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BACKGROUND: The coronavirus disease 2019 (COVID-19) has affected the vulnerable Brazilian population. In this study, we investigated the burden of COVID-19 on caregivers for patients with schizophrenia. OBJECTIVE: This study assessed objective and subjective burden of caregivers for patients with schizophrenia during the COVID-19 pandemic and compared the measurements obtained in the study to that before the pandemic. METHODS: The study included 50 caregivers who were assessed using the Sociodemographic Questionnaire, and the Family Burden Interview Schedule, Brazilian version (FBIS-BR). An adaptation of the Clinical Global Impression-Improvement (CGI-I) was made, in which caregivers evaluated their 'clinical' impression about the patient during the COVID-19 pandemic in comparison to pre-pandemic mental status. RESULTS: Most caregivers were female, aged between 24 and 80 years, who were in contact with the patient for about 88.56 hours/week. In relation to caregiver burden, there was a significant increase in the total subjective burden (p < .001), but not in the total objective burden. The following subjective domains of the burden showed a significant increase: assistance in daily life (p < .001) and worries about patients' present and future life (p = .033). There was a decrease in the objective burden related to supervision of patients' problematic behaviors (p = .031). Although the caregiver's income did not change significantly during the COVID-19 pandemic, there was an increase in the percentage of caregivers who perceived the frequency of financial burden imposed by the patient as 'very frequent' and 'always or almost always'; conversely there was a significant decrease in the subjective perception of the caregiver that the patient imposed financially 'no burden' or a 'seldom burden' (from 34% to 4%). CONCLUSION: Although the objective burden of the caregivers, during the pandemic, was similar the pre-pandemic levels, caregivers' subjective burden increased reinforcing the need for special attention to the caregiver in this global emergency.

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BACKGROUND: To investigate the objective and subjective burden on caregivers of schizophrenia outpatients and their associations with sociodemographic factors, symptomatology, and functioning. METHODS: This study included 60 schizophrenic outpatients aged 18 to 65 years who were clinically stable for at least 6 months, and 60 caregivers aged 18 to 80 years who were in contact with the patient for ⩾30 hours/week. The patients were assessed using a sociodemographic questionnaire, the Clinical Global Impression Scale for Schizophrenia (CGI-SCH), and the Personal and Social Performance scale (PSP). The caregivers were assessed using a sociodemographic questionnaire and the Family Burden Interview Schedule, Brazilian version (FBIS-BR). RESULTS: The objective burden was positively correlated with CGI-SCH cognitive symptom scores (p = .032) and number of hours spent weekly with the patient (p = .028), and negatively correlated with PSP score (r = -.346, p = .007). The subjective burden showed a negative correlation with age of disease onset (r = -.338, p = .08). The independent variables included in the regression model were family income (p = .005), PSP score (p = .009), patient marital status (p = .012), patient gender (p = .046), and reception of financial benefit (p = .027) for objective burden; and disease duration (p = .045) and father/mother or sibling relationship (p = .001) for subjective burden. The coefficient of determination (R2) of the linear regression model for objective burden was 39.4%; subjective burden, 21.6%. CONCLUSION: Caring for female, single patients with longer disease duration, more severe cognitive symptoms, impaired functioning, and more caregiving time required per week were associated with higher caregiver burden levels.

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BACKGROUND: Negative symptoms are a core feature of schizophrenia. The Brief Negative Symptom Scale (BNSS) is a scale developed to measure negative symptoms in schizophrenia. METHODS: The present study aimed to examine the construct validity of BNSS, by using convergent and divergent validities as well as factor analysis, in a Brazilian sample of 111 outpatients diagnosed with schizophrenia by DSM-5. Patients were evaluated by the Brazilian version of the BNSS and positive and negative subscales of the Positive and Negative Syndrome Scale (PANSS). RESULTS: Assessment of patients by both instruments revealed an excellent internal consistency (Cronbach's alpha = 0.938) or inter-rater reliability (ICC = 0.92), as well as a strong correlation between BNSS and Marder negative PANSS (r = 0.866) and a weak correlation of the instrument with the positive PANSS (r = 0.292), thus characterizing convergent and discriminant validities, respectively. The exploratory factor analysis identified two distinct factors, namely, motivation/pleasure and emotional expressivity, accounting for 68.63% of the total variance. CONCLUSION: The study shows that the Brazilian version of the BNSS has adequate psychometric properties and is a reliable instrument for the assessment of negative symptoms in schizophrenia, either for clinical practice or research.

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Schizophrenia is a chronic disabling mental disorder that involves impairments in several cognitive domains, especially in executive functions (EF), as well as impairments in functional performance. This is particularly true in patients with Treatment-Resistant Schizophrenia (TRS). The aim of this study was to test the efficacy of the Occupational Goal Intervention (OGI) method for the improvement of EF in patients with TRS. In this randomized, controlled, single-blind pilot study, 25 TRS patients were randomly assigned to attend 30 sessions of either OGI or craft activities (control) over a 15-week period and evaluated by the Behavioural Assessment of the Dysexecutive Syndrome (BADS) as the primary outcome and the Direct Assessment of Functional Status (DAFS-BR) as well as the Independent Living Skills Survey (ILSS-BR) as secondary outcomes, all adapted for the Brazilian population. The Positive and Negative Syndrome Scale (PANSS) was used for monitoring symptom severity. Results showed significant statistical differences, favoring the OGI group in terms of improvement on the BADS, both in subtests (Action Program and Key Search) and the total score. Improvements in EFs were observed by families in various dimensions as measured by different subtests of the ILSS-BR inventory. The OGI group showed no significant results in secondary outcomes (DAFS-BR) except in terms of improvement of communication skills. Although preliminary, our results indicate that the OGI method is efficacious and effective for patients with TRS.

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Cognitive deficits in schizophrenia can massively impact functionality and quality of life, furthering the importance of cognitive training. Despite the development of the field in Europe and in the United States, no programmes have been developed and tested in developing countries. Different cultural backgrounds, budget restrictions, and other difficulties may render treatment packages created in high income countries difficult for adoption by developing nations. We performed a pilot double-blind, randomized, controlled trial in order to investigate the efficacy and feasibility of an attention and memory training programme specially created in a developing nation. The intervention used simple, widely available materials, required minimal infrastructure, and was conducted in groups. The sample included seventeen stable Brazilians with schizophrenia. Sessions were conducted weekly during five months. The cognitive training group showed significant improvements in inhibitory control and set-shifting over time. Both groups showed improvements in symptoms, processing speed, selective attention, executive function, and long-term visual memory. Improvements were found in the control group in long-term verbal memory and concentration. Our findings reinforce the idea that cognitive training in schizophrenia can be constructed using simple resources and infrastructure, facilitating its adoption by developing countries, and it may improve cognition.

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INTRODUCTION: The best prevention against relapse results when patients are taught to restructure negative core beliefs (CBs). Efficacy of the trial-based thought record (TBTR) in decreasing the credit given by patients to negative CBs and corresponding emotions was evaluated. METHOD: Patients (n = 166) were submitted to a simulation of a legal trial to assess their adherence to negative CBs and corresponding emotions after each cognitive therapy technique incorporated by TBTR. RESULTS: Significant reductions existed in percent values after the first and second defense attorney pleas, as well as after jury's verdict and initial preparation for the appeal (p < 0.001), relative to the investigation phase. Significant differences also emerged between the defense attorney's first and second pleas and between the defense attorney's second plea and jury's verdict, as well as preparation for the appeal (p < 0.001). There was no significant difference between percentages presented by patients submitted to TBTR used in the empty chair format relative to the conventional format. Similarly, there was no difference between outcomes, regardless of therapists' level of exposure to TBTR. CONCLUSION: TBTR may help patients reduce attachment to negative CBs and corresponding emotions. Outcomes were significantly favorable regardless of the format use and therapists' level of exposure to TBTR.

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The use of cognitive-behavior therapy (CBT) in addition to antipsychotic regimen to treat persistent psychotic symptoms of schizophrenia is growing. The aim of this study was to compare the efficacy of CBT to a befriending (BF) control group in patients with schizophrenia who are refractory to clozapine. Twenty-one patients completed the 21-week trial. In comparison with the control group, the CBT group showed a significant improvement in the General Psychopathology and total score of the Positive and Negative Syndrome Scale, as well as an improvement of Quality of Life scale. The improvement in psychopathology persisted at 6-month follow-up assessment.

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