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. 2001;2001(3):CD001360.
doi: 10.1002/14651858.CD001360.

Individual psychodynamic psychotherapy and psychoanalysis for schizophrenia and severe mental illness

L Malmberg  1 , M Fenton
Affiliations

Individual psychodynamic psychotherapy and psychoanalysis for schizophrenia and severe mental illness

L Malmberg et al. Cochrane Database Syst Rev. 2001.

Abstract

Background: People with schizophrenia and severe mental illness may require considerable support from health care professionals, in most cases over a long period of time. Research on the effects of psychotherapy for schizophrenia shows mixed results. Although pharmacological interventions remain the treatment of choice for schizophrenia patients, it is also of interest to look at the effects of treatment methods focusing on psychosocial factors affecting schizophrenia.

Objectives: To review the effects of individual psychodynamic psychotherapy and/or psychoanalysis for people with schizophrenia or severe mental illness.

Search strategy: Electronic searches of Biological Abstracts (1985-1999), CINAHL (1982-1999), The Cochrane Library CENTRAL (Issue 1, 1999), The Cochrane Schizophrenia Group's Register (2000), Dissertation Abstracts On Disc (1866-1999), EMBASE (1980-1999), MEDLINE (1966-1999), National Research Register (2000), PsycLIT (1974-1999), and Sociofile (1974-1998) were made. Authors of included trials were contacted for information on further trials.

Selection criteria: All randomised trials of individual psychodynamic psychotherapy or psychoanalysis for people with schizophrenia or severe mental illness (however defined) were selected.

Data collection and analysis: Data were independently extracted by at least two reviewers. For dichotomous data relative risks (RR) were calculated and for continuous data weighted mean differences (WMD) between groups were calculated.

Main results: No trials of a psychoanalytic approach were identified. Data are sparse for all comparisons involving a psychodynamic approach. There is no evidence of any positive effect of psychodynamic therapy and the possibility of adverse effects seems never to have been considered. The psychodynamic approach may be more acceptable to people than a more cognitive reality-adaptive therapy.

Reviewer's conclusions: Current data do not support the use of psychodynamic psychotherapy techniques for hospitalised people with schizophrenia. If psychoanalytic therapy is being used for people with schizophrenia there is an urgent need for trials.

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Conflict of interest statement

Mark Fenton: has been a patient in both individual and group psychoanalytic psychotherapy and worked as a nurse psychotherapist in the National Health System (UK) and believes that psychoanalytic treatment has a place in any healthcare system. Lena Malmberg: works as a doctor on a psychodynamically‐oriented rehabilitation unit for patients living in the community with schizophrenia in Porvoo, Finland. John Rathbone: none known.

Figures

1
1
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
1.1
1.1. Analysis
Comparison 1 INDIVIDUAL PSYCHODYNAMIC PSYCHOTHERAPY versus MEDICATION, Outcome 1 Committed suicide by three years.
1.2
1.2. Analysis
Comparison 1 INDIVIDUAL PSYCHODYNAMIC PSYCHOTHERAPY versus MEDICATION, Outcome 2 Global impression: 1. Not able to be discharged (long term).
1.3
1.3. Analysis
Comparison 1 INDIVIDUAL PSYCHODYNAMIC PSYCHOTHERAPY versus MEDICATION, Outcome 3 Global impression: 2. Given medication during 12 months to three years follow up.
1.4
1.4. Analysis
Comparison 1 INDIVIDUAL PSYCHODYNAMIC PSYCHOTHERAPY versus MEDICATION, Outcome 4 Global impression: 3. Achieved best level of health MHSS ‐ long term (high=good).
1.5
1.5. Analysis
Comparison 1 INDIVIDUAL PSYCHODYNAMIC PSYCHOTHERAPY versus MEDICATION, Outcome 5 Global impression: 4. Treatment not considered successful by treatment team (long term).
1.6
1.6. Analysis
Comparison 1 INDIVIDUAL PSYCHODYNAMIC PSYCHOTHERAPY versus MEDICATION, Outcome 6 Global impression: 5. Hospital re‐admission (long term).
1.7
1.7. Analysis
Comparison 1 INDIVIDUAL PSYCHODYNAMIC PSYCHOTHERAPY versus MEDICATION, Outcome 7 Leaving the study early (long term).
2.1
2.1. Analysis
Comparison 2 INDIVIDUAL PSYCHODYNAMIC PSYCHOTHERAPY AND MEDICATION versus MEDICATION ALONE, Outcome 1 Committed suicide by three years.
2.2
2.2. Analysis
Comparison 2 INDIVIDUAL PSYCHODYNAMIC PSYCHOTHERAPY AND MEDICATION versus MEDICATION ALONE, Outcome 2 Global impression: 1. Not able to be discharged (long term).
2.3
2.3. Analysis
Comparison 2 INDIVIDUAL PSYCHODYNAMIC PSYCHOTHERAPY AND MEDICATION versus MEDICATION ALONE, Outcome 3 Global impression: 2. Given medication during 12 months to three years follow up.
2.4
2.4. Analysis
Comparison 2 INDIVIDUAL PSYCHODYNAMIC PSYCHOTHERAPY AND MEDICATION versus MEDICATION ALONE, Outcome 4 Global impression: 3. Achieved best level of health ‐ MHSS ‐ high=good (long term).
2.5
2.5. Analysis
Comparison 2 INDIVIDUAL PSYCHODYNAMIC PSYCHOTHERAPY AND MEDICATION versus MEDICATION ALONE, Outcome 5 Global impression: 4. Treatment not considered successful by treatment team (long term).
2.6
2.6. Analysis
Comparison 2 INDIVIDUAL PSYCHODYNAMIC PSYCHOTHERAPY AND MEDICATION versus MEDICATION ALONE, Outcome 6 Global impression: 5. Hospital re‐admission (long term).
2.7
2.7. Analysis
Comparison 2 INDIVIDUAL PSYCHODYNAMIC PSYCHOTHERAPY AND MEDICATION versus MEDICATION ALONE, Outcome 7 Leaving the study early (long term).
3.1
3.1. Analysis
Comparison 3 INSIGHT‐ORIENTED PSYCHODYNAMIC PSYCHOTHERAPY versus REALITY‐ADAPTIVE PSYCHOTHERAPY, Outcome 1 Global impression: 1. Not able to perform major household responsibilities (long term).
3.2
3.2. Analysis
Comparison 3 INSIGHT‐ORIENTED PSYCHODYNAMIC PSYCHOTHERAPY versus REALITY‐ADAPTIVE PSYCHOTHERAPY, Outcome 2 Global impression: 2. Not able to enjoy a significant relationship (long term).
3.3
3.3. Analysis
Comparison 3 INSIGHT‐ORIENTED PSYCHODYNAMIC PSYCHOTHERAPY versus REALITY‐ADAPTIVE PSYCHOTHERAPY, Outcome 3 Global impression: 3. Not self supporting (long term).
3.4
3.4. Analysis
Comparison 3 INSIGHT‐ORIENTED PSYCHODYNAMIC PSYCHOTHERAPY versus REALITY‐ADAPTIVE PSYCHOTHERAPY, Outcome 4 Global impression: 4. Hospital re‐admission (long term).
3.5
3.5. Analysis
Comparison 3 INSIGHT‐ORIENTED PSYCHODYNAMIC PSYCHOTHERAPY versus REALITY‐ADAPTIVE PSYCHOTHERAPY, Outcome 5 Leaving the study early:.
4.1
4.1. Analysis
Comparison 4 INDIVIDUAL PSYCHODYNAMIC PSYCHOTHERAPY versus GROUP PSYCHOTHERAPY, Outcome 1 Global impression: 1. Returned to hospital (long term).
4.2
4.2. Analysis
Comparison 4 INDIVIDUAL PSYCHODYNAMIC PSYCHOTHERAPY versus GROUP PSYCHOTHERAPY, Outcome 2 Global impression: 2. Not improved at 24 months.
4.3
4.3. Analysis
Comparison 4 INDIVIDUAL PSYCHODYNAMIC PSYCHOTHERAPY versus GROUP PSYCHOTHERAPY, Outcome 3 Global impression: 3. Discharged from therapy (long term).
4.4
4.4. Analysis
Comparison 4 INDIVIDUAL PSYCHODYNAMIC PSYCHOTHERAPY versus GROUP PSYCHOTHERAPY, Outcome 4 Global impression: 4. Remaining in therapy (long term).
5.1
5.1. Analysis
Comparison 5 INDIVIDUAL PSYCHODYNAMIC THERAPY AND MEDICATION versus INDIVIDUAL PSYCHODYNAMIC THERAPY, Outcome 1 Global impression: 1. Hospital re‐admission (long term).
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References to other published versions of this review

Malmberg 1999
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