Rehabilitación integral en psiquiatría para la independencia física en pacientes esquizofrénicos hospitalizados / Comprehensive rehabilitation in psychiatry for physical independence in hospitalized schizophrenic patients

Introducción: La independencia física es cuando una persona no necesita de otra para realizar actividades de la vida diaria. La esquizofrenia está dentro de las 10 enfermedades más discapacitantes. Objetivo: Describir los cambios en la independencia física después de aplicado un programa de rehabilitación integral para el adulto esquizofrénico hospitalizado. Métodos: Investigación desarrollada entre el 20 de enero de 2018 y el 13 de febrero de 2022. Integró técnicas y procedimientos de la investigación cualitativa y cuantitativa. Se utilizó un grupo único. Fue aplicada la consulta a especialistas. Participaron 65 pacientes esquizofrénicos que tenían más de 6 meses de estadía hospitalaria, menos de 60 años y que no estaban en su fase aguda o brote. Se diseñó el programa y se aplicó en un periodo de 6 meses con la participación del equipo de salud mental, previa capacitación. Resultados: Después de aplicado el programa predominó la categoría independiente. Se logró mejoría cognitiva, afectiva, conductual, así como de los síntomas positivos y negativos. Se lograron cambios hacia niveles superiores de rehabilitación. Primaron los pacientes satisfechos con el tratamiento recibido. Los 10 especialistas consultados consideraron el programa viable. Conclusiones: El programa de rehabilitación integral para el adulto esquizofrénico hospitalizado, mejora la independencia física, favorece los cambios positivos y es factible de ser aplicado(AU)

Introduction: Physical independence is when a person does not need another person to carry out activities of daily living. Schizophrenia is among the 10 most disabling diseases. Objective: To describe the changes in physical independence after applying a comprehensive rehabilitation program for hospitalized schizophrenic adults. Methods: Research developed between January 20, 2018 and February 13, 2022. It integrated qualitative and quantitative research techniques and procedures. A single group was used. The consultation was applied to specialists. 65 schizophrenic patients participated who had been in hospital for more than 6 months, were less than 60 years old, and who were not in their acute phase or outbreak. The program was designed and applied over a period of 6 months with the participation of the mental health team, after training. Results: After the program was applied, the independent category predominated. Cognitive, affective, and behavioral improvement were achieved, as well as positive and negative symptoms. Changes were achieved towards higher levels of rehabilitation. Patients satisfied with the treatment received prevailed. The 10 specialists consulted considered the program viable. Conclusions: The comprehensive rehabilitation program for the hospitalized schizophrenic adult improves physical independence, promotes positive changes and is feasible to be applied(AU)

COVID-19 Transmission in a Psychiatric Long-Term Care Rehabilitation Facility: An Observational Study.

OBJECTIVE: To report the clinical characteristics and transmission rate of coronavirus disease 2019 (COVID-19) in a community inpatient long-term care psychiatric rehabilitation facility designed for persons with serious mental illness to provide insight into transmission and symptom patterns and emerging testing protocols, as well as medical complications and prognosis. METHODS: This study examined a cohort of 54 residents of a long-term care psychiatric rehabilitation program from March to April 2020. Baseline demographics, clinical diagnoses, and vital signs were examined to look for statistical differences between positive versus negative severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) groups. During the early phase of the pandemic, the facility closely followed the local shelter-in-place order (starting March 19, 2020) and symptom-based testing. RESULTS: Of the residents, the primary psychiatric diagnoses were schizoaffective disorder: 28 (51.9%), schizophrenia: 21 (38.9%), bipolar I disorder: 3 (5.5%), and unspecified psychotic disorder: 2 (3.7%). Forty (74%) of 54 residents tested positive for SARS-COV-2, with a doubling time of 3.9 days. There were no statistical differences between the positive SARS-COV-2 versus negative groups for age or race/ethnicity. Psychiatric and medical conditions were not significantly associated with contracting SARS-COV-2, with the exception of obesity (n = 17 [43%] positive vs n = 12 [86%] negative, P = .01). Medical monitoring of vital signs and symptoms did not lead to earlier detection. All of the residents completely recovered, with the last resident no longer showing any symptoms 24 days from the index case. CONCLUSION: Research is needed to determine optimal strategies for long-term care mental health settings that incorporate frequent testing and personal protective equipment use to prevent rapid transmission of SARS-COV-2.

Desire to Quit Smoking in an Outpatient Population of Persons with Serious Mental Illness.

National survey data indicates that about 32% of adults with any mental illness smoke, compared with 23% of adults without a psychiatric disorder. Smoking rates are higher in clinical populations, where up to 53% of persons with serious mental illnesses (schizophrenia and bipolar disorder) are estimated to smoke. Despite higher rates of smoking among persons with mental illnesses, motivation to quit in this population is similar to that of the general population of smokers. Nevertheless, smoking cessation rates in the USA have been significantly lower among persons with mental illnesses than among persons without a mental illness. Advising patients to quit is among the most basic approaches to smoking cessation used by health care professionals, and there is evidence that the likelihood of cessation increases with even minimal advising. Indeed, advising is the second of five smoking cessation activities recommended in the US Department of Health and Human Services clinical guideline, Treating Tobacco Use and Dependence, which promotes physician intervention activities in steps known as the five A's (ask, advise, assess, assist, and arrange). A randomized, state-wide survey was used to estimate the smoking prevalence among psychiatric outpatients served in Ohio's publicly funded behavioral health care system. A follow-up survey explored a self-selected sample's exposure to cessation advising by health care practitioners and the relationship between that advising and subjects' desire to quit.

Ouvidores de vozes de um serviço de saúde mental: características das vozes e estratégias de enfrentamento / Los que oyen voces en un servicio de salud mental: características de las voces y estrategias de enfrentamiento / Voice hearers of a mental health service: voice characteristics and coping strategies

Resumo Objetivou-se compreender a experiência de ouvir vozes a partir das características e conteúdos das vozes, e das estratégias utilizadas por dezesseis ouvidores usuários de um Centro de Atenção Psicossocial do Sul do Brasil. Trata-se de uma pesquisa qualitativa de caráter exploratório. Se deu através de entrevistas semiestruturadas e análise de conteúdo. Evidenciou-se que as características e conteúdos das vozes podem ser determinantes das reações emocionais dos ouvidores frente à experiência, sendo mais difícil lidar com ela quando os conteúdos são negativos. Através das estratégias utilizadas pelos ouvidores, percebeu-se uma resistência ao modelo biomédico, mesmo dentro de um serviço de saúde mental. Conclui-se que há uma necessidade de se pensar outras possibilidades de recuperação para as pessoas que ouvem vozes, que deem conta da complexidade da experiência e que sejam condizentes com o modelo de atenção psicossocial.

Resumen El estudio objetivó comprender la experiencia de oír voces a partir de las características y contenidos de las voces y las estrategias utilizadas por dieciséis oyentes que utilizan un Centro de Atención Psicosocial en el sur de Brasil. Esta es una investigación exploratoria cualitativa. Se llevó a cabo mediante entrevistas semiestructuradas y análisis de contenido. Se destacó que características y contenidos de las voces pueden ser determinantes de reacciones emocionales de los oidores delante la experiencia, siendo más difícil ocuparse de ella cuando los contenidos son negativos. A través de estrategias utilizadas por los oidores, se notó una resistencia al modelo biomédico, aunque dentro de un servicio de salud mental. Se concluye que hay una necesidad de pensar otras posibilidades de recuperación para las personas que oyen voces, que aporten la complejidad de la experiencia y que sean compatibles con el modelo de atención psicosocial.

Abstract The study aimed to understand the experience of hearing voices from the analysis of the characteristics and contents of the voices, and of the strategies used by sixteen voice hearers who use a Psychosocial Care Center in Southern Brazil. This is a qualitative exploratory research, conducted through semi-structured interviews and content analysis. It was evidenced that the characteristics and contents of the voices can be determinant of the hearer's emotional reactions to the experience, being more difficult to deal with when those are negative. By analyzing the strategies used by the hearers, resistance to the biomedical model was perceived even within a mental health service. It was concluded that there is a need to think about other possibilities of recovery for people who hear voices, possibilities that take into account the complexity of the experience and that are consistent with the psychosocial care model.

Aerobic interval training in standard treatment of out-patients with schizophrenia: a randomized controlled trial.

OBJECTIVE: To evaluate the feasibility and effects of integrating aerobic interval training (AIT) in standard care of out-patients with schizophrenia on aerobic capacity and conventional cardiovascular disease (CVD) risk factors. METHODS: Out-patients with schizophrenia spectrum disorder were randomized to the following: 1) a training group (TG), performing AIT 2 day/week at the clinic with adherence support from municipal services; or 2) a control group (CG), given two AIT sessions and encouraged to exercise on their own. Feasibility was assessed through retention/adherence. V˙O2peak was measured directly along with conventional CVD risk factors before and after 12 weeks. RESULTS: Of 48 out-patients, 16/25 and 18/23 completed the TG and CG respectively. After 12 weeks, V˙O2peak was higher (2.7 ± 4.8 ml/kg/min, P < 0.01) in the TG compared with the CG. The TG improved V˙O2peak by 3.1 ± 3.7 ml/kg/min (P < 0.01), while no change in the CG was observed. No intergroup difference in weight, body mass index (BMI), waist circumference, blood pressure, lipids, or glucose at posttest was observed. Weight (1.9 ± 4.0 kg, P < 0.05) and BMI (0.5 ± 1.1 kg/m2 , P < 0.05) increased in the CG, with no change in the TG. CONCLUSION: AIT, combined with adherence support, of out-patients with schizophrenia was feasible, improved V˙O2peak , and may be integrated in standard care. (ClinicalTrials.gov identifier: NCT02743143).

Divergence of subjective and performance-based cognitive gains following cognitive training in schizophrenia.

BACKGROUND: Cognitive training is effective for improving cognitive performance among people with schizophrenia. An individual's perception of their own cognition is dissociable from performance on objective cognitive tests. Since subjective cognitive benefit may impact engagement, motivation, and satisfaction with time-intensive cognitive interventions, this study aimed to determine whether subjective cognitive difficulties improve in conjunction with cognitive gains following 30 h of cognitive training. METHODS: Patients with schizophrenia or schizoaffective disorder (N = 46) were randomized to treatment as usual (TAU) or TAU augmented with auditory-targeted cognitive training (TCT). All participants completed assessment batteries at baseline and follow-up. As previously reported, the TCT group showed significant improvements in verbal learning and memory and reductions in auditory hallucinations relative to the TAU group. RESULTS: Subjective cognitive difficulties did not significantly improve following TCT, even among TCT participants who showed improvements in cognitive performance (all ps > 0.05). Subjective cognitive difficulties were significantly associated with severity of depressive symptoms and hallucinations (r = 0.48 and r = 0.28, p < 0.001), but not global or specific domains of cognition (all rs < 0.1) at baseline. There were no significant relationships between change in subjective cognitive difficulties and change in cognitive or clinical variables (all ps > 0.05). DISCUSSION: Patients with schizophrenia do not detect change in their cognition following cognitive training, even among those who showed robust gains in cognitive performance. Failure to detect improvement may undermine treatment engagement, motivation, and satisfaction. Translating score improvements on the cognitive exercises into tangible metrics, and providing ongoing, clinician-delivered feedback on performance may facilitate patient ability to detect improvements and improve motivation to engage with cognitive training interventions.

Psicoeducación (PE) en psicosis: evidencias y experiencia de 13 años / Psychoeducation (PE) in psychosis: evidence and experience of 13 years

La esquizofrenia es una prioridad sanitaria de primer orden, debido a su alta frecuencia en relación con otras enfermedades mentales. Patologías que, por sus propias características y curso evolutivo, ponen más a prueba la solidez y consistencia de las pautas de intervención que sobre ellas se realizan. Además un porcentaje alto de familias sienten estrés y dificultades que afectan de manera significativa su funcionamiento. Desde la década de los noventa se ha postulado que aplicar intervenciones integrales, farmacológicas, psicológicas y psicosociales, en una etapa precoz de la enfermedad, sería una estrategia beneficiosa para los pacientes, logrando con ello mejores resultados en cuanto a la evolución de la enfermedad a largo plazo. Entre ellas está la Psicoeducación (PE), que también tiene la función de contribuir a la no estigmatización de los trastornos psicológicos y disminuir las barreras para el tratamiento. En este trabajo presentamos un estudio en Chile de Psicoeducación con familiares de pacientes en primer episodio de esquizofrenia, aplicada por el sector 1 del Instituto Psiquiátrico Dr. José Horwitz Barak. Los contenidos de éste se basan en las Guías Clínicas GES (2016), y se enmarcan en las políticas públicas de salud promovidas por el Ministerio de Salud.

Schizophrenia should be a health priority because of its high frequency in relation to other mental illnesses. Pathologies that, due to their own characteristics and evolutionary course, put more to the test the solidity and consistency of the intervention guidelines that are carried out on them. In addition, a high percentage of families feel stress and difficulties that significantly affect their functioning. Since the nineties it has been postulated that applying comprehensive, pharmacological, psychological and psychosocial interventions, at an early stage of the disease, would be a beneficial strategy for patients, thereby achieving better results in the evolution of the disease in the long term. Among them is Psychoeducation (PE), which also has the function of contributing to the non-stigmatization of psychological disorders and reducing barriers to treatment. In this paper we present a study in Chile of sychoeducation with family members of patients in the first episode of schizophrenia, applied by sector 1 of the Dr. José Horwitz Barak Psychiatric Institute. The contents are based on the GES Clinical Guidelines (2016), and are framed in public health policies promoted by the Ministry of Health.

Influencia del estigma social en la rehabilitación y reinserción social de personas esquizofrénicas / Influence of social stigma on the rehabilitation and social reintegration of schizophrenic people

Introducción: El estigma es un constructo social que incluye actitudes, sentimientos, creencias y comportamiento que está configurado como prejuicio y trae como consecuencias discriminatorias hacia la persona estigmatizada. Las personas que padecen algún trastorno mental son uno de los grupos más estigmatizados de nuestra sociedad, especialmente las que padecen esquizofrenia. Objetivo: Fundamentar cómo el estigma social influye de manera negativa en la rehabilitación y reinserción social de las personas que padecen Esquizofrenia. Material y Métodos: Se realizó una revisión bibliográfica en fuentes de información disponibles en la Biblioteca Virtual de Salud de la red telemática Infomed, entre ellas, las bases de datos SciELO, Pubmed/Medline, Cumed, Lilacs, así como el Google académico. Finalmente se seleccionaron para nuestro estudio un total de 38 referencias. Desarrollo: El estigma se considera un constructo social y está asociado a numerosos factores psicológicos, sociológicos, históricos, así como a la representación social que se tenga de la causa de la estigmatización. Puede clasificarse de varias maneras y su abordaje resulta sumamente complejo, especialmente en lo relacionado con la Esquizofrenia. Conclusiones: El estigma social, unido a la representación que sobre la Esquizofrenia persiste en nuestro medio, son fenómenos que impiden una adecuada reinserción social en este tipo de pacientes. Urge el desarrollo de estrategias que modifiquen los falsos conceptos que sobre a enfermedad mental, persisten en nuestra sociedad(AU)

Introduction: Stigma is a social construct that includes attitudes, feelings, beliefs, and behavior that is configured as prejudice and brings about discriminatory consequences toward the stigmatized person. People who suffer from a mental disorder are recognized as one of the most stigmatized groups in our society, especially those who suffer from Schizophrenia. Objective: To establish how social stigma has a negative influence on the rehabilitation and social reintegration of people suffering from Schizophrenia. Material and Methods: A bibliographic review was made through the search of information in sources available from the Cuban National Health Care Network and Portal (INFOMED), among them, databases such as SciELO, Pubmed / Medline, Cumed, Lilacs, as well as Google Scholar. Finally, a total of 38 references were selected for our study. Development: Stigma is considered a social construct and is associated with many psychological, sociological, and historical factors, as well as the social representation of the cause of stigmatization. It can be classified in several ways. Its approach is extremely complex, especially when it is related to Schizophrenia. Conclusions: The social stigma, together with the representation in Schizophrenia that persists in our environment, are phenomena that prevent an adequate social reintegration in these patients. The development of strategies that modify the false concepts that persist over mental illness in our society is an urgent concern(AU)

[Sport as applied therapy in patients with schizophrenic psychoses]. / Sport als angewandte Therapie bei Patienten mit schizophrenen Psychosen.

Sport as applied therapy in patients with schizophrenic psychoses Abstract. Schizophrenic psychoses are serious mental illnesses associated with low life expectancy compared with healthy individuals and other psychiatric disorders. Overweight and associated health problems such as diabetes mellitus, cardiovascular disease and smoking-associated lung disease have been shown to be risk factors related to high mortality. Low physical activity and increased sedentary behavior have been identified as the most important behavioral risk factors for cardiovascular diseases in people with schizophrenia. Numerous research results show a positive influence of sport on mental symptoms as well as on physical health. In the studies, however, different types of guided movement with divergent intensity were used in group or single setting. The Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde [German Association for Psychiatry, Psychotherapy and Psychosomatics] recommends sports and physical exercise interventions for patients with severe mental illnesses. Still, further large randomized controlled trials are needed to investigate the nature, extent and duration, as well as the effect of the methods used in the various stages of the disease. One goal should be the evidence-based implementation of specific and systematic sport and movement interventions as a complementary module in addition to psychopharmacological and psychotherapeutic treatment in people with schizophrenia.

White matter microstructure predicts cognitive training-induced improvements in attention and executive functioning in schizophrenia.

We examined the relationship between white matter microstructure in schizophrenia using diffusion tensor imaging (DTI) and cognitive improvements induced by 70h (~16weeks) of cognitive training. We measured anatomical connectivity in 48 patients with schizophrenia (SZ) and 28 healthy control participants (HC) at baseline, and then examined the relationship between anatomical connectivity at baseline and training-induced cognitive gains in 30 SZ who performed diffusion imaging after completing 70h of training. Compared with healthy control participants, individuals with schizophrenia showed reduced white matter integrity at baseline, as indexed by fractional anisotropy metrics, in bilateral posterior corona radiata, bilateral retrolenticular internal capsules, bilateral posterior thalamic radiation, left anterior corona radiata, left superior longitudinal fasciculus, left sagittal stratum, right cerebral peduncle and the genu and splenium of the corpus callosum. After training, schizophrenia participants showed significant gains in attention/vigilance, speed of processing, verbal learning, visual learning and executive functioning. White matter integrity within the right fronto-occipital fasciculus predicted training-induced improvements in attention/vigilance, while white matter integrity within the right corticospinal tract and bilateral medial lemnisci predicted cognitive training-induced improvements in executive functioning, areas that did not show white matter tract deficits at baseline. These findings suggest that preserved white matter integrity connecting long-range prefrontal-thalamic-sensorimotor areas may be an important determinant for training-induced neurocognitive plasticity.

Improving quality of life and physical health in patients with schizophrenia: A 30-month program carried out in a real-life setting.

BACKGROUND: Patients with schizophrenia experience low quality of life (QoL) and poor physical health, which is explained, in part, by unhealthy lifestyle, tobacco smoking, poor diet and sedentary behavior. AIM: To measure QoL and physical health in patients with schizophrenia and to quantify associations between QoL and physical health. METHODS: This was a naturalistic longitudinal 30-month follow-up study including individual guidance, group sessions and treatment as usual. RESULTS: We included 190 patients. QoL was low among newly diagnosed patients. Higher body mass index was significantly associated with lower QoL. Newly diagnosed male patients showed lower QoL compared with females. Newly diagnosed patients experienced worsened health during the study period. In contrast, long-term schizophrenic patients started with worse physical health but improved with regard to weight, waist circumferences, intake of fast food and soft drinks, and light physical activity level. Newly diagnosed patients improved their QoL ( p = .056), and the psychological domain improved by 8.0 points ( p = .003). The number of interventions was positively associated with QoL. CONCLUSION: Patients with schizophrenia presented with low QoL and elevated risk factors for poor physical health. The intervention added onto 'treatment as usual' improved some risk factors for poor physical health among long-term patients. The number of interventions had an elevating effect on QoL in patients.

Treating schizophrenia during menopause.

OBJECTIVE: The aim of this review is to examine three questions: What are the risks and benefits of treating women with schizophrenia with hormone therapy (HT) at menopause? Should the antipsychotic regimen be changed at menopause? Do early- and late-onset women with schizophrenia respond differently to HT at menopause? METHODS: MEDLINE databases for the years 1990 to 2016 were searched using the following interactive terms: schizophrenia, gender, menopause, estrogen, and hormones. The selected articles (62 out of 800 abstracts) were chosen on the basis of their applicability to the objectives of this targeted narrative review. RESULTS: HT during the perimenopause in women with schizophrenia ameliorates psychotic and cognitive symptoms, and may also help affective symptoms. Vasomotor, genitourinary, and sleep symptoms are also reduced. Depending on the woman's age and personal risk factors and antipsychotic side effects, the risk of breast cancer and cardiovascular disease may be increased. Antipsychotic types and doses may need to be adjusted at menopause, as may be the mode of administration. CONCLUSIONS: Both HT and changes in antipsychotic management should be considered for women with schizophrenia at menopause. The question about differences in response between early- and late-onset women cannot yet be answered.

[Disability Pension and Productivity Loss in Schizophrenia - An Empirical Analysis of the Financial Burden in Germany]. / Erwerbsminderung bei Schizophrenie ­ eine empirische Analyse der Folgelasten.

Objective Quantification of the economic burden for society and the German Statutory Pension Insurance due to early retirement in schizophrenia. Methods Based on empirical data of the German Statutory Pension Insurance, productivity losses were calculated using the human capital approach. Results The total expenditures of the German Statutory Pension Insurance due to pension payments for schizophrenic insurants amounted to €â€Š450 million. Total indirect costs due to morbidity and mortality were estimated at €â€Š2,3 million. Average indirect costs per patient ranged between €â€Š17 000 - 28 000, depending on rates for discounting and inflation. Conclusion Regarding substantial economic consequences, preventive measures and therapeutic procedures should aim to prevent reduction in earning capacity and to promote occupational reintegration of schizophrenic patients.

La rehabilitación cognitiva para pacientes con esquizofrenia de larga data: un desafío para los equipos de salud / The cognitive rehabilitation of patients with long-standing schizophrenia: a challenge for health teams

Introduction: The differences in the scores observed in the attention, memory and executive functions regarding the use of a cognitive rehabilitation program in patients with long-standing schizophrenia are analysed. Method: The participants were selected through a nonprobability sampling with a purposive sample ofcritical cases (n = 31). It is a causal research, which considers a quasi-experimental design of two groups (experimental and control) with pre and postintervention measures. To measure the variables, the TMTA & B, WAIS, ROCF and the Stroop P & C tests were administered. Results: The intervention had a clinically significant impact on the domains of visual spatial attention and the executive function (speed of verbal information processing), given by the differences caused by the post-intervention means. There were only statistically significant differences of means in the post-test scores for the Rey-Osterrieth complex figure test, in the Memory-Time variable, whose treatment has a low impact and false negative rates higher than initially expected. At the same time, regarding the variability of the scores, there were not statistically significant differences for any of the variables analysed. Conclusions: Training the identification of symbols, using memories of details of projected images and simple words association, in a group-competition context with playful elements, have a clinically relevant impact on the rehabilitation of the visual spatial attention and the speed of verbal information processing of patients with long-standing schizophrenia. The statistically significant differences of means require to be considered with care.

Introducción: Se analizan las diferencias en las puntuaciones observadas en atención, memoria y función ejecutiva en función de un programa de rehabilitación cognitiva en pacientes con esquizofrenia de larga data. Método: Los participantes fueron seleccionados mediante un muestreo noprobabilístico con una muestra intencional de casos críticos (n = 31). Investigación explicativa, con diseño cuasi experimental de dos grupos (experimental y control) y medidas pre y post intervención. Para medir las variables se administraron los test TMT A y B, WAIS, F.C. de Rey, STROOP P y C. Resultados: La intervención tuvo un impacto clínicamente significativo en el Dominio de la Atención focalizada visual y en el Dominio Ejecutivo (velocidad de procesamiento de información verbal) dado por las diferencias de medias post intervención. Sólo existieron diferencias de medias estadísticamente significativas en los puntajes post test para la Figura Compleja de Rey en la variable Memoria-Tiempo, cuyo tratamiento tiene un impacto bajo y tasas de falsos negativos superiores a las esperadas. A su vez, respecto a la variabilidad de las puntuaciones, no se observaron diferencias estadísticamente significativas para ninguna de las variables analizadas. Conclusiones: Entrenar identificando símbolos, recuerdos de detalles de imágenes proyectadas, asociación de palabras simples, en contextos de competición entre grupo con elementos lúdicos, tiene un impacto clínicamente relevante en la rehabilitación de la atención focalizada visual y en la velocidad de procesamiento de información verbal en sujetos con esquizofrenia de larga data. Las diferencias de medias estadísticamente significativas detectadas requerirían ser consideradas con precaución.

[Advocacy for the establishment of a comprehensive strategy to reduce the "burden" of schizophrenic disorders]. / Plaidoyer pour la mise en place d'une stratégie globale pour atténuer le « fardeau ¼ des troubles schizophréniques.

This article attempts to identify and put into perspective the different approaches that could globally prevent the suffering induced by schizophrenia, from the detection of early psychosis to the impact on individual and family functioning and emotional health. Schizophrenia causes, at the community level, a number of difficult consequences and associated costs, which likely could be reduced if specific strategies, already known and documented internationally, were applied. Two areas not explored in this article: the role of medication and the issue of suicide prevention. In the scope of screening and early treatment, genetic risk, as well as the predictive ability of the clinical criteria for individuals at "ultra-high risk" of developing schizophrenia justify an increased vigilance for the detection of symptoms in order for treatment to begin earlier and to be more effective. These risk factors should not be neglected as the benefits of early management impact the course of illness and functional outcome. At this stage of the emergence of the disorder, it is difficult to systematize a therapeutic protocol. Two options are open to the clinician: "wait and watch" given the lack of a conclusive diagnosis and a more pro-active intervention, focused on the therapeutic alliance and enhancing insight and awareness. The second approach seems more productive but requires transparency with the patient and family regarding the uncertainty of the clinical situation, and an attitude that favors sharing information, along the lines of early psych education. Once a pathological stage is reached, early and accurate clinical care is fundamental. They depend heavily on access to care, proximity and availability to clinics or out-reach teams, capable of a thorough diagnostic work-up. Yet conversely, the availability for early and accurate clinical care faces obstacles which are closely related to the pejorative view of psychiatry held by the general public, health care professionals, and public officials. This poor image of psychiatry is partly due to cases of clinical decompensation, dangerous in some instances, underscoring why it is be important to understand and anticipate the contributory factors to these outcomes in the first place so as to avoid them. In this sense, defending a complacent and conciliatory approach can be counter-productive. Following developments of recent decades in other chronic diseases (diabetes, cancer, AIDS, severe heart disease…), the implementation of systematic clinical programs, treatment protocols, psycho-education to reinforce adherence to therapeutic measures, their simplification, the support and appreciation of the role of caregivers, destigmatizing due to proximity of contact, and therefore an increase in the use of care. Similarly, the systematic search for side-effects of medication and pro-actively managing to minimize their occurrence strengthen compliance, a recognized factor of relapse prevention. Preventable comorbidities, addictions, and common physical illnesses are not systematically screened (neoplastic diseases, diabetes, hypertension, dental health, gynecology…) in this population and thus also represent significant potential for a better life expectancy. The tools of psychosocial rehabilitation, unfortunately, are too infrequently used in France. Their goal is to improve the functional outcome of patients, a determinant of social integration and to lessen the burden shouldered by family and other carers, and ultimately to reduce exacerbations of the illness due to situations of interpersonal stress. Work has also proven its worth as a protective factor, as well as strengthening a sense of self-efficiency, of self-esteem, of empowerment, of quality of life, helping attain recovery. It is clear that not all social and health care systems are primarily geared towards these objectives, although they have at their disposal, by the means described above, strong preventive measures for relapses. Beyond the issue of the implementation of clinical programs, the existing culture would benefit from being infused with a prioritization of resource deployment, with debates of these issues regarding parity for mental health services, advocated by users, and forging a place, for example, for the intervention of "peer supports", sociologists, social workers, interested beyond the disease, in community environment, employment opportunities, and housing. Overall, this work argues for updating our conceptions of clinical care, supporting the systematic implementation of modern models of care, and expanding the scope of our concerns regarding patients' lives.

Health for smokers with schizophrenia - a struggle to maintain a dignified life.

PURPOSE: To investigate the health and lifestyle habits of smokers with schizophrenia and describe their experience of smoking in relation to health. METHODS: Semi-structured interviews with 10 smokers with schizophrenia were conducted in Sweden from May to October 2013. A hermeneutic phenomenological approach was used to describe and interpret respondents' experiences. FINDINGS: Good health for a person with schizophrenia was defined as accepting their mental illness, having strategies to gain control over psychotic symptoms, and engaging in activities and good relationships. Lifestyle habits were described as structures in the respondents' daily life: arising in the morning, taking a cigarette, reading the newspaper, eating breakfast and doing the things planned for the day. CONCLUSION: The meaning of health for smokers with schizophrenia is not the same as being well or ill. Rather, health is an experience of a struggle to maintain a dignified life, including self-acceptance of the mental illness and control over the psychotic symptoms. People with schizophrenia have high willingness but low motivation to stop smoking because they fear that cigarette withdrawal will increase their psychotic symptoms. Therefore, they find it difficult to stop smoking. To succeed with health care intervention, health care providers must understand the life style habits and experiences specific to smokers with schizophrenia and the unique experience of health and life style habits that people with schizophrenia experience. IMPLICATIONS FOR REHABILITATION: Smokers with schizophrenia experience health as a struggle to maintain a dignified life and to maintain control over their psychotic symptoms. In smoking cessation programmes, health care providers must pay attention to the fear that people with schizophrenia have of losing control over their psychotic symptoms, if they stop smoking, and support them to find activities to replace smoking. This study suggests that to provide good support in health prevention for people with schizophrenia, it is vital for the health care provider to understand their unique personal experience of health and life style habits.

A 20-week program of resistance or concurrent exercise improves symptoms of schizophrenia: results of a blind, randomized controlled trial

Objective: To evaluate the effects of 20 weeks of resistance and concurrent training on psychotic and depressive symptoms, quality of life outcomes, and serum IGF-1, IGFBP-3, and brain-derived neurotrophic factor (BDNF) concentrations in patients with schizophrenia. Methods: In this blind, randomized controlled clinical trial, 34 patients with schizophrenia were assigned to one of three groups: control (CTRL, n=13), resistance exercise (RESEX, n=12), or concurrent exercise (CONCEX, n=9). Symptoms, quality of life, strength, and other variables were assessed. Results: A significant time-by-group interaction was found for the RESEX and CONCEX groups on the Positive and Negative Syndrome Scale (PANSS) total score for disease symptoms (p = 0.007), positive symptoms (p = 0.003), and on the arm extension one-repetition maximum (1RM) test (p = 0.016). In addition, significant improvements on negative symptoms (p = 0.027), on the role-physical domain of the Short Form-36 Health Survey (p = 0.019), and on the chest press 1RM test (p = 0.040) were observed in the RESEX group. No changes were observed for the other variables investigated. Conclusions: In this sample of patients with schizophrenia, 20 weeks of resistance or concurrent exercise program improved disease symptoms, strength, and quality of life. ClinicalTrials.gov: NCT01674543.

Effective Cessation Strategies for Smokers with Schizophrenia.

Despite availability of smoking cessation aids with proven efficacy and tolerability in those with schizophrenia, addiction to tobacco-derived nicotine remains highly prevalent among those with schizophrenia spectrum disorders. While smokers with serious mental illness have been excluded from most large nicotine-dependence treatment studies, and these treatments are woefully underutilized for smokers with psychiatric illness, a growing evidence base is available to guide cessation treatment for smokers with schizophrenia. The aim of this review is to present the evidence on safety and efficacy of smoking cessation interventions for those with schizophrenia spectrum illness. Smokers with schizophrenia spectrum disorders should receive varenicline or bupropion with or without nicotine replacement therapy in combination with behavioral treatment. Clinical practice guidelines now recommend duration of treatment be 12 weeks, but evidence indicates that maintenance pharmacotherapy for 1 year improves sustained abstinence rates. Controlled trials have found no evidence that in patients with serious mental illness, the use of pharmacotherapeutic cessation aids worsens psychiatric symptoms or increases the rate of psychiatric adverse events. Converging evidence indicates that a majority of smokers with serious mental illness want to quit smoking and that available pharmacotherapeutic cessation aids combined with behavioral support are both effective for, and well tolerated by, these smokers.

Metabolic syndrome and aerobic fitness in patients with first-episode schizophrenia, including a 1-year follow-up.

OBJECTIVE: To compare the prevalence of metabolic syndrome (MetS) and metabolic abnormalities in patients with first-episode schizophrenia (FES) with sex- and age-matched healthy controls; to investigate changes in MetS during 1year of treatment; and to investigate predictors of MetS. METHODS: Patients with FES (N=99) and healthy controls (N=50) were included in the study. MetS was defined according to IDF based on waist circumference (WC), blood pressure (BP), triglycerides (TG), high-density lipoprotein (HDL), and fasting-glucose. Data on physical activity, aerobic fitness, smoking, and dietary habits, sleeping disturbances, psychopathology and psychotropic medication were also obtained. Patients were assessed at baseline and at 1year follow-up. RESULTS: Compared with healthy controls patients with FES had a higher baseline prevalence of MetS (p=.07), and metabolic abnormalities: WC (p<.01), TG (p<.01), HDL (p=.017), and fasting glucose (p=.04). Patients with FES had significantly increased prevalence of MetS (p=.03), WC (p=.04), and TG (p=.01) during the study period. Antipsychotics and low physical activity were significantly correlated with the increase in metabolic abnormalities. In multivariate analyses low aerobic fitness was the most consistent and significant predictor of metabolic abnormalities and MetS. CONCLUSION: MetS and metabolic abnormalities are highly prevalent in patients with FES, and both increase significantly during 1year of treatment. Apart from confirming the metabolic adverse effects of antipsychotics, our study highlights that low aerobic fitness is a significant risk factor for MetS. Promoting a healthier lifestyle should be part of psychiatric treatment and rehabilitation.

Randomized Trial of the Effect of Four Second-Generation Antipsychotics and One First-Generation Antipsychotic on Cigarette Smoking, Alcohol, and Drug Use in Chronic Schizophrenia.

No large-scale randomized trial has compared the effect of different second-generation antipsychotic drugs and any first-generation drug on alcohol, drug and nicotine use in patients with schizophrenia. The Clinical Antipsychotic Trial of Intervention Effectiveness study randomly assigned 1432 patients formally diagnosed with schizophrenia to four second-generation antipsychotic drugs (olanzapine, risperidone quetiapine, and ziprasidone) and one first-generation antipsychotic (perphenazine) and followed them for up to 18 months. Secondary outcome data documented cigarettes smoked in the past week and alcohol and drug use severity ratings. At baseline, 61% of patients smoked, 35% used alcohol, and 23% used illicit drugs. Although there were significant effects of time showing reduction in substance use over the 18 months (all p < 0.0001), this study found no evidence that any antipsychotic was robustly superior to any other in a secondary analysis of data on substance use outcomes from a large 18-month randomized schizophrenia trial.