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

Background: Patients 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.Methods: A 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).Results: 160 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).Conclusion: in 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 identifier: NCT01368406Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Eli Lilly do BrasilCoordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Ministry of EducationJanssen-CilagNovartisRocheConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundacao SafraFundacao ABRADSLundbeckEli Lilly laboratoryUniversidade Federal de São Paulo, Dept Psychiat, BR-04044000 São Paulo, BrazilUniv São Paulo, Med School, Dept & Inst Psychiat, BR-05403010 São Paulo, BrazilCAISM Ctr Atencao Integrada Saude Mental Irmandad, BR-04017030 São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Med, Div Endocrinol, BR-04039002 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, BR-04044000 São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Med, Div Endocrinol, BR-04039002 São Paulo, BrazilFAPESP: 2007/00464-6Web of Scienc

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

Objective: Work is considered one of the main forms of social organizationhowever, 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 workhowever, this calls for discussion about the importance of employment support.Programa de Esquizofrenia (PROESQ)Centro de Atencao Integrada a Saude Mental (CAISM)Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP) [2011/50740-5]Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES)FAPESPConselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq)CAPESUniv Fed Sao Paulo UNIFESP, Dept Psiquiatria, Sao Paulo, SP, BrazilUniv Fed Sao Carlos UFSCar, Dept Med, Sao Carlos, SP, BrazilUniv Fed Sao Carlos, Dept Terapia Ocupac, Sao Carlos, SP, BrazilFac Ciencias Med Santa Casa Sao Paulo, Dept Psiquiatria, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Dept Psiquiatria, Sao Paulo, SP, BrazilFAPESP [2011/50740-5]Web of Scienc

Willingness to Pay in Caregivers of Patients Affected by Schizophrenia

Background: Schizophrenia is a debilitating disorder that often requires the affected individual to receive care from a caregiver. Willingness to Pay (WTP) technique allows a valuation of the health state preferences by assessing the impact of the disease and translating it into monetary terms. Aims of the Study: The objective was to determine the WTP of schizophrenic patients' caregivers on a hypothetical recovery scenario and correlate it to socio-demographic and clinical characteristics, Knowledge of Disease, Quality of life and Burden of Disease. Methods: A convenience sample consecutively assessed 189 outpatients' caregivers from Schizophrenia Program of Federal University of Sao Paulo. A single caregiver was considered for each patient, taking into consideration their close relationship and their direct involvement in the treatment. Open WTP questionnaire for a hypothetical schizophrenia recovery scenario, KAST (Knowledge of Disease), SF-6D (Quality of life) and ZBI-22 (Burden of Disease) scales were applied. Results: A monthly WTP mean value (SD) of US$ 63.63 (111.88) was found. The average value (SD) found was 12.96 (2.45) on KAST, 0.78 (0.08) on SF6D and 29.91 (16.10) on ZARIT. Income, education, social class, knowledge of disease and burden of caregiver were positively correlated to the WTP value. By linear regression model, income and education remained significant. Conclusion: Willingness to Pay (WTP) is a method that can be used to determine the strength of preference of patients and caregivers for a recovery in schizophrenia. The higher the income and education, the higher the willingness to pay. No clinical characteristics of patients had a statistically significant relation to the value the caregiver would pay. Implications for Health Policies: WTP is a potentially useful tool to determine values and health care preferences, and can be used for the development of mental health policies. Implications for Further Research: Future research should be used to enhance WTP tool in mental health studies on the impact of diseases, including schizophrenia.Univ Fed Sao Paulo, Dept Psychiat, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Ctr Hlth Econ, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Psychiat, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Ctr Hlth Econ, Sao Paulo, SP, BrazilWeb of Scienc