A Recovery-Oriented Intervention for People With Psychosis: A Pilot Randomized Controlled Trial.

OBJECTIVE: This pilot randomized controlled trial evaluated the effectiveness of critical time intervention-task shifting (CTI-TS) for people with psychosis in Santiago, Chile, and Rio de Janeiro. CTI-TS is a 9-month intervention involving peer support workers and is designed to maintain treatment effects up to 18 months. METHODS: A total of 110 people with psychosis were recruited when they enrolled in community mental health clinics (Santiago, N=60; Rio de Janeiro, N=50). Participants within each city were randomly assigned to either CTI-TS or usual care for 9 months. Primary outcomes were quality of life, measured with the World Health Organization Quality of Life Assessment-Brief Version (WHOQOL-BREF), and unmet needs, measured with the Camberwell Assessment of Need (CAN), at 18-month follow-up. Results were analyzed according to intention-to-treat guidelines. Generalized estimating equations, with observations clustered within cities, and multiple imputation for missing data were used. RESULTS: At 18 months, both groups showed improved primary outcomes. In both unadjusted and fully adjusted analyses, no significant differences between CTI-TS and usual care (WHOQOL-BREF question on quality of life and CAN mean number of unmet needs) were found. CONCLUSIONS: Three factors might explain the lack of difference between CTI-TS and usual care: first-contact enrollment precluded rapport prior to randomization, a minority of patients were uncomfortable with peers being on the treatment team, and primary outcome measures may not have been sensitive enough to capture the effects of a recovery-oriented intervention. The results have implications for the design of transitional services for people with psychosis, especially in Latin America.

Analysis of psychometric properties of the brazilian portuguese version of the community attitudes towards the mentally ill (CAMI-BR).

OBJECTIVES: To perform an analysis of the psychometric properties of the Brazilian Portuguese version of the COMMUNITY ATTITUDES TOWARDS THE MENTALLY ILL (CAMI-BR), a 40-item scale divided into four sub-scales. METHODS: The study was conducted in a non-probability sample of 230 households located close to therapeutic residences in the west area of Rio de Janeiro. Reliability was assessed by test-retest and the Principal Component Analysis (PCA) was used to test the internal structure of the questionnaire. RESULTS: Most participants were women, married, with children aged 18 years or over. The overall score was 27.72 (SD = 3.31), showing attitudes ranging from neutral to positive stereotypes. The scale showed a high internal consistency (? = 0.842), consistent with other international studies. In the factor analysis, the sample was adequate (KMO = 0.800). The strength of the correlations among subscales and the factors of factor analysis were highly satisfactory. The version in Brazilian Portuguese suggests a better distinction among sub-scales through the lower correlation among them (between 0.336 and 0.441) as compared to higher values (between 0.630 and 0.770) found in the original scale. The community mental health ideology sub-scale showed a strong relation to factor 1 (? = 0.910). Benevolence had a strong relationship with factor 2 (? = 0.847); Authoritarianism and Social Restrictiveness had the highest correlation with factor 3 (? = 0.631 and 0.577 respectively). CONCLUSIONS: The scale psychometric properties were maintained after adjustment. Having registered a lower correlation between the scales the factor analysis further suggests that the Brazilian Portuguese version conveys more clearly the differences between the sub-scales.