Changes in aspects of cognitive functioning in young patients with schizophrenia during group psychodynamic psychotherapy: a preliminary study

A Systematic Review on Add-On Psychotherapy in Schizophrenia Spectrum Disorders

Schizophrenia spectrum disorders represent a varied class of mental illnesses characterised by psychosis. In addition to negative and positive symptoms, a significant lack of insight often hinders the therapeutic process. We performed an overview of the existing literature concerning these disorders to summarise the state of knowledge in the psychotherapies applied to treating psychotic symptoms. We searched the PubMed database, including randomised controlled and clinical trials, including 17 studies conducted on 1203 subjects. Psychotherapy of schizophrenia spectrum disorders can improve social functioning and positive symptoms, as well as many other symptomatic areas, and could therefore be considered a helpful adjunctive treatment of schizophrenia spectrum disorders. Among cognitive-behavioural therapies and the newest derived approaches, there is evidence that they can improve different psychotic symptoms. On the other hand, psychodynamic psychotherapies can have a positive influence on psychotic symptoms as well. Further studies are needed to identify better-tailored treatment protocols for schizophrenia spectrum disorders.

Psychodynamic day treatment programme for patients with schizophrenia spectrum disorders: Dynamics and predictors of therapeutic change

OBJECTIVES

The purpose of this study was to test whether a psychodynamically based group psychotherapeutic programme might improve symptoms, social functions, or quality of life in patients with schizophrenia spectrum disorders and to investigate factors that might predict clinical improvement or dropouts from the programme.

DESIGN

A quantitative prospective cohort study.

METHODS

We have investigated 81 patients with schizophrenia spectrum disorders who participated in a 9-month psychodynamically based psychotherapeutic day programme. The patients were assessed at the beginning and end of the programme, and then at 1-year follow-up. The assessment included psychotic manifestations (HoNOS), quality of life (WHOQOL-BREF), demographic data, and daily doses of medication. 21 patients dropped out from the programme, and 46 patients succeeded in undergoing follow-up assessment.

RESULTS

The psychotic manifestations (self-rating version of HoNOS) and quality of life measured with WHOQOL-BREF (domains of social relationships and environment) were significantly improved at the end of the programme and at follow-up. However, the manifestations on the version for external evaluators of HoNOS were improved only at follow-up. Years of psychiatric treatment, number of hospitalizations or suicide attempts, and experience of relationships with a partner were negatively related to clinical improvement, whereas symptom severity, current working, or study activities were related positively.

CONCLUSIONS

The results show that a group psychodynamic programme may improve the clinical status and quality of life of patients with schizophrenia spectrum disorders. This type of programme is more beneficial for patients with higher pre-treatment symptom severity and the presence of working or study activities.

PRACTITIONER POINTS

A psychodynamically based group programme improves the clinical status and quality of life in patients with schizophrenia spectrum disorders. Data indicate that changes on the subjective level are detectable by the end of the programme, while changes on the objective level are detectable at follow-up assessment. Symptom severity and working or study activities are positively related to the clinical improvement in this type of programme, while a high number of years in psychiatric treatment or psychiatric hospitalizations are negatively related. The doses of medication (antipsychotics or antidepressants) show no significant relationship to clinical improvement.

Breaking Through to the Other Side: A Resident Explores the Benefits of Time-Limited Psychodynamic Therapy for Patients with Schizophrenia

This article recounts the case of a patient with schizophrenia engaged in time-limited psychodynamic psychotherapy with a psychiatry resident-the first case history of its type to the author's knowledge. This patient suffered from chronically debilitating schizophrenia with persistent positive and negative symptoms at the time of treatment, despite usual psychiatric management. He benefited significantly from 18 weekly sessions of weekly dynamic therapy, achieving symptom reduction, increased social involvement, and improved functioning-gains that were sustained at 9-month follow-up. The author narrates the patient's therapeutic progress from a clinician-in-training's perspective, commenting on technical aspects of his treatment. The author examines how the time-limited nature of the therapy may have infused the transference and influenced the patient's outcome. The author also reviews the evidence base for psychodynamic treatment of patients with schizophrenia, focusing on short-term therapy specifically. The author invites greater inquiry into time-limited therapeutic approaches with such patients.