Morita therapy for schizophrenia.
BACKGROUND
Morita therapy was founded in 1919 by Shoma Morita (1874-1938). The therapy involves a behavioural structured programme to encourage an outward perspective on life and hence an increased social functioning.


OBJECTIVE
To evaluate the effects of Morita therapy for schizophrenia and schizophrenia-like psychoses.


METHODS
We searched the Cochrane Schizophrenia Groups Trials Register, the Chongqing VIP Database, the Wanfang Database (August 2006), all relevant references and contacted the first author of each included study.


METHODS
We included all randomised clinical trials comparing Morita therapy with any other treatment.


METHODS
We reliably selected studies and extracted data. For homogenous dichotomous data we calculated random effects, relative risk (RR), 95% confidence intervals (CI) and, where appropriate, numbers needed to treat (NNT) on an intention-to-treat basis. For continuous data, we calculated weighted mean differences (WMD).


RESULTS
We found 11 small, studies of medium-poor quality (total n=1041). The standard care versus Morita therapy comparison (total n=679 people) had very low attrition (<2%, 9 RCTs, RR 1.02 CI 0.3 to 3.1). Mental state did tend to improve with Morita therapy (n=76, 1 RCT, RR no >25-30% decline in BPRS RR 0.36 CI 0.1 to 0.9, NNT 5 CI 4 to 25). For negative symptoms data were inconsistent, with data from three trials favouring Morita therapy (n=243, RR -10.87 CI -20.5 to -1.2), but heterogeneity was considerable (I(2) =92%). Morita therapy plus standard treatment did significantly improve the ability of daily living compared with standard treatment alone (n=104, 1 RCT, WMD -4.1 CI -7.7 to -0.6). Compared with a rehabilitation programme Morita therapy did not promote attrition (n=302, 2 RCTs, RR 1.00 CI 0.5 to 2.1). In two very similar studies Morita therapy showed better effect on mental state with lower BPRS score (n=278, 2 RCTs, WMD -6.95 CI 9.3 to 4.6, I(2) =0%) insight (n=278, 2 RCTs, WMD -1.11 CI -1.3 to -0.9, I(2) = 0%) and social functioning (n=278, WMD average IPROS score -18.14 CI -21.3 to -15.0, I(2) =0%).


CONCLUSIONS
Currently trial based data on Morita therapy is inconclusive. Morita therapy for schizophrenia remains an experimental intervention, new trials are justified and specific outlines for design of future studies are outlined in additional tables.
He
Y
Y
Shanghai Mental Health Center, 600 Wan Ping Nan Lu, Shanghai, China, 200030. heyl@public9.sta.net.cn
Li
C
C
D000203:Activities of Daily Living; D001008:Anxiety Disorders / Q000628:therapy*; D001510:Bed Rest / Q000379:methods; D003469:Culture; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012559:Schizophrenia / Q000628:therapy*; D012565:Schizophrenic Psychology; D012960:Socioenvironmental Therapy / Q000379:methods*; D014937:Work