BackgroundPatients with schizophrenia have lower longevity than the general population as a consequence of a combination of risk factors connected to the disease, lifestyle and the use of medications, which are related to weight gain.MethodsA multicentric, randomized, controlled-trial was conducted to test the efficacy of a 12-week group Lifestyle Wellness Program (LWP). The program consists of a one-hour weekly session to discuss topics like dietary choices, lifestyle, physical activity and self-esteem with patients and their relatives. Patients were randomized into two groups: standard care (SC) and standard care plus intervention (LWP). Primary outcome was defined as the weight and body mass index (BMI).Results160 patients participated in the study (81 in the intervention group and 79 in the SC group). On an intent to treat analysis, after three months the patients in the intervention group presented a decrease of 0.48 kg (CI 95% -0.65 to 1.13) while the standard care group showed an increase of 0.48 kg (CI 95% 0.13 to 0.83; p=0.055). At six-month follow-up, there was a significant weight decrease of −1.15 kg, (CI 95% -2.11 to 0.19) in the intervention group compared to a weight increase in the standard care group (+0.5 kg, CI 95% -0.42–1.42, p=0.017).ConclusionIn conclusion, this was a multicentric randomized clinical trial with a lifestyle intervention for individuals with schizophrenia, where the intervention group maintained weight and presented a tendency to decrease weight after 6 months. It is reasonable to suppose that lifestyle interventions may be important long-term strategies to avoid the tendency of these individuals to increase weight.Clinicaltrials.gov identifierNCT01368406

(peso: diferença da média: 0,41, IC 95%: 0,64, p = 0,001; índice de massa corporal: diferença da média: 0,13, IC 95%: 0,22, p = 0,006

Objective:Work is considered one of the main forms of social organization; however, few individuals with schizophrenia find work opportunities. The purpose of this study was to evaluate the relationship between schizophrenia symptoms and job acquisition.Method:Fifty-three individuals diagnosed with schizophrenia from an outpatient treatment facility were included in an 18-month follow-up study. After enrollment, they participated in a prevocational training group. At the end of training (baseline) and 18 months later, sociodemographic, clinical data and occupational history were collected. Positive and negative symptoms (Positive and Negative Syndrome Scale – PANSS), depression (Calgary Depression Scale), disease severity (Clinical Global Impression – CGI), functionality (Global Assessment of Functioning – GAF), personal and social performance (Personal and Social Performance – PSP) and cognitive functions (Measurement and Treatment Research to Improve Cognition in Schizophrenia – MATRICS battery) were applied at baseline and at the end of the study.Results:Those with some previous work experience (n=19) presented lower scores on the PANSS, Calgary, GAF, CGI and PSP scales (p < 0.05) than those who did not work. Among those who worked, there was a slight worsening in positive symptoms (positive PANSS).Conclusions:Individuals with less severe symptoms were more able to find employment. Positive symptom changes do not seem to affect participation at work; however, this calls for discussion about the importance of employment support.

Background: There is a strong association between good psychosocial functioning and the ability to carry out everyday tasks in patients with schizophrenia. Valid instruments become increasingly necessary to evaluate the performance of these patients in independent living activities. Objective: To adapt and assess the psychometric properties of the Brazilian version of the Independent Living Skills Survey (ILSS-BR/P) in patients with schizophrenia. Methods: Reliability was assessed with test-retest, interrater and internal consistency. Furthermore, construct, discriminant and concurrent validity were assessed. Results: Fifty patients were included in the interrater study, with an agreement of 64.4% between responses and an Intraclass Correlation (ICC) ranged from 0.80-0.99. Forty-six patients participated in the test-retest, with an ICC ranged from 0.84-0.94 and an agreement of 44.3%. The internal consistency was good (0.23-0.98). Hundred and sixty patients participated in the validation. Regarding to the discriminant validity, female patients presented a higher performance in the overall score and five subscales compared with men. The concurrent validity confirmed the specificity of the dimensions of the scale, comparing the ILSS with the PANSS, Calgary, CGI, GAF, WHOQOL and the Rosenberg Self-Esteem. Discussion: The ILSS-BR/P is a valid and reliable research instrument to assess social functioning in patients with schizophrenia.

Objective: Sleep disturbances play a fundamental role in the pathophysiology posttraumatic stress disorder (PTSD), and are not only a secondary feature. The aim of this study was to validate and assess the psychometric properties of the Brazilian version of the Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI-A-BR), a self-report instrument designed to assess the frequency of seven disruptive nocturnal behaviors, in a sample of participants with and without PTSD. Methods: PSQI-A was translated into Brazilian Portuguese and applied to a convenience sample of 190 volunteers, with and without PTSD, who had sought treatment for the consequences of a traumatic event.Results: The PSQI-A-BR displayed satisfactory internal consistency (Cronbach's coefficient of 0.83 between all items) and convergent validity with the Clinician Administered PTSD Scale (CAPS), even when excluding sleep-related items (r = 0.52). Test-retest yielded high agreement in the global PSQI-A-BR, with good stability over time (r = 0.88). A global PSQI-A-BR cutoff score of 7 yielded a sensitivity of 79%, specificity of 64%, and a global score of 7 yielded a positive predictive value of 93% for discriminating participants with PTSD from those without PTSD. Conclusion:The PSQI-A-BR is a valid instrument for PTSD assessment, applicable to both clinical and research settings.

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RESUMOObjetivo: Adaptar para o Brasil e investigar a confiabilidade e validade da Recovery Assessment Scale (RAS) em pessoas com esquizofrenia. Métodos: Etapa 1 -foi realizada tradução profissional para o português, adaptação e retrotradução da RAS. Etapa 2 -estudo-piloto em um grupo de 12 pessoas com esquizofrenia para garantir compreensão dos itens da escala. Etapa 3 -As pessoas com esquizofrenia (N = 104) foram submetidas à versão brasileira da RAS e a instrumentos de funcionalidade, qualidade de vida e sintomas para busca de evidências de validade. Resultados: Os resultados revelaram bons índices de consistência interna e de precisão teste e reteste dos instrumentos. Foram estabelecidas evidências de validade convergente entre a RAS e medidas de qualidade de vida (r = 0,58; p < 0,001), funcionamento ocupacional (r = 0,40; p < 0,001), habilidades de vida independente (r = 0,24; p < 0,02), gravidade (CGI, r = -0,31; p < 0,003) sintomas da esquizofrenia: PANSS total (r = -0,21; p < 0,05), PANSS negativa (r = -0,28; p < 0.007), PANSS positiva (r = -0.08; p = 0,437)] e depressão [Calgary (r = -0,27; p < 0,01)]. A análise fatorial exploratória revelou seis fatores, sendo quatro destes similares a estudos prévios. Conclusão: A partir deste estudo, considerou-se que a palavra "superação" reflete melhor o conceito de "recovery". A versão brasileira da escala RAS é um instrumento válido e reprodutível para aferir a capacidade de "superação" das pessoas com esquizofrenia. ABSTRACTObjective: To adapt and investigate the validity reliability study of the Brazilian version of the Recovery Assessment Scale-RAS in people with schizophrenia. Methods: Stage 1 -professional translation to Portuguese, adaptation, and back-translation of the RAS; Stage 2 -RAS was presented to 12 outpatients with schizophrenia to evaluate if they would be able to understand and respond to the instrument; Stage 3 -patients with schizophrenia (n = 104) were assessed with the Brazilian version of the RAS, functional outcomes measures, quality of life and symptoms scales. Results: Results showed good internal consistency and retest reliability, and convergent validity between the RAS and quality of life measures (r = 0.58;

ResumoIntrodução: Pacientes com esquizofrenia têm maior prevalência de obesidade em comparação à população geral. Esse fato está relacionado a uma alimentação inadequada, ao sedentarismo e ao uso de antipsicóticos. O aumento da obesidade associa-se a diversos distúrbios metabólicos, como o diabetes melito. As intervenções para prevenção e controle do ganho de peso são necessárias nessa população, em especial as intervenções não farmacológicas. Objetivo: Revisar os estudos sobre intervenções não farmacológicas para prevenção e controle do ganho de peso em pacientes com esquizofrenia. Métodos: Foram encontrados oito estudos controlados e quatro não controlados sobre intervenções não farmacológicas. Foi feita uma revisão sobre a metodologia e os fatores positivos e limitações dos estudos. Conclusões: As intervenções não farmacológicas parecem ter um efeito importante em termos de prevenção e controle do ganho de peso e, portanto, devem ser incentivadas e adaptadas à realidade dos pacientes e serviços de saúde. Arq Bras Endocrinol Metab. 2009;53(4):391-8. DescritoresGanho de peso; esquizofrenia; antipsicóticos; atividade física; nutrição AbstRAct Introduction: Schizophrenic patients have a higher prevalence of obesity than the general population. There are several factors implicated in weight gain, including poor dietary conditions, sedentary lifestyle and antipsychotic drugs use. Obesity is also associated with metabolic disturbances such as diabetes mellitus. Weight gain interventions are necessary in this population, especially non-pharmacological interventions. Objective: To review the non-pharmacological interventions for weight gain management in patients with schizophrenia. Methods: Eight clinical trials and four open-label studies using these interventions were found. The methodology, strength and limitations of the studies were reviewed. Conclusions: Non-pharmacological interventions seem to have an important effect on weight gain prevention and control, and should be encouraged and adapted to patients and in mental health institution's reality. Arq Bras