Cognitive Remediation and Sheltered Employment in Schizophrenia

Specific Cognitive Remediation for Schizophrenia (RECOS) and Sheltered Employment: a Multicentre Controlled Randomized Trial.

This study, driven on schizophrenic patients, is aimed at :

1. Measuring the efficiency of the cognitive remediation program RECOS (COgnitive REmediation in Schizophrenia) on the capacity of the patients suffering from schizophrenia to improve the integration in sheltered employment (ESAT and EA).

2. Comparing the efficiency of the program of cognitive remediation RECOS (RECOS arm) to the one of an usual program of coverage/care (TAU arm = Treatment As Usual) on integration in sheltered employment of patients suffering from schizophrenia.

3. Realizing a comparative analysis, in both arms, of :

   1. the number of working hours achieved in sheltered environment during the 6 months following the two programs (reported to the working time planned by the contract of employment)
   2. the duration of such employments in sheltered areas.

4. Estimating the impact of RECOS on the neuropsychological variables, the symptomatology, the consciousness of the disorders(insight), the quality of life and the social autonomy before the treatment (month M0), at the end of the treatment (month M3), and 6 months later (month M9), and looking for a correlation between the improvement of these parameters and sheltered employment.

5. Estimating the impact of cognitive remediation on integration in sheltered employment.

Inclusion Criteria:

• Age from 18 to 50 years.
• Schizophrenia according to the criteria of the DSM-IV-TR.
• Project of entry to ESAT or to EA in the 6 weeks which follow.
• IQ > 70 (F-NART).
• Stable symptomatology during the month preceding the inclusion.
• Psychotropic treatment unchanged during the month preceding the inclusion (change no more than 25 % posology).
• Overdrawn performances in at least one of the 6 functions estimated by the kit of neuropsychological tests.
• French mother tongue.
• Informed and signed consent by the patient.
• Agreement of the guardian (for protected adults).
• Membership in a national insurance scheme.

Exclusion Criteria:

• Dependence and recent abuses of cannabis (> 2 / week) or in any other substance (according to the criteria of the DSM-IV-TR), except tobacco.
• Neurological disorders of vascular, infectious or neurodegenerative origin; dyschromatopsie.
• Taking of medicine with somatic tropism having a cerebral or psychic impact (eg: corticoids).
• Simultaneous participation to any other program of remediation targeting the neurocognitive deficits.
• Resistance to neuroleptic.
• Reading and writing not acquired.