The use of cognitive-behavior therapy (CBT) in addition to antipsychotic regimen to treat persistent psychotic symptoms of schizophrenia is growing. The aim of this study was to compare the efficacy of CBT to a befriending (BF) control group in patients with schizophrenia who are refractory to clozapine. Twenty-one patients completed the 21-week trial. In comparison with the control group, the CBT group showed a significant improvement in the General Psychopathology and total score of the Positive and Negative Syndrome Scale, as well as an improvement of Quality of Life scale. The improvement in psychopathology persisted at 6-month follow-up assessment.

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Importance: The occupational goal intervention (OGI) method has been proven effective in improving executive function (EF) in people with schizophrenia, but it has not yet been tested with those with treatment-resistant schizophrenia (TRS). Objective: To test the efficacy of the OGI in people with TRS. Design: Single-blind randomized controlled trial. Setting: The Schizophrenia Program, Institute of Psychiatry, University of São Paulo General Hospital, Brazil. Participants: People with TRS according to Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria, ages 18 to 55. Outcomes and Measures: Primary outcome: improvement in EF as measured by the Behavioural Assessment of the Dysexecutive Syndrome (BADS). Secondary outcomes: improvement of functionality, as measured by the Direct Assessment of Functional Status–Revised (DAFS–BR), and improvement in autonomy in activities of daily living (ADLs), as measured by the Independent Living Skills Survey (ILSS–BR), administered to caregivers. The outcomes were measured at baseline, posttreatment, and follow-up. Intervention: Participants were divided into two groups: OGI and craft activities (control). Each group participated in 30 sessions during 15 wk, with follow-up at 6 mo postintervention. Results: The OGI group improved significantly compared with the control group, with medium to large effect sizes in posttreatment scores on the BADS and DAFS–BR. The ILSS–BR showed the highest effect sizes at posttreatment and follow-up. Conclusions and Relevance: The OGI method is effective for improving EF, occupational performance and ADLs in people with TRS. What This Article Adds: The OGI method is an important therapeutic tool for use in the occupational therapy clinic.

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Background: To investigate the objective and subjective burden on caregivers of schizophrenia outpatients and their associations with sociodemographic factors, symptomatology, and functioning. Methods: This study included 60 schizophrenic outpatients aged 18 to 65 years who were clinically stable for at least 6 months, and 60 caregivers aged 18 to 80 years who were in contact with the patient for ⩾30 hours/week. The patients were assessed using a sociodemographic questionnaire, the Clinical Global Impression Scale for Schizophrenia (CGI-SCH), and the Personal and Social Performance scale (PSP). The caregivers were assessed using a sociodemographic questionnaire and the Family Burden Interview Schedule, Brazilian version (FBIS-BR). Results: The objective burden was positively correlated with CGI-SCH cognitive symptom scores ( p = .032) and number of hours spent weekly with the patient ( p = .028), and negatively correlated with PSP score ( r = −.346, p = .007). The subjective burden showed a negative correlation with age of disease onset ( r = −.338, p = .08). The independent variables included in the regression model were family income ( p = .005), PSP score ( p = .009), patient marital status ( p = .012), patient gender ( p = .046), and reception of financial benefit ( p = .027) for objective burden; and disease duration ( p = .045) and father/mother or sibling relationship ( p = .001) for subjective burden. The coefficient of determination ( R2) of the linear regression model for objective burden was 39.4%; subjective burden, 21.6%. Conclusion: Caring for female, single patients with longer disease duration, more severe cognitive symptoms, impaired functioning, and more caregiving time required per week were associated with higher caregiver burden levels.