As We Were and as We Should Be, Combined Exercise Training in Adults with Schizophrenia: CORTEX-SP Study Part I.

INTRODUCTION: Given the health benefits and the role of exercise as an anti-inflammatory adjuvant program, this study aimed to determine the effectiveness of a combined exercise program on cardiorespiratory fitness (CRF), body composition, and biochemical levels in adults with schizophrenia (SZ) characterized at baseline as metabolically unhealthy overweight with low CRF. METHODS: Participants diagnosed with SZ ( n = 112, 41.3 ± 10.4 yr, 28.7% women) were randomly assigned into a treatment-as-usual control group ( n = 53) or a supervised exercise group ( n = 59, 3 d·wk -1 ). Each combined exercise session consisted of both a low-volume high-intensity interval training (<10 min of high-intensity time per session) and a resistance circuit-training program. All variables were assessed before and after the intervention (20 wk). For the assessment of CRF, a peak cardiopulmonary exercise test on a cycle ergometer was used. RESULTS: After the intervention, participants from the exercise group ( n = 51) showed increases in CRF ( P < 0.001) through peak oxygen uptake (L·min -1 ; Δ = 17.6%; mL·kg -1 ·min -1 , Δ = 19.6%) and the metabolic equivalent of task (Δ = 19%), with no significant changes ( P > 0.05) in body composition and biochemical variables. However, the treatment-as-usual group ( n = 38) did not show any significant change in the study variables ( P > 0.05). Between-group significant differences ( P ≤ 0.05) were observed in CRF, first ventilatory threshold, and heart rate peak after the intervention period, favoring the exercise group. CONCLUSIONS: This study demonstrated that a supervised combined exercise program in people with SZ helps to maintain body composition values and improve CRF levels. This could lead to an important clinical change in the characterization from metabolically unhealthy overweight to a metabolically healthy overweight population. Hence, exercise should be considered a co-adjuvant program in the treatment of the SZ population.

The Multi-Component Smoking Cessation Support Programme (McSCSP) is effective in patients with severe mental disorder without gender differences. / El programa multicomponente de apoyo para el cese del tabaquismo (McSCSP) es efectivo en pacientes con trastorno mental grave sin diferencias de género.

High prevalence of smoking in people with severe mental disorders (SMD) contributes to their medical morbidity and reduced life expectancy. Despite the evidence of gender differences in smoking cessation, few studies have tested those differences among people with SMD. This is a non-randomized, open-label, prospective, 9-month follow-up multicentre trial to examine gender differences in the efficacy, safety and tolerability of a Multi-Component Smoking Cessation Support Programme (McSCSP). The results showed that there were no significant differences in short- (males 44.9% vs females 57.7%, chi-square = 1.112, p = 0.292) or long-term efficacy (week 24: males 40.8%, females 42.3%, chi-square = 0.016, p = 0.901; week 36: males 36.7%, females 38.5%, chi-square = 0.022, p = 0.883) between gender, neither controlled by diagnosis or treatment. Regarding safety and tolerability, there was significant increase in abdominal perimeter in males [from 105.98 (SD 13.28) to 108.52 (SD 14.01), t = -3.436, p = 0.002)], but not in females. However, there were no significant gender differences in adverse events (constipation, abnormal/vivid dreams, nausea/vomiting or skin rash/redness around patch site). In conclusion, we have demonstrated that is effective and safe to help either male or female patients with stabilized SMD to quit smoking. However, it might be a tendency in females to respond better to varenicline treatment in the short-term. Future research with larger samples is required to more clearly determine whether or not the there are differences, in addition to their reliability and robustness.

La elevada prevalencia del tabaquismo en personas con trastorno mental grave (TMG) contribuye a su morbilidad médica y reduce su esperanza de vida. A pesar de la existencia de diferencias de género en el cese del tabaquismo, pocos estudios han evaluado esas diferencias en personas con TMG. Este es un ensayo multicéntrico de seguimiento prospectivo, no aleatorizado, abierto de 9 meses para examinar las diferencias de género en la eficacia, seguridad y tolerabilidad de un programa multicomponente de apoyo para el cese del tabaquismo (McSCSP). Los resultados mostraron que no hubo diferencias de género significativas en la eficacia a corto (hombres 44,9% vs mujeres 57,7%, chi cuadrado = 1,112, p = ,292) ni a largo plazo (semana 24: hombres 40,8%, mujeres 42,0.3%, chi cuadrado = 0.016, p = ,901; semana 36: hombres 36,7%, mujeres 38,5%, chi cuadrado = 0,022, p = ,883), incluso controlando por diagnóstico o tratamiento.  Con respecto a la seguridad y la tolerabilidad, hubo un aumento significativo en el perímetro abdominal en los hombres [de 105,98 (DT 13,28) a 108,52 (DT 14,01), t = -3,436, p = ,002)], pero no en las mujeres. Sin embargo, no hubo diferencias de género significativas en los eventos adversos (estreñimiento, sueños anormales/vívidos, náuseas/vómitos o erupción cutánea/enrojecimiento alrededor de la zona del parche). En conclusión, hemos demostrado que es efectivo y seguro ayudar a los hombres y mujeres con TMG estabilizados a dejar de fumar.  Sin embargo, podría haber una tendencia en las mujeres a responder mejor al tratamiento con vareniclina a corto plazo. Se requiere investigación futura con muestras más amplias para determinar con más claridad la existencia de diferencias, además de la fiabilidad y robustez.

El programa multicomponente de apoyo para el cese del tabaquismo (McSCSP) es efectivo en pacientes con trastorno mental grave sin diferencias de género / The Multi-Component Smoking Cessation Support Programme (McSCSP) is effective in patients with severe mental disorder without gender differences

La elevada prevalencia del tabaquismo en personas con trastorno mentalgrave (TMG) contribuye a su morbilidad médica y reduce su esperanzade vida. A pesar de la existencia de diferencias de género en el cese deltabaquismo, pocos estudios han evaluado esas diferencias en personascon TMG. Este es un ensayo multicéntrico de seguimiento prospectivo,no aleatorizado, abierto de 9 meses para examinar las diferencias de género en la eficacia, seguridad y tolerabilidad de un programa multicomponente de apoyo para el cese del tabaquismo (McSCSP). Los resultadosmostraron que no hubo diferencias de género significativas en la eficaciaa corto (hombres 44,9% vs mujeres 57,7%, chi cuadrado = 1,112, p =,292) ni a largo plazo (semana 24: hombres 40,8%, mujeres 42,0.3%, chicuadrado = 0.016, p = ,901; semana 36: hombres 36,7%, mujeres 38,5%, chi cuadrado = 0,022, p = ,883), incluso controlando por diagnóstico otratamiento. Con respecto a la seguridad y la tolerabilidad, hubo unaumento significativo en el perímetro abdominal en los hombres [de105,98 (DT 13,28) a 108,52 (DT 14,01), t = -3,436, p = ,002)], pero no enlas mujeres. Sin embargo, no hubo diferencias de género significativasen los eventos adversos (estreñimiento, sueños anormales/vívidos, náuseas/vómitos o erupción cutánea/enrojecimiento alrededor de la zonadel parche). En conclusión, hemos demostrado que es efectivo y seguroayudar a los hombres y mujeres con TMG estabilizados a dejar de fumar.Sin embargo, podría haber una tendencia en las mujeres a respondermejor al tratamiento con vareniclina a corto plazo. Se requiere investigación futura con muestras más amplias para determinar con más claridadla existencia de diferencias, además de la fiabilidad y robustez. (AU)

High prevalence of smoking in people with severe mental disorders(SMD) contributes to their medical morbidity and reduced lifeexpectancy. Despite the evidence of gender differences in smokingcessation, few studies have tested those differences among peoplewith SMD. This is a non-randomized, open-label, prospective,9-month follow-up multicentre trial to examine gender differencesin the efficacy, safety and tolerability of a Multi-Component SmokingCessation Support Programme (McSCSP). The results showed thatthere were no significant differences in short- (males 44.9% vs females57.7%, chi-square = 1.112, p = 0.292) or long-term efficacy (week 24:males 40.8%, females 42.3%, chi-square = 0.016, p = 0.901; week 36:males 36.7%, females 38.5%, chi-square = 0.022, p = 0.883) between gender, neither controlled by diagnosis or treatment. Regarding safetyand tolerability, there was significant increase in abdominal perimeterin males [from 105.98 (SD 13.28) to 108.52 (SD 14.01), t = -3.436,p = 0.002)], but not in females. However, there were no significantgender differences in adverse events (constipation, abnormal/vividdreams, nausea/vomiting or skin rash/redness around patch site). Inconclusion, we have demonstrated that is effective and safe to helpeither male or female patients with stabilized SMD to quit smoking.However, it might be a tendency in females to respond better tovarenicline treatment in the short-term. Future research with largersamples is required to more clearly determine whether or not thethere are differences, in addition to their reliability and robustness. (AU)

Cross-Validation of Predictive Equation for Cardiorespiratory Fitness by Modified Shuttle Walk Test in Adults with Schizophrenia: A Secondary Analysis of the CORTEX-SP Study.

Cardiorespiratory fitness (CRF) can be direct or estimated from different field tests. The Modified Shuttle Walk Test (MSWT) is suitable for all levels of function, allowing a peak response to be elicited. Therefore, we aimed (1) to validate the equation presented in the original study by Singh et al. for evaluating the relationship between MSWT with peak oxygen uptake (VO2peak) in adults with schizophrenia (SZ), (2) to develop a new equation for the MSWT to predict VO2peak, and (3) to validate the new equation. Participants (N = 144, 41.3 ± 10.2 years old) with SZ performed a direct measurement of VO2peak through a cardiopulmonary exercise test and the MSWT. A new equation incorporating resting heart rate, body mass index, and distance from MSWT (R2 = 0.617; adjusted R2 = 0.60; p < 0.001) performs better than the Singh et al. equation (R2 = 0.57; adjusted R2 = 0.57; p < 0.001) to estimate VO2peak for the studied population. The posteriori cross-validation method confirmed the model's stability (R2 = 0.617 vs. 0.626). The findings of the current study support the validity of the new regression equation incorporating resting heart rate, body mass index, and distance from MSWT to predict VO2peak for assessment of CRF in people with SZ.

Modelo predictivo de la funcionalidad en la esquizofrenia: una aproximación desde el modelado de ecuaciones estructurales / An outcome prediction model for schizophrenia: a structural equation modelling approach

Introducción: Aunque la relación de los síntomas y las funciones cognitivas con la funcionalidad de pacientes con esquizofrenia es bien conocida, la complejidad de la patología hace necesario el estudio de esta relación por medio de un método más analítico que los enfoques de relaciones simples. Material y métodos: Ciento sesenta y cinco pacientes con esquizofrenia se sometieron a una evaluación clínica (síntomas clínicos, insight, síntomas afectivos y ajuste premórbido). La neurocognición fue representada mediante una estructura de 5 factores obtenida por medio del análisis factorial confirmatorio. La funcionalidad se obtuvo mediante la escala DAS-WHO y la calidad de vida mediante la Escala de Calidad de Vida. Resultados: Utilizando el modelado de ecuaciones estructurales (MEE), específicamente el «measured-variable path analysis», el modelo de mediación formado por la capacidad neurocognitiva, los síntomas clínicos y el funcionamiento premórbido mostró un buen ajuste con los datos observados (Satorra-Bentler χ2=604,83; RMSEA=0,08; SRMR=0,11; NNFI=0,96; CFI=0,97). La velocidad de procesamiento, la memoria verbal y el funcionamiento premórbido predijeron directamente la funcionalidad. La fluidez verbal predijo la funcionalidad de manera directa e indirecta, a través de los síntomas negativos. Las funciones ejecutivas, el insight, los síntomas afectivos y los datos cognitivos adicionales no contribuyeron de manera significativa al modelo. Conclusiones: Los resultados indican que los síntomas negativos y el funcionamiento premórbido predicen directamente la funcionalidad, mientras que los factores cognitivos muestran interacciones más complejas con los síntomas negativos y la funcionalidad. Estos resultados deberían ser considerados para nuevas estrategias de intervención

Introduction: Although it is well-known that several factors such as symptoms and cognition are related with functional outcome in schizophrenia, the complex nature of the disorder makes necessary to study their interaction by means of a more analytic method than simple linkages approaches. Material and methods: One hundred and sixty-five patients with schizophrenia underwent a clinical evaluation (including clinical symptoms, insight, affective symptoms and premorbid adjustment). Neurocognition was represented by a 5-factor structure obtained by confirmatory factor analysis from a neurocognitive battery. The estimation for outcome was obtained throughout the DAS-WHO scale, and quality of life with the Quality of Life Scale. Results: Using structural equation modeling (SEM), specifically measured-variable path analysis, a mediational model consisting of neurocognitive capacity linked to clinical symptoms and premorbid functioning showed good fit to the observed data (Satorra-Bentler χ2=604.83; RMSEA=.08; SRMR=.11; NNFI=.96; CFI=.97). Processing speed, verbal memory and premorbid functioning directly predicted outcome. Verbal fluency predicted outcome both directly and indirectly via negative symptoms. Executive functions, insight, affective symptoms, and additional cognitive data did not significantly contribute to the model. Conclusions: Results suggest that negative symptoms and premorbid functioning directly predict outcome, whereas cognitive factors show more complex interactions with negative symptoms and outcome. These results should be considered for new intervention strategies

An outcome prediction model for schizophrenia: A structural equation modelling approach. / Modelo predictivo de la funcionalidad en la esquizofrenia: una aproximación desde el modelado de ecuaciones estructurales.

INTRODUCTION: Although it is well-known that several factors such as symptoms and cognition are related with functional outcome in schizophrenia, the complex nature of the disorder makes necessary to study their interaction by means of a more analytic method than simple linkages approaches. MATERIAL AND METHODS: One hundred and sixty-five patients with schizophrenia underwent a clinical evaluation (including clinical symptoms, insight, affective symptoms and premorbid adjustment). Neurocognition was represented by a 5-factor structure obtained by confirmatory factor analysis from a neurocognitive battery. The estimation for outcome was obtained throughout the DAS-WHO scale, and quality of life with the Quality of Life Scale. RESULTS: Using structural equation modeling (SEM), specifically measured-variable path analysis, a mediational model consisting of neurocognitive capacity linked to clinical symptoms and premorbid functioning showed good fit to the observed data (Satorra-Bentler χ2=604.83; RMSEA=.08; SRMR=.11; NNFI=.96; CFI=.97). Processing speed, verbal memory and premorbid functioning directly predicted outcome. Verbal fluency predicted outcome both directly and indirectly via negative symptoms. Executive functions, insight, affective symptoms, and additional cognitive data did not significantly contribute to the model. CONCLUSIONS: Results suggest that negative symptoms and premorbid functioning directly predict outcome, whereas cognitive factors show more complex interactions with negative symptoms and outcome. These results should be considered for new intervention strategies.

Combining social cognitive treatment, cognitive remediation, and functional skills training in schizophrenia: a randomized controlled trial.

This study examined the efficacy of an integrative cognitive remediation program (REHACOP) in improving cognition and functional outcome in patients with schizophrenia. The program combines cognitive remediation, social cognitive intervention, and functional skills training. Few studies have attempted this approach. One hundred and eleven patients diagnosed with schizophrenia were randomly assigned to either the cognitive remediation group (REHACOP) or an active control group (occupational activities) for 4 months (three sessions per week, 90 min). Primary outcomes were change on general neurocognitive performance and social cognition, including theory of mind (ToM), emotion perception (EP), attributional style, and social perception (SP). Secondary outcomes included changes on clinical symptoms (Positive and Negative Syndrome Scale) and functional outcome (UCSD Performance-Based Skills Assessment and the Global Assessment of Functioning). The trial was registered with clinicaltrials.gov (NCT02796417). No baseline group differences were found. Significant differences were found in the mean change between the REHACOP group and control group in neurocognition ([Formula: see text]), SP ([Formula: see text]), ToM ([Formula: see text]), EP ([Formula: see text]), negative symptoms ([Formula: see text]), emotional distress ([Formula: see text]), Global Assessment of Functioning ([Formula: see text]), and UCSD Performance-Based Skills Assessment ([Formula: see text]). The combination of cognitive remediation, social cognitive intervention, and functional skills training demonstrated statistically significant and clinically meaningful changes in neurocognition, social cognition, negative, and functional disability.

It is feasible and effective to help patients with severe mental disorders to quit smoking: An ecological pragmatic clinical trial with transdermal nicotine patches and varenicline.

Despite the proven association between smoking and high rates of medical morbidity and reduced life expectancy in people with severe mental disorders (SMD), their smoking rates do not decline as they do in the general population. We carried out a non-randomized, open-label, prospective, 9-month follow-up multicentre trial to investigate the clinical efficacy, safety and tolerability of a 12-week smoking cessation programme for patients with SMD in the community under real-world clinical conditions. Eighty-two adult outpatients with schizophrenic/bipolar disorder smoking ≥15 cigarettes/day were assigned by shared decision between doctors and patients to transdermal nicotine patches (TNP) [36(46.2%)] or varenicline [39(50%)]. Short-term efficacy: The 12-week 7-day smoking cessation (self-reported cigarettes/day=0 and breath carbon monoxide levels≤9ppm) prevalence was 49.3%, without statistically significant differences between medications (TNP 50.0% vs varenicline 48.6%, chi-square=0.015, p=1.000). Long-term efficacy: At weeks 24 and 36, 41.3 and 37.3% of patients were abstinent, with no statistically significant differences between treatments. Safety and Tolerability: no patients made suicide attempts/required hospitalization. There was no worsening on the psychometric scales. Patients significantly increased weight [TNP 1.1(2.8) vs varenicline 2.5(3.3), p=0.063], without significant changes in vital signs/laboratory results, except significant decreases in alkaline phosphatase and low-density lipoprotein-cholesterol levels in the varenicline group. Patients under varenicline more frequently presented nausea/vomiting (p<0.0005), patients under TNP experienced skin reactions more frequently (p=0.002). Three patients under varenicline had elevated liver enzymes. In conclusion, we have demonstrated that in real-world clinical settings it is feasible and safe to help patients with stabilized severe mental disorders to quit smoking.

Improvements in negative symptoms and functional outcome after a new generation cognitive remediation program: a randomized controlled trial.

Cognitive remediation improves cognition in patients with schizophrenia, but its effect on other relevant factors such as negative symptoms and functional outcome has not been extensively studied. In this hospital-based study, 84 inpatients with chronic schizophrenia were recruited from Alava Hospital (Spain). All of the subjects underwent a baseline and a 3-month assessment that examined neurocognition, clinical symptoms, insight, and functional outcome according to the Global Assessment of Functioning (GAF) scale and Disability Assessment Schedule from World Health Organization (DAS-WHO). In addition to receiving standard treatment, patients were randomly assigned either to receive neuropsychological rehabilitation (REHACOP) or to a control group. REHACOP is an integrative program that taps all basic cognitive functions. The program included experts' latest suggestions about positive feedback and activities of daily living in the patients' environment. The REHACOP group showed significantly greater improvements at 3 months in the areas of neurocognition, negative symptoms, disorganization, and emotional distress compared with the control group (Cohen's effect size for these changes ranged from d = 0.47 for emotional distress to d = 0.58 for disorganization symptoms). The REHACOP group also improved significantly in both the GAF (d = 0.61) and DAS-WHO total scores (d = 0.57). Specifically, the patients showed significant improvement in vocational outcomes (d = 0.47), family contact (d = 0.50), and social competence (d = 0.56). In conclusion, neuropsychological rehabilitation may be useful for the reduction of negative symptoms and functional disability in schizophrenia. These findings support the integration of neuropsychological rehabilitation into standard treatment programs for patients with schizophrenia.

Effectiveness of a multi-component Smoking Cessation Support Programme (McSCSP) for patients with severe mental disorders: study design.

Only a few studies have examined the efficacy and safety of smoking cessation programmes in patients with mental disorders. The aim of this paper is to describe in detail the methodology used in the study as well as the Multi-component Smoking Cessation Support Programme in terms of pharmacological treatments and psychological interventions. An open-label 9-month follow-up study was conducted in Spain. A total of 82 clinically stable outpatients with schizophrenia, schizoaffective or bipolar disorder were enrolled. Treatment consisted of a programme specifically developed by the research team for individuals with severe mental disorders. The programme consisted of two phases: (1) weekly individual motivational therapy for 4-12 weeks, and (2) a 12-week active treatment phase. During this phase, at each study visit patients received a one- or two-week supply of medication (transdermal nicotine patches, varenicline or bupropion) with instructions on how to take it, in addition to group psychotherapy for smoking cessation. Evaluations were performed: (1) at the time of enrollment in the study, (2) during the 12-week active treatment phase of the study (weekly for the first 4 weeks and then biweekly), and (3) after the end of this phase (two follow-up assessments at weeks 12 and 24). Evaluations included: (1) smoking history, (2) substance use, (3) psychopathology, (4) adverse events, and (5) laboratory tests. The importance of this study lies in addressing a topical issue often ignored by psychiatrists: the unacceptably high rates of tobacco use in patients with severe mental disorders.

Evidencias de eficacia de la rehabilitación cognitiva en psicosis y esquizofrenia con el programa REHACOP. Réplica / Evidence of the effectiveness of cognitive rehabilitation in psychosis and schizophrenia with the REHACOP programme. Reply

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The course of the schizophrenia and its impact on cognition: a review of literature.

There has been increasing interest about cognition in schizophrenia during recent years. The greater focus of the investigators has been focused greater interest on the relation of cognitive deterioration with positive and negative symptoms, and functionality. However very few studies, if any, have specifically focused on the course of cognition in schizophrenic patients throughout the years. Those who have attempted to answer this question have done so by comparing cross-sectional studies of patients at different stages of their disease. Only a minority have used a longitudinal methodology in their studies. This article reviews a total of 31 cross-sectional and 43 longitudinal studies published in patients with a diagnosis of schizophrenia. The diversity of criteria and methods used significantly limits the conclusions that can be drawn. After a comprehensive review of the literature on this topic, the authors have come to the conclusion that there are two opposite trends: 1) Cognition in schizophrenia follows a progressive decline over the years of evolution of the disease (a conclusion predominant in studies with cross-sectional methodology) and 2) Cognition in schizophrenia remains stable once it appears during the first stages of the disease (a conclusion predominant in longitudinal studies). The authors conclude that the question about the likely decline of cognition in schizophrenia cannot be answered due to the lack of rigorous and thorough follow-up studies.

Curso evolutivo de la esquizofrenia y su impacto en la cognición: una revisión de la literatura / The course of the schizophrenia and its impact on cognition: a review of literature

Durante los últimos años ha habido un creciente interés sobre el problema de la cognición en la esquizofrenia. El mayor foco de interés de los investigadores ha descansado sobre la relación del deterioro cognitivo con los síntomas positivos y negativos de la enfermedad así como con la funcionalidad. Sin embargo muy pocos estudios se han centrado, específicamente, en determinar el curso del deterioro cognitivo a lo largo de la evolución de la enfermedad. La mayoría de quienes lo han intentando han empleado una metodología consistente en comparar transversalmente el estatus cognitivo de pacientes en diversos estadios evolutivos de la enfermedad. Solo una minoría ha empleado una metodología longitudinal. Este artículo revisa un total de 31 estudios transversales y 43 longitudinales en pacientes con esquizofrenia. La gran variabilidad de criterios y métodos dificulta enormemente la obtención de conclusiones a partir de los diversos hallazgos. Tras una exhaustiva revisión de la literatura sobre este asunto, los autores aprecian que hay dos tendencias principales: 1) El deterioro cognitivo evoluciona progresivamente a lo largo de la enfermedad (tesis predominante en los estudios de metodología transversal)y 2) El deterioro cognitivo permanece estable una vez que hace aparición (la tesis predominante de los estudios longitudinales). Los autores concluyen que la pregunta sobre la posible evolución del deterioro cognitivo no puede aún ser respondida por la carencia de suficientes estudios longitudinales con metodología rigurosa y suficientemente extensos (AU)

There has been increasing interest about cognition in schizophrenia during recent years. The greater focus of the investigators has been focused greater interest on the relation of cognitive deterioration with positive and negative symptoms, and functionality. However very few studies, if any, have specifically focused on the course of cognition in schizophrenic patients throughout the years. Those who have attempted to answer this question have done so by comparing cross-sectional studies of patients at different stages of their disease. Only a minority have used a longitudinal methodology in their studies. This article reviews a total of 31 cross-sectional and 43 longitudinal studies published in patients with a diagnosis of schizophrenia. The diversity of criteria and methods used significantly limits the conclusions that can be drawn. After a comprehensive review of the literature on this topic, the authors have come to the conclusion that there are two opposite trends: 1) Cognition in schizophrenia follows a progressive decline over the years of evolution of the disease (a conclusion predominant in studies with cross-sectional methodology) and 2) Cognition in schizophrenia remains stable once it appears during the first stages of the disease (a conclusion predominant in longitudinal studies). The authors conclude that the question about the likely decline of cognition in schizophrenia cannot be answered due to the lack of rigorous and thorough follow-up studies (AU)

[Evidence of the effectiveness of cognitive rehabilitation in psychosis and schizophrenia with the REHACOP programme]. / Evidencias de eficacia de la rehabilitación cognitiva en psicosis y esquizofrenia con el programa REHACOP.

INTRODUCTION: Neuropsychological rehabilitation in schizophrenia is a recent development and few studies have been conducted to determine its effectiveness in samples of a Spanish population. Specific therapeutic programmes have recently been designed, like REHACOP, which is a programme of cognitive rehabilitation in psychosis. This study aims to test the effectiveness of REHACOP in samples of patients with schizophrenia in a Spanish population in different phases of the disease. PATIENTS AND METHODS: Seventy-six patients were recruited and randomly assigned to either an experimental REHACOP group or a control group. The REHACOP group took part in three structured sessions held weekly for a period of three months, while the control group attended occupational therapy sessions with the same frequency and intensity. Both groups received standard additional treatment according to their course and progress. All the patients were evaluated before and after the intervention on attention, language, learning and memory, processing speed and executive functions. RESULTS: The REHACOP group offered significant improvements, with respect to the control group, in all the cognitive functions that were explored including attention, visuomotor integration, learning and memory or executive functions. Likewise, the REHACOP group showed a significant clinical and emotional improvement compared to the control group, as well as additional gains in their capacity for insight into the disease. CONCLUSIONS: The data from this study suggest that REHACOP can be an effective programme of intervention for bringing about improvements in the neuropsychological deterioration of patients with schizophrenia, regardless of the degree of impairment and the stage of progress of the disease.

Evidencias de eficacia de la rehabilitación cognitiva en psicosis y esquizofrenia con el programa REHACOP / Evidence of the effectiveness of cognitive rehabilitation in psychosis and schizophrenia with the REHACOP programme

Introducción. La rehabilitación neuropsicológica en esquizofrenia tiene un recorrido reciente y su eficacia en muestras depoblación española se ha comprobado en escasas ocasiones. Recientemente se han diseñado programas terapéuticos específicos,como el REHACOP, programa de rehabilitación cognitiva en psicosis. El objetivo de este estudio es probar la eficacia del REHACOP en muestras de pacientes con esquizofrenia en población española en diferentes fases de la enfermedad. Pacientes y métodos. Se reclutaron 76 pacientes que fueron asignados aleatoriamente a un grupo experimental REHACOP o a un grupo control. El grupo REHACOP realizó tres sesiones estructuradas semanales durante tres meses, mientras que el grupo control acudió a sesiones de terapia ocupacional con la misma frecuencia e intensidad. Ambos grupos recibieron el tratamiento adicional estándar en función de su curso y evolución. Se evaluó a todos los pacientes antes y después dela intervención en atención, lenguaje, aprendizaje y memoria, velocidad de procesamiento y funciones ejecutivas. Resultados. El grupo REHACOP presentó mejorías significativas en todas las funciones cognitivas exploradas respecto algrupo control, incluyendo atención, integración visuomotora, aprendizaje y memoria o funciones ejecutivas. Asimismo, el grupo REHACOP mostró una mejoría clínica y emocional significativa respecto al grupo control y ganancias adicionales en su capacidad de insight sobre la enfermedad. Conclusión. Los datos de este estudio sugieren que el REHACOP puede ser un programa de intervención eficaz para inducirmejoras en el deterioro neuropsicológico en pacientes con esquizofrenia independientemente del grado de deterioro y del estado evolutivo de la enfermedad (AU)

Introduction. Neuropsychological rehabilitation in schizophrenia is a recent development and few studies have been conducted to determine its effectiveness in samples of a Spanish population. Specific therapeutic programmes have recently been designed, like REHACOP, which is a programme of cognitive rehabilitation in psychosis. This study aims to test the effectiveness of REHACOP in samples of patients with schizophrenia in a Spanish population in different phases of the disease.Patients and methods. Seventy-six patients were recruited and randomly assigned to either an experimental REHACOPgroup or a control group. The REHACOP group took part in three structured sessions held weekly for a period of three months, while the control group attended occupational therapy sessions with the same frequency and intensity. Bothgroups received standard additional treatment according to their course and progress. All the patients were evaluated before and after the intervention on attention, language, learning and memory, processing speed and executive functions.Results. The REHACOP group offered significant improvements, with respect to the control group, in all the cognitive functions that were explored including attention, visuomotor integration, learning and memory or executive functions.Likewise, the REHACOP group showed a significant clinical and emotional improvement compared to the control group, as well as additional gains in their capacity for insight into the disease. Conclusions. The data from this study suggest that REHACOP can be an effective programme of intervention for bringing about improvements in the neuropsychological deterioration of patients with schizophrenia, regardless of the degree ofimpairment and the stage of progress of the disease (AU)

[REHACOP: a cognitive rehabilitation programme in psychosis]. / REHACOP: programa de rehabilitacion cognitiva en psicosis.

INTRODUCTION: In this work we present REHACOP, a programme of cognitive rehabilitation in psychosis. MATERIALS AND METHODS: The foundation of the REHACOP programme (its structure, materials, aims, work methodology and means of implementation) are described in detail. RESULTS AND CONCLUSIONS: This new therapeutic tool is presented with the aim of being of use to guide professionals who seek to design an intervention of this kind in samples of patients with schizophrenia or other pathologies.

REHACOP: programa de rehabilitación cognitiva en psicosis / REHACOP: a cognitive rehabilitation programme in psychosis

Introducción. En el presente trabajo se presenta el programa REHACOP, programa de rehabilitación cognitiva en psicosis. Materiales y métodos. La fundamentación del programa REHACOP -su estructura, materiales, objetivos, metodología de trabajo y modos de implementación- se describe de modo detallado. Resultados y conclusiones. Se ofrece una nueva herramienta terapéutica con el objetivo de que pueda servir de orientación a profesionales que se planteen el diseño de una intervención de estas características en muestras de pacientes con esquizofrenia u otras patologías (AU)

Introduction. In this work we present REHACOP, a programme of cognitive rehabilitation in psychosis. Materials and methods. The foundation of the REHACOP programme (its structure, materials, aims, work methodology and means of implementation) are described in detail. Results and conclusions. This new therapeutic tool is presented with the aim of being of use to guide professionals who seek to design an intervention of this kind in samples of patients with schizophrenia or other pathologies (AU)

An explanatory model of quality of life in schizophrenia: the role of processing speed and negative symptoms.

INTRODUCTION: Improving the quality of life of patients with schizophrenia is a major goal in managing this devastating disorder, but agreement is lacking about the factors that predict quality of life (QoL) over the course of the disorder. METHODS: We examined 165 hospitalized patients with schizophrenia in this study. We included measures for psychiatric (PANSS, insight and affective symptoms) and cognitive symptoms. Confirmatory factor analysis established a cognitive structure composed of the following six factors: attention, processing speed, verbal memory, fluency, working memory and executive functioning. Quality of life was assessed using the Heinrichs-Hanlon-Carpenter Scale. RESULTS: Age, duration of illness, presence of more severe negative symptoms and most cognitive factors correlated significantly with QoL indicators. Regression analysis showed that processing speed (PS) was by far the most important cognitive factor that predicted QoL. Moreover, the interaction between PS and negative symptoms, patient age and executive functions modified the effect of PS on QoL. Finally, positive symptoms and other socio-demographic data were not related to QoL in the current study. CONCLUSIONS: Our findings suggest that PS and negative symptoms predict QoL in schizophrenia.

Un modelo explicativo de la calidad de vida en la esquizofrenia: el papel de la velocidad de procesamiento y los síntomas negativos / An explanatory model of quality of life in schizophrenia: the role of processing speed and negative symptoms

Introducción. Mejorar la calidad de vida de los pacientes con esquizofrenia es un objetivo fundamental en una enfermedad que resulta devastadora, pero no hay acuerdo sobre qué factores predicen la calidad de vida (CV) en el curso de la enfermedad. Metodología. En el presente estudio se examinaron a165 pacientes hospitalizados con esquizofrenia. Se incluyeron medidas de síntomas psiquiátricos (PANSS, insight y síntomas afectivos) y cognitivas. Un análisis factorial confirmatorio estableció una estructura cognitiva compuesta de seis factores, que incluyen atención, velocidad de procesamiento, memoria verbal, fluidez, memoria de trabajo y funciones ejecutivas. La calidad de vida fue medida mediante la Escala de Calidad de Vida de Heinrichs-Hanlon-Carpenter. Resultados. La edad, tiempo de duración de la enfermedad, mayor gravedad de síntomas negativos y la mayoría de factores cognitivos correlacionaron significativamente con los indicadores de CV. Los análisis de regresión mostraron que, muy por encima de los demás factores cognitivos, la velocidad de procesamiento (VP) es un importante predictor de la CV. Además, la interacción de la VP con los síntomas negativos, la edad del paciente y el nivel de deterioro en funciones ejecutivas modificaron el efecto de la VP sobre la CV. Finalmente, los síntomas positivos y otros datos sociodemográficos no guardaron relación con la CV en nuestro estudio. Conclusiones. Nuestros hallazgos sugieren que la VP y los síntomas negativos predicen la CV en la esquizofrenia (AU)

Introduction. Improving the quality of life of patients with schizophrenia is a major goal in managing this devastating disorder, but agreement is lacking about the factors that predict quality of life (QoL) over the course of the disorder. Methods. We examined 165 hospitalized patients with schizophrenia in this study. We included measures for psychiatric (PANSS, insight and affective symptoms) and cognitive symptoms. Confirmatory factor analysis established a cognitive structure composed of the following six factors: attention, processing speed, verbal memory, fluency, working memory and executive functioning. Quality of life was assessed using the Heinrichs-Hanlon-Carpenter Scale. Results. Age, duration of illness, presence of more severe negative symptoms and most cognitive factors correlated significantly with QoL indicators. Regression analysis showed that processing speed (PS) was by far the most important cognitive factor that predicted QoL. Moreover, the interaction between PS and negative symptoms, patient age and executive functions modified the effect of PS on QoL. Finally, positive symptoms and other socio-demographic data were not related to QoL in the current study. Conclusions. Our findings suggest that PS and negative symptoms predict QoL in schizophrenia (AU)