilleure compréhension des effets du vieillissement sur la mémoire prospective en mettant en évidence le rôle médiateur de la mémoire rétrospective et du contrôle exécutif dans le déclin lié à l'âge de la mémoire prospective. La troisième étude a notamment montré que les personnes âgées semblent spontanément compenser certaines difficultés de mémoire prospective en ayant recours à des aides mnésiques externes. Ces trois études nous ont permis d'élaborer et de tester l'effet d'un programme d'intervention, visant à améliorer la mémoire prospective, basé sur le renforcement de la mémoire rétrospective, du contrôle exécutif et de certaines connaissances méta-mnésiques. Les résultats n'ont pas mis en évidence d'effet de l'intervention. Ces résultats suggèrent que des interventions individualisées ciblées sur des difficultés spécifiques seraient peut-être plus adaptées que des interventions destinées à améliorer le fonctionnement global de la mémoire prospective de la personne âgée

Les hypersignaux de la substance blanche (HSB) ont été associés à des déficits exécutifs et mnésiques et à une atteinte des circuits corticaux et sous-corticaux frontaux. Leur présence, en plus du dépôt ß-amyloïde chez de nombreux patients avec un MCI (Mild Cognitive Impairment ou trouble cognitif léger) augmenterait le risque de conversion vers une maladie d'Alzheimer (MA). Un des enjeux importants dans la phase préclinique de la maladie est d'explorer le potentiel des interventions cognitives pour prévenir le déclin cognitif et la progression vers une MA. Alors que les HSB sont de plus en plus considérés comme un des facteurs déterminant l'hétérogénéité des patients MCI, peu d'étude ont pris en compte leur présence dans les interventions cognitives. L'hypothèse qu'une intervention pourrait induire des effets différentiels selon l'existence ou non d'hypersignaux dans le MCI reste inexplorée à notre connaissance, et est au cœur de ce travail de thèse. / White matter hyper signals (WMH) were associated with executive and memory deficits and impairment of the cortical and subcortical frontal circuits. Their presence, in addition to amyloid deposition in many patients with Mild Cognitive Impairment (MCI), would increase the risk of conversion to Alzheimer's disease (AD). An important issues in the preclinical phase of MCI is to explore the potential of cognitive interventions to prevent cognitive decline and progression to AD. While WMH are increasingly considered as one of factors determining the heterogeneity of MCI patients, few studies have take into account their presence in cognitive interventions. The hypothesis that an intervention could induce differential effects according to the existence or not of WMH in MCI remains unexplored to our knowledge, and is at the heart of this work of thesis.

Paper one: The attitudes and reasoning of abusive behaviour in adolescents who have been exposed to domestic abuse Exposure to domestic abuse in childhood can go on to negatively affect every aspect of that individual’s life. During adolescence, the impact of exposure to domestic abuse may go beyond the borders of the family and the individual, and affect the development of intimate relationships. This study explores the attitudes and reasoning of eleven young people who have been exposed to domestic abuse and are displaying perpetrator behaviours. Results reveal a complex interaction between experiences and skill deficits at a crucial time of identity formation, resulting in the formation and maintenance of destructive attitudes and contradictory reasoning about abusive behaviour. The direct implications of this study, suggestions for further research, and for Educational Psychology Services are discussed. Paper two: An evaluation of an intervention for adolescents who have been exposed to domestic abuse and are displaying perpetrator behaviours Where domestic violence occurs, children and young people are likely to have been exposed to such abuse. Evidence suggests that this is likely to have a detrimental impact on them. There is an acute gap in provision for such individuals, despite evidence suggesting a link between exposure to domestic abuse in childhood, and involvement in abusive dating relationships in late adolescence and adulthood. There has been little research testing the effectiveness of intervention programmes which aim to reduce this risk. In this study a before and after design was used to evaluate a cognitive-behavioural intervention programme for young people who have been exposed to domestic abuse and are displaying abusive behaviours. This evaluation was based on the views of the young people on this programme. Results indicate that certain elements of the programme were more successful in achieving the programme aims. Considerations for the development of further programmes which target this client group are discussed.

Background: Bipolar disorders (BD) are among the most severe mental disorders with first clinical signs and symptoms frequently appearing in adolescence and early adulthood. The long latency in clinical diagnosis (and subsequent adequate treatment) adversely affects the course of disease, effectiveness of interventions and health-related quality of life, and increases the economic burden of BD. Despite uncertainties about risk constellations and symptomatology in the early stages of potentially developing BD, many adolescents and young adults seek help, and most of them suffer substantially from symptoms already leading to impairments in psychosocial functioning in school, training, at work and in their social relationships. We aimed to identify subjects at risk of developing BD and investigate the efficacy and safety of early specific cognitive-behavioural psychotherapy (CBT) in this subpopulation. Methods/Design: EarlyCBT is a randomised controlled multi-centre clinical trial to evaluate the efficacy and safety of early specific CBT, including stress management and problem solving strategies, with elements of mindfulness-based therapy (MBT) versus unstructured group meetings for 14 weeks each and follow-up until week 78. Participants are recruited at seven university hospitals throughout Germany, which provide in- and outpatient care (including early recognition centres) for psychiatric patients. Subjects at high risk must be 15 to 30 years old and meet the combination of specified affective symptomatology, reduction of psychosocial functioning, and family history for (schizo)affective disorders. Primary efficacy endpoints are differences in psychosocial functioning and defined affective symptomatology at 14 weeks between groups. Secondary endpoints include the above mentioned endpoints at 7, 24, 52 and 78 weeks and the change within groups compared to baseline; perception of, reaction to and coping with stress; and conversion to full BD. Discussion: To our knowledge, this is the first study to evaluate early specific CBT in subjects at high risk for BD. Structured diagnostic interviews are used to map the risk status and development of disease. With our study, the level of evidence for the treatment of those young patients will be significantly raised.