BACKGROUND: There is growing evidence that specialized clinical services targeted toward individuals early in the course of a psychotic illness may be effective in reducing both the clinical and economic burden associated with these illnesses. Unfortunately, the United States has lagged behind other countries in the delivery of specialized, multi-component care to individuals early in the course of a psychotic illness. A key factor contributing to this lag is the limited available data demonstrating the clinical benefits and cost-effectiveness of early intervention for psychosis among individuals served by the American mental health system. Thus, the goal of this study is to present clinical and cost outcome data with regard to a first-episode psychosis treatment center within the American mental health system: the Early Psychosis Intervention Center (EPICENTER). METHODS: Sixty-eight consecutively enrolled individuals with first-episode psychosis completed assessments of symptomatology, social functioning, educational/vocational functioning, cognitive functioning, substance use, and service utilization upon enrollment in EPICENTER and after 6 months of EPICENTER care. All participants were provided with access to a multi-component treatment package comprised of cognitive behavioral therapy, family psychoeducation, and metacognitive remediation. RESULTS: Over the first 6 months of EPICENTER care, participants experienced improvements in symptomatology, social functioning, educational/vocational functioning, cognitive functioning, and substance abuse. The average cost of care during the first 6 months of EPICENTER participation was lower than the average cost during the 6-months prior to joining EPICENTER. These savings occurred despite the additional costs associated with the receipt of EPICENTER care and were driven primarily by reductions in the utilization of inpatient psychiatric services and contacts with the legal system. CONCLUSIONS: The results of our study suggest that multi-component interventions for first-episode psychosis provided in the US mental health system may be both clinically-beneficial and cost-effective. Although additional research is needed, these findings provide preliminary support for the growing delivery of specialized multi-component interventions for first-episode psychosis within the United States. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01570972; Date of Trial Registration: November 7, 2011

Cette étude examine l’effet de l’âge, du niveau scolaire, du milieu socioéconomique, de la latéralité et des pratiques linguistiques, sur la réalisation d’une épreuve psychologique non verbale dynamisée selon la procédure Test –Apprentissage- Re-test (T.A.R). Nous partons du constat que les tests non verbaux sont culturellement connotés (Dasen, 1993 ; Lautrey, 2001) ainsi, les facteurs culturels peuvent être considérés comme des biais ne permettant pas de comparer directement les performances réelles des personnes issues de cultures différentes. Notre hypothèse est qu’une évaluation psychologique dynamique est possible en Algérie permettant de distinguer les profils psychologiques des enfants d’âge scolaire ayant un niveau d’intelligence normal, de ceux pour qui une remédiation cognitive serait nécessaire.Les 93 enfants âgés de 5 à 11 ans, en plus d’avoir complété un questionnaire sociodémographique, ont participé à une épreuve de latéralité et à une épreuve de compétences linguistiques. Le test non verbal, la Figure Complexe de Rey (Rey, 1959), leur a été proposé une première fois, puis une seconde fois après une phase d’apprentissage selon le modèle de Kirkwood & al., 2001.Les résultats montrent que ce sont les enfants les plus âgés qui réussissent le mieux la FCR autant au test qu’au re-test. Les enfants plus âgés réalisent la Figure Complexe de Rey plus rapidement que les plus jeunes. La latéralité et le milieu socioéconomique d’appartenance ne semblent pas influencer la réalisation de la FCR. Par contre, les enfants plurilingues réalisent de meilleurs dessins que leurs homologues monolingues. Pour la grande majorité des enfants, la phase d’apprentissage est bénéfique quel que soit leurs caractéristiques personnelles. / This study examines the effect of age, school level, socioeconomic status, handedness and language skills, on children’s performance in the non-verbal test that is rendered dynamic according to the Test – Learning – Retest procedure (TLR). We argue that non-verbal tests are also culturally connoted (Dasen, 1993 ; Lautrey, 2001). Therefore, cultural factors can be considered as biases rendering questionable direct comparisons of performances of subjects from different cultures. Our hypothesis is that a dynamic psychological evaluation is possible in Algeria allowing us to differentiate psychological profiles of elementary school children with normal intelligence from those needing cognitive remediation.93 children aged between 5 and 11 years filled out a sociodemographic questionnaire, were tested for handedness and linguistic competence. They realized the Rey-Osterrieth Complex Figure Test (Rey, 1959) once and then again a second time after a learning phase according to Kirkwood & al. 2001 model.Results indicate that older children perform better at the RCFT both in the test and re-test situations than younger children. Handedness and socioeconomic status do not affect children’s performance. However, children who are speaked more than one language realize more precise drawings than unilingual children. All children profit from the learning phase. / تتناول هذه الدراسة تأثير العمر ، والمستوى التعليمي ، والبيئة الاجتماعية والاقتصادية ، و تجانب والممارسات اللغة على إعمال الاختبار النفسي غير اللفظي مدعوما بإجراء تجارب التعلم - إعادة الاختبار (T.A.R ) . نبدأ من فرضية أن الاختبارات غير اللفظية يبينها ثقافيا ( Dasen ، 1993؛ Lautrey ، 2001) و يمكن اعتبار العوامل الثقافية لا تسمح للمقارنة بشكل مباشر على الأداء الفعلي لل أشخاص من ثقافات مختلفة . لدينا فرضية هي أن التقييم النفسي الديناميكي هو ممكن في الجزائر لتمييز الملامح النفسية للأطفال في سن المدرسة مع المستوى العادي للذكاء من أولئك الذين سيلزم المعالجة المعرفية .93أطفال تتراوح أعمارهم بين 5 سنوات و 11 سنة ، بالإضافة إلى بعد الانتهاء من استبيان الاجتماعية والديموغرافية ، شارك في اختبار ل تجانب و اختبارا ل مهارات اللغة . واقترح الاختبار غير اللفظي ، و الرسم المعقدة لى ري( ري، 1959) ،قدمت لهم لأول ؤهلة ، ثم مرة ثانية بعد مرحلة التعلم في نموذج كيركوود وآخرون، 2001.وتظهر النتائج أنه الأطفال الأكبر سنا الذين هم الأكثر نجاح اإختبار FCR و إعادة الاختبار. الأطفال الأكبر سنا تحقيق هذا الرقم من لرسم ري أسرع من الأصغر سنا . لا يبدو أن هناك تأثيربالانتماء للبيئة الاجتماعية والاقتصادية و تجانب على إعمال FCR . الأطفال متعددي اللغات تحقيق أفضل التصاميم من نظرائهم أحادي اللغة . بالنسبة للغالبية العظمى من الأطفال ، مرحلة التعلم هو مفيد بغض النظر عن الخصائص الشخصية.

Introduction : Près de 60% des patients bipolaires stabilisés souffrent de déficits cognitifs associés à des troubles du fonctionnement psychosocial. En l’absence de traitement, ces troubles sont susceptibles de persister tout au long de la vie. Malgré cela, les déficits cognitifs ont longtemps été ignorés dans les troubles bipolaires et il n’existe que peu d’études à l’heure actuelle ciblant cette problématique. Méthodologie : Nous avons développé le programme individuel écologique de remédiation cognitive ECo, élaboré pour les troubles de l’humeur. Nous avons mené une série d’études empiriques afin d’explorer les corrélats psychologiques des troubles cognitifs, ainsi que l’amélioration cognitive, fonctionnelle et psychologique de patients bipolaires suite à une intervention en remédiation cognitive ou une psychothérapie individuelle.Résultats : Les troubles métacognitifs pourraient être associés à une augmentation de la fréquence des activités des patients et à une fragilisation sur le plan cognitif et émotionnel. La remédiation cognitive, et en particulier le programme ECo, a permis d’améliorer les capacités de résolution de problèmes dans notre population. Le programme ECo peut normaliser les fonctions cognitives déficitaires et la régulation métacognitive chez certains patients, mais peut également améliorer la résistance aux facteurs de stress, le contrôle émotionnel, l’ouverture aux relations et l’estime de soi.Conclusion : Un programme de remédiation cognitive écologique et individualisé, centré sur la métacognition et le sentiment d’efficacité personnelle, peut contribuer à améliorer des composantes de la santé fonctionnelle chez les patients bipolaires. / Background: Nearly sixty percent of stabilized bipolar patients suffer from important cognitive impairments that lead to significant functional disabilities. Without proper treatment, these impairments remain throughout lifespan. However, cognitive deficits in bipolar disorders have been overlooked and only a few studies investigated treatments to improve cognitive functioning for bipolar patients. Method: We developed ECo, an individual ecological cognitive remediation intervention that was designed for mood disorders. We conducted experimental studies to investigate psychological correlates of cognitive impairments, and the cognitive, functional and psychological improvements of bipolar patients after either cognitive remediation or individual psychotherapy.Results: Our results suggest that metacognitive impairments lead to an increased frequency of everyday life activities that can create a cognitive and emotional overload. We observed that cognitive remediation, and in particular the ECo program, can improve problem solving skills in our population. The ECo program can improve impaired cognitive functions and metacognitive regulation, as well as coping skills, emotional control, openness to relationships and self-esteem.Conclusion: An ecological, individualized cognitive remediation program, targeting metacognition and self-efficacy, can contribute to an improvement of functional health components in bipolar disorders.

Advances in cancer treatment have led to a significant increase in the number of pediatric oncology survivors. These survivors often have late effects in their cognitive, academic, executive, and psychological functioning subsequent to their chemotherapy and radiation treatment. In particular, executive functioning (EF), which is crucial for cognitive and academic functioning, has been recognized as an area that is impacted by treatment. Several studies have described cognitive remediation programs that seek to improve EF skills in pediatric oncology survivors. Although these programs have led to improvements in EF skills, they are often difficult to replicate due to the extensive time requirement. Many survivors also experience distress and anxiety and would likely benefit from cognitive behavioral therapy, which has been shown to be an effective intervention for children with internalizing disorders. Thus, a brief intervention that combines treatment for executive functioning and psychological distress is warranted. A mixed methods study was conducted to evaluate the impact of a nine-week blended cognitive remediation and cognitive behavior therapy group for pediatric oncology survivors and their parents. Participants were pediatric cancer survivors, age 9-14, and their parents who were referred through a local children's hospital that specialized in oncology treatment. Pre and post measures of EF, psychological functioning, and parental stress were examined. Semi-structured interviews with participants and their parents were completed and analyzed to learn more about the function of short-term group therapy for pediatric oncology survivors. Content analysis of the parent support group sessions was also conducted. Significant changes were found for youth internalizing symptoms, youth adaptive skills, youth executive functioning, and parental stress. There was also a positive correlation between parental stress and parent-rated youth internalizing problems as well as parent-rated youth behavioral symptoms and a negative correlation between parental stress and parent-rated youth adaptive behavior. Qualitative interviews indicated that participants felt that the intervention was helpful. Themes from the parent group included the challenge of managing late effects, balancing multiple roles, and coping with distress. Implications, limitations, and recommendations for further areas of research are presented. / text

Children with Fetal Alcohol Spectrum Disorder (FASD) may suffer numerous cognitive impairments, including significant problems with executive functioning, language, attention, and memory [40]. It is estimated that two to five percent of children born in the U.S. are affected by FASD [34]. It has been shown that training improvements can be made in working memory and attention in children with ADHD [25]. Computerized training with game elements enhances not only motivation but training efficacy of these interventions [38]. This thesis examines the creation of two suites of serious games, Cognitive Carnival and Caribbean Quest, intended to improve working memory aspects of attention with the assistance of a trained psychology interventionist in a therapeutic setting. A game-based approach is chosen to provide motivation to children for sustained cognitive challenges presented by cognitive exercises built into the gameplay. Cognitive Carnival was shown by interventionists to have positive effects in neuropsychological studies of populations of children with epilepsy and FASD [33, 30]. / Graduate

L'efficacité de la remédiation cognitive assistée par ordinateur (RCAO) n'a pas été démontrée jusqu’ici dans le traitement des dépressions, la notion d’efficacité étant ici à évaluer non seulement sur le plan neurocognitif mais aussi sur le plan du retentissement fonctionnel et relationnel des troubles. En particulier, les facteurs favorisant le transfert des compétences cognitives vers la vie quotidienne du sujet sont à identifier afin de potentialiser l’effet de ce soin.Nous avons réalisé trois études :- La première a vérifié l’efficacité de la RCAO dans le traitement des dépressions et a précisé le rôle du thérapeute dans ce dispositif. Elle a montré l’importance de la motivation et de la métacognition pour en potentialiser les effets.- Notre seconde étude a adapté en français, et a débuté la validation, d’un outil anglophone d’auto-évaluation de la métacognition, le MCQ-30.- Notre troisième étude a testé, chez des personnes dépressives, un nouveau dispositif de soins alliant RCAO et développement métacognitif. Nos résultats confirment que la RCAO a une efficacité dans le traitement de la dépression sur les plans neuropsychologiques, cliniques et fonctionnels. Ils montrent aussi l'importance des aspects métacognitifs et motivationnels dont la prise en compte est nécessaire à une efficacité optimale dans des contextes différenciés. En particulier, une relation thérapeutique développant ces aspects renforce la diminution du retentissement fonctionnel et l’amélioration de la qualité de vie. La RCAO doit ainsi être utilisée comme support et médiation d’une relation psychothérapique nouvelle, tenant compte du profil éminemment singulier de chaque patient / The effectiveness of Computer-assisted cognitive remediation (CACR) hadn’t been proven so far in the treatment of depression, the notion of effectiveness having to be evaluated here not only on the neurocognitive level, but also on the level of the functional and relational impacts of the disorder. The factors favouring the transfer of cognitive skills towards the daily life of the subject in particular are to be identified in order to potentiate the effect of that care.We have conducted three studies:-The first one has verified the effectiveness of CACR in the treatment of depressions and specified the role of the therapist in this plan. It has proven the importance of motivation and metacognition to potentiate their effects.- Our second study has adapted in french, and started to validate, an english questionnaire for auto-evaluation of the metacognition, the MCQ-30.- Our third study has tested on depressive people a new set of cares combining CACR and metacognitive development.Our results confirm that CACR is effective in the treatment of depression on the neuropsychological, clinical and functional levels. They also demonstrate the importance of the metacognitive and motivational aspects, that have to be taken into account for an optimal effectiveness in differencial contexts. A therapeutic relationship developing these aspects in particular reinforces the diminution of functional impact and the improvement of the quality of life. The CACR thus has to be used as support and mediation of a new therapeutic relationship, taking into account the eminently singular profile of each patient.

No description available.

Rationale Cognitive deficits are now recognised as a major symptom of schizophrenia with a number of studies reporting profound deficits in cognitive function in both chronic and first episode patients. Recent advances in cognitive remediation therapy have provided the opportunity for patients to improve their cognitive function and therefore improve their functional outcome. Aim The aim of the present study was to investigate cognitive deficits using the Cambridge Neuropsychological Test Automated Battery (CANTAB®) in first episode psychosis and chronic schizophrenia patients. In the first episode population the effect of ethnicity on cognition was also examined. In the chronic schizophrenia study comparisons between severity of deficits with first episode psychosis patients were also made. The effects of cognitive remediation therapy were also examined in a sample of first episode patients. Methods A total of 35 patients and 30 healthy controls were recruited into the first episode study, 17 patients and 17 controls into the chronic schizophrenia study and 11 patients into the cognitive remediation study. The first episode psychosis patients were recruited from the Bradford and Airedale Early Intervention Service and the chronic patients from the Leeds Partnership NHS Foundation Trust. The control subjects were matched as closely as possible in terms of intelligence and demographics to the patient groups. The Wechsler Test of Adult Reading (WTAR) was used to estimate subjects pre-morbid IQ. The severity of symptoms was assessed using the Positive and Negative Syndrome Scale (PANSS). All subjects who took part in the study completed a comprehensive battery of neuropsychological tests from the CANTAB®. Patients in the cognitive remediation study participated in group therapy sessions using X-cog®. Results There were no significant differences found between There were no significant differences found between patients and controls in relation to intelligence or demographics in all studies. The effect of ethnicity was shown to be not significant in the first episode study. Results show that patients performed significantly worse than controls across all iv cognitive domains tested in all studies. A correlation between negative symptoms and executive function was found in both first episode and chronic schizophrenia patients. Comparisons between first episode psychosis and chronic schizophrenia patients in cognition showed no significant differences, however significant differences were found in levels of negative symptoms and age between the two groups with chronic patients scoring higher on negative symptoms and being older. In the cognitive remediation study a significant improvement was observed in patients in the domain of executive function and a reduction in negative symptoms following completion of the intervention. Conclusion First episode and chronic schizophrenia patients display significant cognitive deficits across all domains when tested using the CANTAB®. Some of these deficits appear to be independent of the length of the illness but dependent on negative symptoms. This study demonstrates that cognitive deficits exist across all patient groups regardless of age, gender, pre-morbid IQ, years in education and ethnicity. Cognitive remediation therapy has also been shown to be effective in improving cognitive functioning in patients.

Rationale Cognitive deficits are now recognised as a major symptom of schizophrenia with a number of studies reporting profound deficits in cognitive function in both chronic and first episode patients. Recent advances in cognitive remediation therapy have provided the opportunity for patients to improve their cognitive function and therefore improve their functional outcome. Aim The aim of the present study was to investigate cognitive deficits using the Cambridge Neuropsychological Test Automated Battery (CANTAB®) in first episode psychosis and chronic schizophrenia patients. In the first episode population the effect of ethnicity on cognition was also examined. In the chronic schizophrenia study comparisons between severity of deficits with first episode psychosis patients were also made. The effects of cognitive remediation therapy were also examined in a sample of first episode patients. Methods A total of 35 patients and 30 healthy controls were recruited into the first episode study, 17 patients and 17 controls into the chronic schizophrenia study and 11 patients into the cognitive remediation study. The first episode psychosis patients were recruited from the Bradford and Airedale Early Intervention Service and the chronic patients from the Leeds Partnership NHS Foundation Trust. The control subjects were matched as closely as possible in terms of intelligence and demographics to the patient groups. The Wechsler Test of Adult Reading (WTAR) was used to estimate subjects pre-morbid IQ. The severity of symptoms was assessed using the Positive and Negative Syndrome Scale (PANSS). All subjects who took part in the study completed a comprehensive battery of neuropsychological tests from the CANTAB®. Patients in the cognitive remediation study participated in group therapy sessions using X-cog®. Results There were no significant differences found between There were no significant differences found between patients and controls in relation to intelligence or demographics in all studies. The effect of ethnicity was shown to be not significant in the first episode study. Results show that patients performed significantly worse than controls across all iv cognitive domains tested in all studies. A correlation between negative symptoms and executive function was found in both first episode and chronic schizophrenia patients. Comparisons between first episode psychosis and chronic schizophrenia patients in cognition showed no significant differences, however significant differences were found in levels of negative symptoms and age between the two groups with chronic patients scoring higher on negative symptoms and being older. In the cognitive remediation study a significant improvement was observed in patients in the domain of executive function and a reduction in negative symptoms following completion of the intervention. Conclusion First episode and chronic schizophrenia patients display significant cognitive deficits across all domains when tested using the CANTAB®. Some of these deficits appear to be independent of the length of the illness but dependent on negative symptoms. This study demonstrates that cognitive deficits exist across all patient groups regardless of age, gender, pre-morbid IQ, years in education and ethnicity. Cognitive remediation therapy has also been shown to be effective in improving cognitive functioning in patients.

Cette thèse s’inscrit dans le paradigme de la linguistique cognitive. C’est une étude de cas d’aphasie d’installation soudaine par accident vasculaire cérébral (AVC), avec une hémiplégie droite associée. À quinze ans de l’atteinte, le sujet et/ou objet de l’étude, Élisabeth, garde des séquelles d’une aphasie motrice, avec quelques désordres de l’expression orale (sub-agrammatisme) mais une bonne compréhension verbale et écrite. L’étude descriptive du cas s’appuie sur la neuropsychologie et ses bases anatomo-fonctionnelles (Annexe 1). L’analyse sémiologique se fonde sur la communication dialogique via un « préceptorat de remédiation cognitive », en 47 leçons de français : la didactique des langues, d’une part (préceptorat) et la neuropsychologie de la réadaptation langagière (remédiation cognitive), d’autre part, formant le noyau dur des interactions.L’analyse préliminaire de cinq leçons situe la cohérence et la cohésion du discours et ses lacunes. Ensuite, une étude qualitative des erreurs, liée à la reconstitution des unités manquantes, précise les faits, la morphologie des verbes, surtout (le vocabulaire est bien préservé). Enfin, effectué sur les 47 leçons, le comptage des mots d’Henmon (1924), charpente du discours, rend compte de la variété structurelle des thèmes abordés. En effet, la distribution catégorielle de cet inventaire est corrélée aux thèmes choisis et à la didactique partagée des deux acteurs du préceptorat. Cette corrélation sémantique et distributionnelle montre une cohérence globale des interactions, via l’inventaire d’Henmon, mentionné dans aucune étude, à notre connaissance, ce qui nous induit à approfondir cette orientation de recherche. / This thesis concerns the paradigm of cognitive linguistics. It is a case study of sudden aphasia, with associated right hemiplegia. At fifteen years of the attack, the subject and / or objet of the study, Elizabeth, shows sequelae of motor aphasia, with some disorders of oral expression (sub-agrammatism) but a good verbal and written comprehension. The descriptive case study is based on neuropsychology and its anatomical and functional bases (Appendix 1).The semiotic analysis is constructed on the dialogic communication via a "preceptorship of cognitive remediation", in 47 lessons of French: the language teaching, on the one hand (Preceptorship) and the neuropsychology of language rehabilitation (cognitive remediation), on the other hand, are forming the hard core of the interactions. The preliminary analysis of five lessons explores the coherence and the cohesion of the discourse and its shortcomings. Then, a qualitative study of the errors, related to the reconstitution of the missing units, specifies the facts, the morphology of the verbs, especially (the vocabulary is well preserved). Finally, done on 47 lessons, the counting of the Henmon inventory words (1924), framing the discourse reflects the structural variety of topics. Indeed, the morphological distribution of this inventory is correlated with the themes chosen and the shared teaching of both preceptorship actors. This semantic and distributional correlation shows an overall wealth of interactions, via the Henmon inventory. We don’t know of any studies mentioning it, which leads us to deepen this path.