Larissa Campagna Martini

A 6-month randomized controlled trial to test the efficacy of a lifestyle intervention for weight gain management in schizophrenia

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

The effectiveness of a non-pharmacological intervention for weight gain management in severe mental disorders: results from a national multicentric study

OBJECTIVE To evaluate the effectiveness of a non-pharmacological intervention for weight gain management in severe mental disorders. METHOD An open, multicentre interventional study was conducted in 93 mental health services. Patients concerned with weight gain were included in this study and received a 12-week 1-hour group intervention focused on nutrition counseling, lifestyle, physical activity and self-esteem. Weight, waist circumference and blood pressure were measured before and after the intervention. RESULTS 1,071 patients were enrolled in the study, and 73.9% completed the 12-week intervention. Significant weight loss (Mean difference: 0.41, CI 95%: 0.18 to 0.64, p = 0.001) and a significant BMI reduction (Mean difference: 0.13, CI 95%: 0.04 to 0.22, p = 0.006) were observed. During the intervention 37 (4.4%) patients lost > 7% of their initial weight, 780 (92.5%) maintained their weight, and 26 (3.1%) of the patients had a meaningful weight gain (> 7%). There was a significant increase in the proportion of patients undertaking physical activity after the intervention (70.8%, p < 0.001). CONCLUSION In this 3-month open study we found a small weight and waist reduction, and increased physical activity practice, suggesting a trend towards anthropometric profile improvement. However, further randomized-controlled trials are necessary to evaluate the efficacy and clinical relevance of this psychosocial intervention for weight gain.

Adaptação cultural, validade e confiabilidade da versão brasileira do Inventário de Habilidades de Vida Independente: versão do paciente (ILSS-BR/P), na esquizofrenia

CONTEXTO: Existe uma forte associacao entre um bom funcionamento psicossocial e a habilidade de realizar tarefas diarias em pacientes com esquizofrenia. Instrumentos validos tornam-se cada vez mais necessarios para avaliar o desempenho desses pacientes nas atividades de vida independente. OBJETIVO: Avaliar as propriedades psicometricas do Inventario de Habilidades de Vida Independente - versao do paciente (ILSS-BR/P) em portadores de esquizofrenia. METODOS: Confiabilidade foi avaliada pelo teste-reteste, entre observadores e consistencia interna. Alem disso, a validade de construto, discriminante e concorrente, foi avaliada. RESULTADOS: Cinquenta pacientes foram incluidos no estudo entre observadores, com 64,4% de concordância entre as respostas e uma variacao de 0,80-0,99 do Coeficiente de Correlacao Intraclasses (ICC). Quarenta e seis pacientes participaram do teste-reteste, e o ICC variou de 0,84-0,94, com 44,3% de concordância. A consistencia interna apresentou bom resultado (0,23-0,98). Cento e sessenta pacientes participaram da validacao. Na validade discriminante, as mulheres apresentaram desempenho superior no escore global e em cinco subescalas quando comparadas aos homens. A validade concorrente confirmou a especificidade das dimensoes da escala, comparando a ILSS com a PANSS, Calgary, CGI, GAF, WHOQOL e Autoestima de Rosemberg. CONCLUSAO: A ILSS-BR/P e um instrumento de pesquisa valido e confiavel para avaliar o funcionamento social desses pacientes.

Intervenções não farmacológicas para manejo do ganho de peso em pacientes com esquizofrenia em uso de antipsicóticos

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 institutions reality.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 institutions reality.

Validação da Recovery Assessment Scale (RAS) no Brasil para avaliar a capacidade de superação das pessoas com esquizofrenia

Objetivo Adaptar para o Brasil e investigar a confiabilidade e validade da Recovery Assessment Scale (RAS) em pessoas com esquizofrenia. Metodos Etapa 1 – foi realizada traducao profissional para o portugues, adaptacao e retrotraducao da RAS. Etapa 2 – estudo-piloto em um grupo de 12 pessoas com esquizofrenia para garantir compreensao dos itens da escala. Etapa 3 – As pessoas com esquizofrenia (N = 104) foram submetidas a versao brasileira da RAS e a instrumentos de funcionalidade, qualidade de vida e sintomas para busca de evidencias de validade. Resultados Os resultados revelaram bons indices de consistencia interna e de precisao teste e reteste dos instrumentos. Foram estabelecidas evidencias 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 depressao [Calgary (r = -0,27; p < 0,01)]. A analise fatorial exploratoria revelou seis fatores, sendo quatro destes similares a estudos previos. Conclusao A partir deste estudo, considerou-se que a palavra “superacao” reflete melhor o conceito de “recovery”. A versao brasileira da escala RAS e um instrumento valido e reprodutivel para aferir a capacidade de “superacao” das pessoas com esquizofrenia.

Psychometric properties of the Brazilian version of the Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI-A)

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 (Cronbachs 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.

Schizophrenia and work: aspects related to job acquisition in a follow-up study

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.