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20-08-2013 | Mental health | Article

Integrated therapy has few long-term schizophrenia benefits

Abstract

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medwireNews: The benefits of early integrated treatment for recent onset schizophrenia may not be sustained over the long term, findings from a 12-year follow-up study show.

The only long-term benefit of integrated treatment was the possible prevention of involuntary hospital treatment; otherwise there were no significant differences in the use of in- and outpatient services between patients receiving this therapy versus standard treatment.

The findings “further strengthen the implications from other recent studies,” note lead researcher Viðir Sigrúnarson (Norwegian University of Science and Technology, Trondheim) and team.

They add, however, that recovery of schizophrenia is complex and the use of in- and outpatient services is only one of many outcome measures.

“Because of the limited scope of the outcome measures in this study the possible long-term effects of [integrated therapy] on these multiple aspects of recovery may be hidden and not revealed,” the team writes in BMC Psychiatry.

The 50 study participants with recent-onset schizophrenia, aged 18 to 35 years, all received treatment as usual, which comprised regular outpatient case management with antipsychotic medication, emergency inpatient treatment when needed, supportive housing and day care, rehabilitation care, supportive psychotherapy, and brief psycho-education.

Thirty of these patients also received 2 years of integrated therapy, involving cognitive–behavioral family communication and problem-solving skills training, individual cognitive–behavioral strategies for residual symptoms and disability, and structured single-family psycho-education, as well as education on the use of medication and improving adherence.

Integrated therapy had a beneficial effect on symptoms and their stabilization in the short term. But during the 12 years following treatment there was no advantage to receiving integrated therapy in terms of number of days spent in hospital, time to readmission, number of admittances to psychiatric wards, or number of outpatient contacts.

It was associated with fewer involuntary hospital admissions, however, at 39% compared with 71% with standard psychotherapy. And the median time to readmission was considerably longer for those receiving integrated therapy, although this difference was not significant.

Sigrúnarson and colleagues note that most of the patients entered the study after their first hospitalization and so had relatively established psychosis, albeit of recent onset.

“It is possible that integrated interventions at an earlier stage could have improved their long-term use of services,” they suggest, adding that the treatment in their study may have also been too time-limited.

medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Lucy Piper, Senior medwireNews Reporter