Effects of psychological treatments on functioning in people with Schizophrenia: a systematic review and meta-analysis of randomized controlled trials

Abstract

Functioning is recognized as a key treatment goal in alleviating the burden of schizophrenia. Psychological interventions can play an important role in improving functioning in this population, but the evidence on their efficacy is limited. We therefore aimed to evaluate the effect of psychological interventions in functioning for patients with schizophrenia. To conduct this systematic review and meta-analysis, we searched for published and unpublished randomized controlled trials (RCTs) in EMBASE, MEDLINE, PsycINFO, BIOSIS, Cochrane Library, WHO International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov and the Study register of the Cochrane Schizophrenia Group. The outcome functioning was measured with validated scales. We performed random-effects pairwise meta-analysis to calculate standardized mean differences (SMDs) with 95% confidence intervals (CIs). We included 58 RCTs (5048 participants). Psychological interventions analyzed together (SMD = – 0.37, 95% CI – 0.49 to – 0.25), cognitive behavioral therapy (30 RCTs, SMD = – 0.26, 95% CI – 0.39 to – 0.12), and third wave cognitive-behavioral therapies (15 RCTs, SMD = – 0.60, 95% CI – 0.83 to – 0.37) were superior to control in improving functioning, while creative therapies (8 RCTs, SMD = 0.01, 95% CI – 0.38 to 0.39), integrated therapies (4 RCTs, SMD = – 0.21, 95% CI – 1.20 to 0.78) and other therapies (4 RCTs, SMD = – 0.74, 95% CI – 1.52 to 0.04) did not show a benefit. Psychological interventions, in particular cognitive behavioral therapy and third wave cognitive behavioral therapies, have shown a therapeutic effect on functioning. The confidence in the estimate was evaluated as very low due to risk of bias, heterogeneity and possible publication bias.

Exploring Personal Recovery in Schizophrenia: The Role of Mentalization

“…A recent meta-analysis by Thibaudeau et al exploring the associations between ToM and different domains of functioning in schizophrenia showed a strong association between mentalization abilities and functioning in areas involving social interactions such as social functioning and productive activities [ 43 ]. Most interventions in mental healthcare aim to reduce symptoms and improve functioning [ 54 ]. With regard to PR, these interventions may also benefit from focusing on mentalization.…”

Efficacy and safety of clozapine combination with different antipsychotics in schizophrenia: a systematic review

“…Clozapine is one of the antipsychotic that is often used in combination in hospitalized schizophrenia patients. 6,7 However, refractory schizophrenia patients who do not respond to clozapine monotherapy can cause clinical problems. One rational strategy is to give clozapine in combination with other antipsychotics belonging binding properties to dopamine receptors that are stronger than clozapine.…”

Introduction for the follow-up of the Eighth International Kraepelin Symposium at LMU Munich

“…Wright et al [ 8 ] investigate the relationship between patterns of cannabis use in first-episode psychosis (FEP) and its functional and symptomatic trajectories. There is heterogeneous data on cannabis use predicting outcome, however, sporadic user who received early intervention therapy (EIS) improved more in overall psychosocial functioning than those in clinical care.…”

“…Bighelli et al [ 8 ] investigate the effects of psychological treatment on psychosocial functioning in people with schizophrenia providing a systematic review and meta-analysis of 58 randomized controlled trials (5048 participants). CBT and third wave CBT were superior to controls in improving psychosocial functioning, whereas creative or integrated therapies showed no benefit.…”

“…Translation from mechanism to mental health practices covers basic research in psychological targets in trauma and its translation in mental health practices [4]. Translation of new mechanisms in secondary prevention focus on family communication [5], cannabis patterns in first episode [6] or cognitive biases in metacognitive training [7] as well as on evidence advancing understanding and treatment in later phases of psychoses based on meta-analysis [8]. Pioneering psychoeducational groups in borderline personality disorder [9] and metabolic disturbances and weight gain in a transdiagnostic sample [10] are novel topics.…”