Cristiano Noto

The Brazilian Journal of Psychiatry is the official publication of Brazilian Psychiatric Association (Associação Brasileira de Psiquiatria - ABP)

Background : Translating cognitive remediation gains into everyday functioning remains limited in schizophrenia. We evaluated a peer-mediated Feuerstein Instrumental Enrichment (FIE) approach, grounded in mediated learning principles, in individuals in the early phase of illness. The FIE approach utilizes small-group sessions, mediator oversight, and explicitly guided transfer strategies to promote metacognitive reflection and strengthen real-world generalization. Objective : This pilot study aimed to assess the feasibility and acceptability of a peer-mediated FIE program in first-episode psychosis (FEP) and to generate preliminary signals of its effect on patient-centered functional outcomes. Methods : In this open-label, single-arm pilot study, 16 individuals with FEP participated in a 10-week, group-based FIE program. Outcomes were assessed at baseline (T0), post-intervention (T1), and 6-month follow-up (T2). The primary outcome was patient-centered functioning, measured by the Goal Attainment Scale (GAS). Secondary outcomes included cognitive domains (MCCB) and symptom severity (PANSS). Change over time were analyzed using the non-parametric Friedman test. Results : The intervention demonstrated excellent feasibility, with 100% participant retention. Significant and sustained improvements were observed in patient-defined functional goals (GAS; χ2(2)=24.43, p<.001). Additionally, preliminary cognitive gains emerged in Processing Speed, as measured by the Coding subtest (χ2(2)=10.47, p<.005), and in Verbal Working Memory, assessed by the Letter–Number Span (χ2(2)=10.34, p<.006), suggesting domain-specific enhancement of cognitive efficiency and working memory manipulation. Furthermore, significant reductions were noted in positive, general, and total PANSS scores, while negative symptoms remained stable. Conclusions : Peer-mediated FIE is a highly feasible and acceptable intervention for individuals with FEP. The promising preliminary signals on patient-centered functioning and specific cognitive domains strongly support the need for a large-scale randomized controlled trial with an active control group to definitively establish efficacy.

The Brazilian Journal of Psychiatry is the official publication of Brazilian Psychiatric Association (Associação Brasileira de Psiquiatria - ABP)

Background: Schizophrenia is a disorder associated with neurocognitive deficits that adversely affect daily functioning and impose an economic burden. Cognitive rehabilitation interventions, particularly during the early phases of illness, have been shown to improve cognition, functionality, and quality of life. The Feuerstein Instrumental Enrichment (FIE) program, based on the Mediated Learning Experience and the Structural Cognitive Modifiability theory, has been applied in various disorders, but its applicability in schizophrenia has not yet been clarified. Objective: This study aims to investigate the effects of the FIE program on the functionality of patients with first-episode schizophrenia. Methods: In total, 17 patients will be recruited for an open-label intervention consisting of twice-weekly sessions for 10 weeks. The primary outcome measure will be changes in the Goal Achievement Scale score. Maze task performance from the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) battery will serve as a secondary outcome measure. At the same time, changes in Positive and Negative Syndrome Scale scores and other MATRICS domains will be analyzed as exploratory outcomes. Assessments will be administered before and after the intervention, with a follow-up period of 6 months. Results: This trial was preregistered in The Brazilian Registry of Clinical Trials (RBR-4gzhy4s). By February 2024, 11 participants were enrolled in the training. Recruitment is expected to be completed by May 2024. Data analysis will be conducted between May and September 2024. The results are expected to be published in January 2025. Conclusions: This study may establish a protocol for the FIE program that uses mediation techniques for individuals in the early stages of schizophrenia. The results will add to the knowledge about strategies to promote cognitive skills and functional impairment in daily life. International Registered Report Identifier (IRRID): DERR1-10.2196/57031

BACKGROUND Schizophrenia is a disorder associated with neurocognitive deficits that adversely affect daily functioning and impose an economic burden. Cognitive rehabilitation interventions, particularly during the early phases of illness, have been shown to improve cognition, functionality, and quality of life. The Feuerstein Instrumental Enrichment (FIE) program, based on the Mediated Learning Experience and the Structural Cognitive Modifiability theory, has been applied in various disorders, but its applicability in schizophrenia has not yet been clarified. OBJECTIVE This study aims to investigate the effects of the FIE program on the functionality of patients with first-episode schizophrenia. METHODS In total, 17 patients will be recruited for an open-label intervention consisting of twice-weekly sessions for 10 weeks. The primary outcome measure will be changes in the Goal Achievement Scale score. Maze task performance from the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) battery will serve as a secondary outcome measure. At the same time, changes in Positive and Negative Syndrome Scale scores and other MATRICS domains will be analyzed as exploratory outcomes. Assessments will be administered before and after the intervention, with a follow-up period of 6 months. RESULTS This trial was preregistered in The Brazilian Registry of Clinical Trials (RBR-4gzhy4s). By February 2024, 11 participants were enrolled in the training. Recruitment is expected to be completed by May 2024. Data analysis will be conducted between May and September 2024. The results are expected to be published in January 2025. CONCLUSIONS This study may establish a protocol for the FIE program that uses mediation techniques for individuals in the early stages of schizophrenia. The results will add to the knowledge about strategies to promote cognitive skills and functional impairment in daily life. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/57031

Nuclear distribution element like-1 (Ndel1) is a cytosolic oligopeptidase, which was suggested as a potential biomarker of aberrant neurodevelopment and early stage of schizophrenia (SCZ). The invo...

Objective: Clozapine is a second-generation antipsychotic indicated for treatment-resistant schizophrenia. Studies in several countries have shown a low rate of clozapine use despite the fact that approximately 30% of schizophrenia cases are treatment-resistant. In Brazil, few studies have addressed the frequency and variety of antipsychotic use in individuals diagnosed with schizophrenia (ICD F20). The objective of this study was to measure the rates of clozapine use in this population in the last decade using Brazilian Ministry of Health data.Methods: Prescriptions made between 2010 and 2020 in all 26 states and the Federal District registered at the Outpatient Information System Database from the Brazilian Health System (SIASUS) were evaluated.Results: A total of 25,143,524 prescriptions were recorded in this period, with clozapine representing 8.86% of all antipsychotics. The most frequently prescribed antipsychotic for patients with schizophrenia was olanzapine (35.8%), followed by quetiapine (27.5%). From 2010 to 2020, the rate of clozapine prescriptions in Brazil increased from 7.2% to 10.9%.Conclusions: Despite a slight increase in prescriptions in the last decade, clozapine is still underutilized in Brazil.