[Clinical management and rehabilitation of the treatment refractory patient: conceptual foundations and outcome data]. / Gestion clinique et réhabilitation du patient souffrant de schizophrénie et réfractaire au traitement: fondements conceptuels et résultats (première partie).

Despite advances in psychopharmacology for people with schizophrenia, many patients remain too disabled to be discharged from public psychiatric facilities. This paper describes the development of a public-private partnership which led to the creation of a specialized, intensive behavioral rehabilitation program for schizophrenia patients who were considered to be treatment-refractory at public hospitals. The essential elements of this treatment program are described, along with the philosophical bases of its treatment. Outcome data are discussed to emphasize the point that when evidence-based treatment is implemented with this population, outcomes can be positive in most cases, and therefore, the number of "treatment-refractory" patients is actually less than is estimated based on response to medication alone.

[Interpersonal techniques for optimizing positive outcomes in the inpatient psychiatric rehabilitation of schizophrenia]. / Techniques interpersonnelles pour optimiser les résultats positifs de la réhabilitation psychiatrique (deuxième partie).

There now exist a number of milieu-based and group-based behavioral treatments that have demonstrated effectiveness with so-called "treatment-refractory" schizophrenia patients. These interventions are not likely to achieve their maximal impact, however, unless program staff consistently employ behavioral principles in their moment-to-moment interactions with patients throughout the day. In this paper we describe a number of interpersonal techniques that are effective in dealing with a variety of institutionalized/dependent and provocative/aggressive behaviors. Each technique is explained and detailed examples are given to demonstrate appropriate and inappropriate staff responses to patient behavior. The discussion ends with the description of a successful behavior contract that employed a number of these techniques.

[Techniques for improving attentiveness and treatment engagement among "treatment refractory" schizophrenia patients with severe cognitive impairment]. / Techniques pour améliorer l'attention et l'engagement dans le traitement des patients souffrant de schizophrénie avec de graves déficits cognitifs (troisième partie).

While many effective group-based psychiatric rehabilitation interventions now exist, many severely disabled patients are unable to benefit from them due to a reduced ability to pay attention in group sessions. Moreover, inattentiveness can be due to one or more of multiple factors, including a sustained attention deficit, poor motivation, sedating side effects of medication, and the interfering effects of hallucinations and disturbing thoughts. Existing cognitive rehabilitation interventions for schizophrenia typically do not address these factors, instead targeting higher level functions such as memory, learning, problem-solving, and executive functioning. In this paper, we describe techniques for promoting attentiveness and treatment engagement among severely disabled "treatment-refractory" patients. This includes both individual and group-based interventions.

[Cognitive rehabilitation of schizophrenia: a pragmatic approach of the integration process to battle against refractory symptoms]. / Réhabilitation cognitive de la schizophrénie: une approche pragmatique du processus d'intégration pour lutter contre les symptômes réfractaires.

Classical approaches of treatment of people with schizophrenia recognize that successful treatment of this illness requires more than simply reducing the frequency, intensity and duration of positive symptoms such as hallucinations. In fact, a more comprehensive approach aimed at reducing disability is indicated in most cases. It has recently been proposed that new approaches to the cognitive rehabilitation of schizophrenia need to recognize the importance of 1) systematically addressing motivation, self-esteem, and affective factors when designing cognition enhancing interventions ; 2) the need to move beyond one-size-fits-all interventions and develop individual-specific treatments ; and 3) the need to address abnormalities in the experience of the self when designing interventions to optimize cognitive and behavioural performance. The case study presented here is an example of a cognitive rehabilitation approach of schizophrenia that attempts to promote the self integration process by means of a range of specific interventions and addresses three issues noted above. Preliminary results suggest that it could be very beneficial for patients suffering of schizophrenia.