Schizophrenia Daily News Blog

Update on Integrated Psychological Treatment

Including Integrated Psychological Treatment as part of standard medical therapy for patients with schizophrenia

A Summary by Victoria Cosgrove, PhD Candidate, Clinical Psychology, University of Colorado

Introduction
Integrative Psychological Treatment (IPT) is an effective and economical cognitive-behavioral group treatment designed to enhance overall quality of life for people with schizophrenia. It consists of six hierarchical subsections: cognitive differentiation, social perception, verbal communication, social skills, emotional management, and problem solving. Its effectiveness has been authenticated in over two dozen research studies across the world.

Why is this review of interest?
Although research shows that IPT works for diverse populations and in a variety of settings, the present study is the first to specifically evaluate its effectiveness when combined with standard medical therapy for people diagnosed with schizophrenia.

Furthermore, the effectiveness of psychological intervention for schizophrenia is often underreported or ignored. Research has shown that the hierarchical approach of IPT leads to substantive gains in cognitive and social functioning for schizophrenia sufferers. This knowledge is important to frequently revisit.

Who are the Authors?
The authors are a group of Canadian researchers interested in cognitive and behavioral predictors influencing clinical outcome in patients with schizophrenia.

How did the Authors Design the Study?
Patients were recruited at nine clinical sites throughout Quebec. Clinical teams consisted predominantly of occupational therapists. Candidates for the IPT program were offered enrollment if they met the following criteria: (1) were under the care of a psychiatrist at the clinical site (2) were diagnosed with schizophrenia according to DSM-IV criteria, and (3) were capable of taking part in a group rehabilitation program. Candidates were excluded if they were moderately to severely mentally retarded.

Consenting patients continued to receive their standard psychiatric care (i.e., visits with psychiatrists, psychologists, nurses, occupational therapists, and social workers). In addition, they received IPT. Patients were assessed at four time points: prior to IPT, after the first three IPT subsections, after completing six IPT subsections, and 3-4 months after the completion of IPT. Assessments at each time point included the Structured Clinical Interview for DSM-IV; the Cambridge Neuropsychological Test Automated Battery; the Client’s Assessment of Strengths, Interests, and Goals; the Multnomah Community Ability Scale, and the Frankfurt Complaint Questionnaire.

Analyses employed SAS statistical software in a nine group (clinical sites) by four repeated measures ANOVA, including time and group effect and their interaction.

What did they find?
Patients were mainly French-speaking, Caucasian, male, and Canadian-born. Mean age was 32.7 years and mean duration of illness was 6.8 years. Prior to IPT program implementation, 99% of the patients were on antipsychotic medication.

55 of 90 patients completed the IPT program. Withdrawal was mainly during the follow-up period and due to illness-related reasons.

The longer that patients in all groups were involved in the IPT program, the more their symptoms improved. Patients reported that their overall symptoms abated at the beginning of the IPT program, whereas therapists rated improvement immediately after the program’s completion. Patients subjectively reported an improvement in their cognitive functioning after completing the IPT program, and objective cognitive evaluations confirmed improvements in visual-motor coordination, visual memory, and working memory and planning.

Results on social functioning were varied. At six of nine sites, results from therapist ratings showed improvement in the daily living skills, social competence, and behavior problems of patients who completed an IPT regimen. However, patients improved at different rates and to varying degrees at different sites. Patients who completed IPT, however, reported an overall improvement in their quality of life.

The Take-Home Message
Patients who receive IPT as part of standard medical therapy improve in all fundamental operative areas of schizophrenia, including overall symptoms, cognitive and social realms, and quality of life. Although the effectiveness of IPT is well-documented worldwide, this is the first study of its kind to demonstrate its effectiveness as an adjunct to standard psychiatric care.

The study is not without limitations. Most importantly, its quasi-experimental design did not allow for a “pure” control group. In other words, all participants in the study received IPT. State-of-the-art science calls for such control conditions in order that participants receiving IPT are easily compared with an IPT-naïve group at the same points in time.

However, like its predecessors, this study of IPT for schizophrenia suggests that psychosocial treatments enhance clinical outcomes. This fact is resoundingly important and often overlooked.

Source Document: Including Integrated Psychological Treatment as part of standard medical therapy for patients with schizophrenia. J Nerv Men Dis. 194(7): 463-470., Briand C, Vasiliadis HM, Lesage A, Lalonde P, Stip E, Nicole L, Reinharz D, Prouteau A, Hamel V & Villeneuve K (2006)

Additional Reading on Psychological Treatments for Schizophrenia:

Harvard University on Cognitive Behavioral Therapy for Schizophrenia

Related Research Reading:

Psychological Interventions for Schizophrenia (Schizophrenia Bulletin, 1995)