Integrated Psychological Therapy: Effectiveness in Schizophrenia Inpatient Settings Related to Patients' Age

Abstract

Objective: Elderly people with schizophrenia often suffer from cognitive impairments, which affect their social functioning. Today, only few therapy approaches for middleaged and older patients are available. The Integrated Psychological Therapy (IPT) combines neurocognitive and social cognitive interventions with social skills approaches. The aim of this study was to evaluate (1) whether IPT is effective in younger patients (age<40 years) and middle-aged patients (age≥40 years), and (2) whether control conditions (CC: treatment as usual or unspecific group activities) reveal some change in outcome depending on age. Method: A total of 15 controlled IPT studies with 632 schizophrenia inpatients were included into a standard meta-analytic procedure. Studies were categorized into two age-categories. Results: Significant medium to high effect sizes (ES) were evident for IPT independent of age on the global cognitive score (mean score of all cognitive variables), on neurocognition, social cognition, social functioning, psychopathology, and on the global therapy effect (mean of all variables). The IPT effects in middleaged patients were significantly higher on the global cognitive score, on neurocognition and on social cognition compared to younger patients. Opposite results could be observed in CC. Only younger patients participating in the CC showed small but significant ES on these variables, but almost middle-aged control patients did not. However, none of the differences in CC were significant between the two age-categories. A moderator analysis obtained no evidence for a strong impact of IPT variations, therapy setting, patient characteristics and methodological rigor of the research design. Conclusions: These results support evidence for the efficacy of IPT independent of age. Results further indicate the need of goal-oriented specific psychological interventions for middle-aged and older schizophrenia patients.Keywords: Schizophrenia, aged, middle-aged, elderly, cognition, therapy, integrated therapy, cognitive remediation, meta-analysis 3 There is evidence for a gradual aging of the population in developed countries all over the world, and also an increase of middle-aged and elderly schizophrenia patients. 1 Therefore, research focusing on the impact of the age on schizophrenia features as well as on the successful treatment of these features becomes important. During the last decades, a large bulk of data was published addressing younger people suffering from schizophrenia, but the needs of older schizophrenia patients were often neglected. Recent reviews of published data on the rehabilitation goals for older people with serious mental illness summarized that poor outcome in social functioning and lower quality of life are strongly associated with social isolation, depression, cognitive impairment, and chronic medical illness. 1,2 The authors concluded that specific interventions are needed with regard to these specific features associated with social functioning and quality of life in older patient...

Effectiveness of integrated psychological therapy on clinical, neuropsychological, emotional and functional outcome in schizophrenia: a RCT study

“…Regarding clinical and functional assessment, the results revealed significant differences in favour of IPT group in the negative and total PANSS and in the GAF and WHOQOL scales. These findings could be explained by the positive effect of the five IPT rehabilitation subprograms on overall symptoms (Mueller et al, 2013), quality of life in the psychological domain (Rakitzi et al, 2016), socio-working and general functioning (Zimmer et al, 2007).…”

Effet de l’Integrated Psychological Treatment chez des patients souffrant de schizophrénie hospitalisés au Liban

“…Les scores obtenus par le groupe expérimental aux différents tests et échelles permettent de conclure que la participation au programme IPT engendre une amélioration du fonctionnement cognitif, d'une part, et une diminution de la symptomatologie, n. Ces résultats corroborent ceux de la littérature qui démontrent l'efficacité de l'IPT chez les patients souffrant de schizophrénie [17], quel que soit l'âge des patients [18]. Cette étude démontre que l'IPT repré-sente un programme thérapeutique accessible et bénéfique aux patients hospitalisés au long court (au moins sept ans) du fait d'une schizophrénie chronique et sévère.…”

INT-Integrated Neurocognitive Therapy for Schizophrenia Patients

“…IPT is also less emotionally straining compared to INT. IPT has also consistently demonstrated signifi cantly greater treatment eff ects on middle-aged and older patients then on control patients under standard treatment conditions (Mueller et al 2013 ). Th e results of the research on IPT, now stretching over three decades, have also repeatedly demonstrated a reduction of negative symptoms (summarized in Roder et al 2006aMueller and Roder 2008 ).…”