Schizophrenia, affecting 1% of the population, is a persistent disorder characterized by varied symptoms. Antipsychotic medications effectively address positive symptoms (delusions, hallucinations) and relapse but have limited impact on negative symptoms (e.g., blunted affect, anhedonia) and cognitive impairment. These dimensions significantly influence social functioning and quality of life. Combining non-pharmacological approaches like Cognitive Remediation (CR) and psychosocial rehabilitation alongside antipsychotic drugs is recommended to enhance overall functioning and quality of life. Current CR programs show moderate effectiveness due to patient commitment issues. However, completed programs demonstrate higher efficacy. Real-life applicability of these programs lacks sufficient data. We propose musical learning for cognitive remediation due to its established cognitive benefits in the general population, targeting executive functions, working memory, attention, and inhibition. These functions are specifically impaired in schizophrenia and thus are relevant for remediation. Though unexplored in schizophrenia, music learning seems promising due to its motivational and pleasurable aspects for long-term commitment and its transferability through embodied and situated dimensions. A pilot study (ARCoS-1) on CR by musical learning demonstrated feasibility and preliminary positive results on cognitive and negative symptoms. This project aims to assess this method's effectiveness on a larger scale. Our hypothesis posits that musical learning offers an efficient and well-received medium for CR in patients with schizophrenia.
Patient with a diagnosis of schizophrenia or schizoaffective disorder (DSM-5 TR criteria)
Clinically stable (no full-time hospitalization related to schizophrenia for 3 months)
Regular psychiatric follow-up
Enrolled in at least 1 therapeutic or social out-of-home activity
Patient with moderate to severe intellectual disability (clinical criteria)
Engaged in a Social rythmic or musical activity
Presenting an addictive comorbidity (excluding tobacco addiction and behavioural addictions)
Presenting a neurological pathology with cognitive impact
Parallel
"Diapason & Metronome" musical learning
Other interventionParticipants will make music with the two instruments we all have in common: the voice and the body. The method is three-dimensional built on: rhythm, simple sound and harmony. The music sessions will take place in the same place and on the same day of the week, at a fixed time to establish a regularity that is suitable to this population. The courses will be taught in a cultural location, both to give meaning to the approach on a contextual level and to allow patients to be in the city and not in the hospital. A training of the music teachers will be planned before the beginning of the study. This training combined with regular debriefings during the music sessions, should ensure that the teachers' practices are consistent across the different groups.
attention capacity
The primary endpoint will be to compare treated and control groups on the change from baseline to M6 (evaluation at the end of the remediation phase) of the D2-R scale score. D2-R scale (Brickenkamp, R. et al, 2015) is a paper-and-pencil test that provides a fine-tuned measure of selective and sustained attention. The test requires the subject to identify and cross out target characters (d with 2 dashes) from a large number of distractor characters. It therefore requires concentrated and sustained visual attention, and mobilises inhibitory control. There are three indicators of the strategy employed and the evolution of concentration: * CC - concentration capacity or concentration performance * CCT - work rhythm or processing speed * E% - processing precision --\> the higher the score for each category, the better the attention capacity is
Attentional deficits at 3 months after the start of the remediation (M3) and at 3 months post-remediation (M9)
Change from baseline to M3 and M9 (evaluation at 3 month of the remediation phase) of the D2-R scale score D2-R scale (Brickenkamp, R. et al, 2015) is a paper-and-pencil test that provides a fine-tuned measure of selective and sustained attention. The test requires the subject to identify and cross out target characters (d with 2 dashes) from a large number of distractor characters. It therefore requires concentrated and sustained visual attention, and mobilises inhibitory control. There are three indicators of the strategy employed and the evolution of concentration: * CC - concentration capacity or concentration performance * CCT - work rhythm or processing speed * E% - processing precision --\> the higher the score for each category, the better the attention capacity is
Attentional phasic alert at 3 months after the start of remediation (M3), at the end of the remediation phase (M6) and at 3 months post-remediation (M9).
Change in attention abilities evaluated by the results obtained in the phasic alert test of the TAP, from baseline to M3, M6 and M9. TAP = Test of Attentional Performance is a computer-based battery for assessing attention. The phasic alert test : refers to a state of general arousal that allows for quick and appropriate responses to stimuli. It is an indispensable condition for effective behavior and constitutes, from this point of view, a basis for all attentional performances. Reaction times (RT) are examined under two conditions. The first concerns the evaluation of simple RT: a cross appears in the center of the screen after randomly varying inter-stimulus intervals, and the subject must react as quickly as possible by pressing a response key. In this condition, intrinsic alertness is measured. In the second condition, RTs are measured as responses to the same cross but this time preceded by a (auditory) stimulus. --\> The lowest the RT, the better is the attention ability
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