Cognitive Remediation Program for Family Caregivers in Schizophrenia

Context and justification It has been shown that when patient's family commits to a psycho-educational programme, the relapse rate of the patients themselves is halved to an equivalent level to that of drug treatment. Cognitive disorders affect 80% of patients with schizophrenia and have deleterious consequences on their autonomy and daily functioning. Cognitive remediation has now clearly demonstrated its effectiveness in the management of these cognitive disorders, particularly with regard to compensatory approaches that aim modifying the environment and providing external support. However, access to cognitive remediation remains extremely limited. It is only available in a limited number of specialized centres. In order to allow a better access to these cognitive remediation methods and to maintain its effects over time, the objective of this research project is to develop a web-based intervention, the Cognitive Adaptative Training for Caregivers ("CAT famille"), aimed at accompanying and guiding family carers via an internet video chat with a psychologist to implement cognitive remediation techniques of compensatory approach directly into their sick relative living home. Main and secondary objectives The main objective is to evaluate the impact of a web-based intervention aimed at training a family caregiver in cognitive remediation techniques using a compensatory approach on the daily life functioning of his/her family member suffering from schizophrenia. Secondary objectives are to assess improvement in: 1) caregiver burden, 2) caregiver and patient quality of life, 3) negative symptoms, and 4) patient compliance. Methodology This is a comparative, prospective, randomized study including two groups of (patient/caregiver) dyads: 1) an intervention group consisting of a (patient + family carer) dyad benefiting, in addition to the usual treatment, from the intervention for the family carer, and 2) a group consisting of a (patient + caregiver) dyad with usual care (control group). Control group: Psycho-education manual, with a weekly reading module and a 15-minute webcam feedback by the psychologist. Intervention group: Family CAT manual, with a module each week to be read according to the patient's objectives and a 15-minute webcam feedback by the psychologist. For all groups: Before intervention: Neuropsychological assessment + home assessment of the environment and the performance of daily living activities by psychologist A. After intervention: Home assessment of the environment and the performance of daily living activities by psychologist B. The inclusion criteria are: 1) for patients: patients with schizophrenia, aged 18 to 50, who can read, understand and speak French, 2) for parents: understand, speak and read French. The main outcome will be the assessment of the patient's daily life functioning as measured by the Life Skills Profile. Process: Total number of visits and follow-up: 3 visits during a prospective follow-up over 10 months Duration of inclusions: 18 months and duration of statistical analysis/valuation: 3-6 months Feasibility: The University Service of Adult Psychiatry of the University Hospital of Montpellier is one of the schizophrenia expert centres of the Fondamental network. SUPA has proven expertise in the field of cognitive remediation (see PRME Grecco in progress). SUPA works in collaboration with the family carers of people diagnosed with schizophrenia, in particular through the Profamille program (psychoeducation for carers) and UNAFAM. Outcomes / Perspectives: The management of cognitive disorders is essential in the care of patients with schizophrenia, in combination with other types of therapies. This research, aimed at training family carers in the use of compensatory cognitive remediation techniques that require little knowledge of neuropsychology, will be of direct benefit to patients. The expected results will contribute to the optimization of management by demonstrating that intervention and training of relatives in compensatory cognitive techniques will improve functional autonomy.