Individual psychodynamic psychotherapy and psychoanalysis for schizophrenia and severe mental illness.
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.


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


METHODS
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.


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


METHODS
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.


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.


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.
Malmberg
L
L
Department of Psychiatry/ Rehabilitation Unit, Porvoo Hospital, Sairaalantie 2, Porvoo, Finland, FIN-06200. lena.malmberg@pp.inet.fi
Fenton
M
M
D006760:Hospitalization; D006801:Humans; D001523:Mental Disorders / Q000628:therapy; D011575:Psychoanalytic Therapy; D011613:Psychotherapy; D016032:Randomized Controlled Trials as Topic; D012559:Schizophrenia / Q000628:therapy*