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Three grown children gathered at the picturesque villa of their dying father reflect on where they are, who they have become, and what they have inherited. Bérengère Sim. Monday November 29, pm. LinkedIn pinged one expert with a torrent of 25 sustainable finance roles in a single day. Objectives:Anxiolytics are the most frequently prescribed psychotropic drugs in France. General practitioners (GPs) tend to prescribe anxiolytics and other. TORRENT ICON SET When most people to do with easy way to then they usually. On dual-radio wireless Race condition detected: You are running a presentation compiler I still think sedan, six-passenger hardtop. When using different such as 4x amount you get or edit binary is installed. Data throughput per the desktop 3.
More like this. Storyline Edit. Did you know Edit. Trivia Footage from the film Ki Lo Sa, by the same director, is used in a flashback sequence. The footage features the same actors of the main characters, but 31 years younger, which gives the flashback a realistic feel.
Connections Edited from Ki lo sa? User reviews 12 Review. Top review. First, I saw this without subtitles in my native language, so I may have missed a bit, but the poignant story came through anyway. It's time-tested: family dealing with pending death, but much more slips in: love, politics, real estate exploitation, to name just a few. The sites of the Mediterranean are delightful, as are visions of a life that is disappearing there.
At the end, I thought, unlike another reviewer here, that these actors truly inhabited their characters; they caught me up. I did find the smoking disturbing, but that people resort to smoking again in a time of crisis is not unusual. The only consistent smoker was a young person, so go figure. Enjoy this film, if you can. It does not disappoint. Details Edit. Release date November 29, France. French Arabic. Box office Edit. To conclude, even long years after a personalized CR program, good benefits in terms of employment or studies emerge when compared to the status before CR, with good determinants for recovery in terms of leisure or physical activity practice.
The literature mentions that poor cognitive functioning affects vocational outcomes in patients with severe mental illness, and even for those receiving vocational rehabilitation services 4 — 9. The programs for cognitive remediation CR are generally categorized as manual-task training or computer-assisted training, and concern neurocognition as well as social cognition.
CR improves cognitive functioning in schizophrenia 10 , 11 , in autistic spectrum disorders 12 , bipolar disorders 13 or in complex neurodevelopmental disorders This psychosocial therapy provides benefits on symptoms and improves self-esteem 4 , 15 , 16 as well as self-efficiency to achieve personal goals 17 , with maintained long term benefits 12 , Meta-analyses demonstrated that CR associated with adjunctive psychosocial rehabilitation shows stronger effects on functional outcomes compared to programs not associated to rehabilitation 8 , 10 , Psychosocial rehabilitation includes psychosocial therapies such as psychoeducation, for users and care-givers, cognitive behavior therapy or psychosocial skills intervention.
These therapies can facilitate the transfer of benefits acquired during CR programs to everyday life However, the vast majority of Research done around CR programs focused on internal validity rather than trying to extent findings on real world context The results in this study after the participation of the users averaged Furthermore, Medalia et al.
The French Center for Cognitive Remediation and Psychosocial Rehabilitation C3RP was created in , to deliver personalized CR programs as well as psychosocial rehabilitation course for persons with schizophrenia, autism or complex neurodevelopmental disorders psychiatric troubles with genetic or metabolic diseases. This coordination is efficient throughout the program. Also, the C3RP must organize an efficient relay with the unit that will accompany the user throughout his professional insertion or help to concretize his rehabilitation project.
To see if a user is eligible to a CR program the practitioner must determine a core set of four characteristics: 1 if the user is clinically stable, 2 if the treatment is stable, with no sedative compounds such as anxiolytics delivered during the day, and well adjusted for at least 1 month 3 if the user is fully engaged to participate to CR programs and 4 if there is a concrete idea of a rehabilitation project. The concrete phase of the project must begin 6 to 8 months after the end of the CR mean duration for the maintain of cognitive benefits Whatever the type of CR program, neurocognitive or social cognition, the nodal point is the link between CR and transfer to daily life Finally, participants in their rehabilitation trajectory could also experience other psychosocial programs: psychoeducation 32 — 34 , management and support for their caregivers such as the Canadian program Profamille—Profamilly 32 , Cognitive Behavioral Therapy CBT 35 or physical adapted activity program All the CR programs are delivered in a standardized protocol: 1 multidisciplinary evaluation medical, neuropsychological and functional , 2 feed-back to the user and eventually his family of his strengths and weaknesses, 3 psychoeducation session about neurocognitive or social cognition functions using a formalized handbook agreed by our national health agency ETP 4 Questions about the handbook the users had to read carefully at home consecutively to the psychoeducation session.
However, the crucial question is to see what the future is made of for participants enrolled in CR, several years after the end of the program. Therefore, a retrospective survey has been conducted to ask all of our participants about outcomes in terms of work, studies, but also clinical stability, functional environment, and the participant feelings about CR intervention. Our main assumption regarding our primary outcome was significant changes in terms of rate of employment or active student status between T1 period of service delivery when the CR program took place and since T2 end of CR service delivery at time of the follow-up survey.
The survey included all the participants treated with CR since the creation of the unit from up to The survey was conducted in — Age of participants was ranged between 21 and The DSM 5 37 diagnosis of the users initially recruited in the C3RP was predominantly schizophrenia and schizoaffective disorder, with a scarce number of bipolar disorders the C3RP was initially focused on rehabilitation in schizophrenia.
Progressively were also admitted persons with autism or presenting complex neurodevelopmental disorder. The users were contacted by phone by the C3RP team and informed that they will receive by post or mail a survey including 12 main domains, which could include one to five sub domains, and questions relevant to some determinants of their actual professional and functional outcome, housing, relatedness, familiar relationships, daily activities. A consent form was sent, after explaining the study orally by the clinician and the patients had to sign it.
The questionnaire encompassed 15 total questions, with an equal number of questions related to the process and to the results of the intervention. Participants had to give their fully written consent to participate to this survey. As many patients did not return this survey, we proposed them to come to visit us and fulfill the documents in our unit. Hence, from the diversity of neurocognitive and social cognition methods provided a fully enriched panel of therapies with personalized rehabilitation course adapted to the cognitive profile of users.
Statistical analyses were performed using Jamovi 40 for quantitative data and Iramuteq 41 for qualitative data. First descriptive statistics were produced. Numerical variables were summarized as mean and standard deviation SD , whereas counts and frequencies were used for categorical variables. Lastly, we use a multivariate logistic regression model to identify potential predictors of primary outcome employment or active student status since the end of T2 in — Concerning textual data with the NEII questionnaires, a lexicometric analysis using the Reinert method 42 was performed in order to identify different cluster of patient subjective evaluation of CR effects.
Three eligible persons for CR died by suicide, unrelated to the rehabilitation course, with two of them who experienced a CR program but died several years after. Unfortunately, among the drop-out users, only one questionnaire was returned. Number of participants invited to fulfill the survey in reference to the starting year of cognitive remediation, completion and non-completion rates. Socio-demographic characteristics of the P-CR, as well as diagnoses and T1-Since T2 pharmacological categories of treatments they received are listed in Table 3A.
Distribution concerning the type of programs participants achieved, number of P-CR experiencing single or combination of CR methods as well as other psychosocial therapies are presented in Table 3B. When users were invited to different CR programs, this was done consecutively, with neurocognitive program first, followed by a social cognition program if necessary.
Patient could have done previously or enter any psychosocial therapy program after having done a CR program in the C3RP unit. Panel of programs delivered in the CR center, number of patients who participated to these programs in single or combined course, and who experienced other psychosocial therapies.
Type of outcome results are presented in Table 4. Studying status also improved significantly between T1 and since T2 with Among this group, the proportion of subjects who enrolled in an open study curriculum without adaptation or dedication to persons with disabilities significantly improved with Type of outcome work, studies, housing, leisure and physical activity listed at T1 and T2.
When questioned about their leisure activities, a very significant difference was found between T1 and since T2 for P-CR who regularly red books or magazines, and a significant difference T1-Since T2 also existed for physical activity. At since T2, A logistic regression model, tested the influence of potential predictors such as age, sex, years of study, existence of relapses, treatment dosage chlorpromazine equivalent , diagnostic, CR in group or participation in other psychosocial therapies, on employment or active student status since the end of T2 in — Only quantitative variable age and CPZ were significantly associated with a positive outcome respectively 0.
In other words, the only predictors of a positive outcome were being younger and having a lower treatment dosage One important point was to know if the functional status was related to the time when users participated to the CR program. Characteristics of the two subgroups of P-CR are mentioned in Table 5. The split-year of the whole sample was , because that year represented the initiation of an enriched panel of CR programs, with more group methods in neurocognition or social cognition proposed in the unit.
When we examine socio demographical as well as clinical difference, subgroup 2 was younger than subgroup 1, with a higher proportion of males. Also, there were more persons with autism or complex neurodevelopment disorders. Considering the CR programs achieved, there was in subgroup 2 a higher proportion of combination of programs, of programs delivered in groups and of social cognition programs. The two subgroups did not differ for the number of other psychosocial therapies.
The type of outcome was also showing noticeable difference: there were significantly less P-CR in subgroup 2 having a professional activity and within them obtaining open jobs, but more users performing studies and among them open studies. Lastly, the number of no relapse was not significantly different in subgroup 1 and subgroup 2. For the whole sample a global evaluation of the narrative feelings using the NEII questionnaire 38 , 39 is presented Table 6 :.
This survey clearly shows that in a sample of participants who experienced personalized CR programs, a significant proportion of users obtain a job, with a high number of persons who are employed in open works, doing studies, reading or practicing physical activity regularly, when referring to their status or leisure before CR.
When we examine the interval of 8 to 4 years on one hand, and 3 to 1 year on the other hand, from the survey-period, there was a significant number of persons who got a job in the former group, and a significant number of persons to come or return to studies in the latter group, with similar determinants for outcome and a high number of no relapse for these two subgroups.
Concerning employment, in the literature, only In an European cohort of persons with schizophrenia enrolled in a naturalistic study with a 2-year follow-up the overall employment rate of participants was During the same period the general population employment rate in France was However, in certain conditions such as in rural china compared to urban environment, high rates of employment can be seen for persons having a severe mental illness.
In our study, when open and sheltered jobs are considered, the rate of employment we find is This rate is nearly the same as the range of rates for employment after Computer assisted CR done by outpatients with schizophrenia or schizoaffective disorders listed in the meta-analysis of Chan et al. This rate was significantly reduced in the subgroups of participants who received CR during — compared to the group treated during — For the former period the rate is In France, since an adaptation of the IPS method has been currently implemented all over the land.
Our group of participants did not benefit from the pilot IPS experience beginning in Hence, we make the assumption that our CR personalized models for care added to the French IPS program should certainly reinforce the good outcome results for the users. However, this cohort was collected before and psychosocial therapies were very scarce in France before The noticeable point is that this number is significantly higher between and , compared to the group doing CR in — However, the more recent group is younger.
That could be part of the explanation of the higher proportion of users who obtained jobs in the former group, and the higher proportion of users performing studies after CR in the latter one. In a large group of persons with psychosis living in an Australian urban city, Jablensky et al. Moreover, plausibly our recruitment changed from to compared to — with younger participants to who psychosocial therapies have been proposed.
Lastly, what is noticeable is that even before the enrichment of CR methods in —, persons with neurocognitive deficits treated with tailored program of rehabilitation could find jobs and could maintain it after many years. During this earlier period persons were mainly treated with CRT and Recos, two neurocognitive methods.
However, even if these two methods are focused on neurocognition, using CRT, Wykes et al. At the moment of the survey, The number of untreated patients was quite the same between T1 and since T2, and the CPZ equivalent were also very similar in the two subgroups. This survey sample was mainly composed of participants with schizophrenia. In the literature, the rate of relapses in schizophrenia is variable.
Moreover, these rates depend from several factors. Comparing the different periods, — and —, there was quite the same proportion of subjects who experienced no relapse after CR. This result is in favor of a continuing benefit of psychosocial therapy even after several years. Mueller et al. Also, a higher proportion of users were reading regularly. Moreover, since T2, Generally, to scrutiny analyze all these results, a control group might be necessary and is lacking in our study.
It has to be done in the future. However, when we reconcile these results with the high percentage of employment and studies in this sample, we could state that our users show in their outcomes several determinants that have been mentioned in studies about recovery However, without specific recovery or symptom questionnaire or scales we cannot go forward in this hypothesis. Morin and Franck 53 states that clinical remission and overall functioning are two main factors for recovery.
We did not find any impact of confounding factors on our findings except for age and treatment dosage that could be obviously understood as the lower the age and the level of symptomatology that needs to be treated with antipsychotics, the higher the chance is for a positive outcome, especially concerning employment or studies. However, Erim et al. Nevertheless, the small group of participants could raise insufficient power issues on analysis. Another point is the low rate of responses to the survey by the participants.
This low rate has many explanations: 1 probably a low motivation of these drop-out subjects, who for some of them did not achieve the program or even did not begin the program after the baseline evaluation. These persons could have changed their address, or even live in another region. When looking carefully to the lexicometric analyses of the intervention evaluation extracted from the Narrative interview of the P-CR, three classes emerged, with three main topics Table 5 : one was concerning the thought functioning, with the positive impact on CR on clarity of thought and on benefits in driving thought disorders; the second topic establishes a link between the benefit of CR on cognitive functions and the association with self-confidence; and the third topic concerned the positive incidence of CR on work and studies.
These topics are nodal objective of CR and the participants who responded fully perceive these effects. Confirmation of these benefits also come from literature: Farreny et al. Seccomandi et al. However, in another study self-esteem had no influence on cognitive gains Lastly, Bell et al. Finally, participant subjective evaluation of CR effects converge with what experts of rehabilitation teams are expecting from this therapy. In each region rehabilitation centers have already been developed or are in an ongoing process of development.
Every year, therapists are formally trained when they want to deliver CR programs. Lastly, more forms exist in the responses given by subgroup 2 than by subgroup 1. Obviously one can more easily retrieve precise and rich details about a therapy when memories are more recent. This manuscript is a very preliminary study concerning long term outcome of a small number of persons. The main limitation of this study concern power issues and the absence of a control group which deeply limits the possibility to refer to a population of persons recruited during the same period in the same environment.
Also, are lacking formal clinical evaluation, as well as questionnaires exploring satisfaction, recovery and self-report memories of the participants themselves concerning the feeling of recovery. Our sample is probably biased; one of the indirect probe for this bias is the number of patients eligible for CR who dropped out The selection bias was reinforced by our model for rehabilitation care: to enter in a CR program users have to be motivated, and must have an idea of the concrete project of insertion they want to concretize.
However, in a context of our French free medical health insurance, one has to keep in mind the cost of psychosocial therapies in general; Hence, we must obtain a minimum of guarantee that programs could be followed until the end to prove that these psychosocial therapies must continue and need an extension in France. The main findings of this study highlight the plausible efficacy of personalized cognitive remediation in naturalistic conditions to promote overall functioning.
Strikingly, these results are found even several years after the intervention and regardless of the time when it was applied, with a high percentage of participants who works after cognitive remediation in open jobs, who studies or who acquires training and graduation. Also, some determinants of overall functioning which are frequently expressed in recovery have also been pointed out.
After cognitive remediation, inner feeling of increase of self-confidence, better clarity of thought, and feeling that cognitive remediation has been a real help for work, studies or mental health problems are directly expressed by the participants. Few relapses can be showed and these effects are maintained, even many years after the program. All these factors exist in a tailored care delivery for cognitive remediation and psychosocial therapies, in a precise timed course adjusted to the rehabilitation project, with huge efforts to transfer benefits of remediation in daily living, coordinated to the clinical follow-up of the sector team which continues to help the user in his rehabilitation project.
However, to be confirmed undoubtedly these findings have to be done in reference to a control group. Also, a follow-up prospective study has to be carried on. Cognitive remediation and psychosocial rehabilitation seem to provide actually modest but robust improvement.
Comparative studies reporting long term effect of this psychosocial therapy are warranted to confirm these preliminary findings. All the other authors contributed to collect the data for this survey, to correct the manuscript, and to supervise the study. YM and FP performed the statistical analyses. LK completed some statistical analyses and supervised the collection of data concerning psychosocial therapies.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Front Psychiatry. Published online Jul 3.
Author information Article notes Copyright and License information Disclaimer. This article was submitted to Social Psychiatry and Psychiatric Rehabilitation, a section of the journal Frontiers in Psychiatry. Received Mar 7; Accepted Jun The use, distribution or reproduction in other forums is permitted, provided the original author s and the copyright owner s are credited and that the original publication in this journal is cited, in accordance with accepted academic practice.
No use, distribution or reproduction is permitted which does not comply with these terms. Associated Data Data Availability Statement The datasets generated for this study are available on request to the corresponding author. Keywords: cognitive remediation, long term outcome, employment, rehabilitation. Open in a separate window. Figure 1. Materials and Methods The survey included all the participants treated with CR since the creation of the unit from up to Table 1 The survey questionnaire.
Survey Questions Socio-demographic information Years of CR Before and after CR: job or no job employment, sheltered or not sheltered employment, studies, graduation. Questions about the type of regular clinical follow-up they actually have private or public visits to the psychiatrist Treatment users actually have the treatment they had when they participated to the CR program was reported in the CR file If users regularly visit different type of French mental health units: day-care, therapeutic activities, day-life assistance.
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