Supportive therapy for schizophrenia.
BACKGROUND
Supportive therapy is often used in everyday clinical care and in evaluative studies of other treatments.


OBJECTIVE
To estimate the effects of supportive therapy for people with schizophrenia.


METHODS
We searched the Cochrane Schizophrenia Group's register of trials (January 2004), supplemented by manual reference searching and contact with authors of relevant reviews or studies.


METHODS
All randomised trials involving people with schizophrenia and comparing supportive therapy with any other treatment or standard care.


METHODS
We reliably selected studies, quality rated these and extracted data. For dichotomous data, we estimated the relative risk (RR) fixed effect with 95% confidence intervals (CI). Where possible, we undertook intention-to-treat analyses. For statistically significant results, we calculated the number needed to treat/harm (NNT/H). We estimated heterogeneity (I-square technique) and publication bias.


RESULTS
We included 21 relevant studies. We found no significant differences in the primary outcomes between supportive therapy and standard care. There were, however, significant differences favouring other psychological or psychosocial treatments over supportive therapy. These included hospitalisation rates (3 RCTs, n=241, RR 2.12 CI 1.2 to 3.6, NNT 8) but not relapse rates (5 RCTs, n=270, RR 1.18 CI 0.9 to 1.5). We found that the results for general functioning significantly favoured cognitive behavioural therapy compared with supportive therapy in the short (1 RCT, n=70, WMD -9.50 CI -16.1 to -2.9), medium (1 RCT, n=67, WMD -12.6 CI -19.4 to -5.8) and long term (2 RCTs, n=78, SMD -0.50 CI -1.0 to -0.04), but the clinical significance of these findings based on few data is unclear. Participants were less likely to be satisfied with care if receiving supportive therapy compared with cognitive behavioural treatment (1 RCT, n=45, RR 3.19 CI 1.0 to 10.1, NNT 4 CI 2 to 736). The results for mental state and symptoms were unclear in the comparisons with other therapies. No data were available to assess the impact of supportive therapy on engagement with structured activities.


CONCLUSIONS
There are insufficient data to identify a difference in outcome between supportive therapy and standard care. There are several outcomes, including hospitalisation and general mental state, indicating advantages for other psychological therapies over supportive therapy but these findings are based on a few small studies. Future research would benefit from larger trials that use supportive therapy as the main treatment arm rather than the comparator.
Buckley
L A
LA
Claremont House, Department of Psychotherapy, Off Framlington Place, Newcastle Upon Tyne, UK, NE2 4AA. Lucy.Buckley@ntw.nhs.uk
Pettit
T
T
Adams
C E
CE
D014150:Antipsychotic Agents / Q000627:therapeutic use; D005196:Family Therapy; D006801:Humans; D008605:Mental Health Services; D011613:Psychotherapy / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D012559:Schizophrenia / Q000628:therapy*; D012565:Schizophrenic Psychology; D012944:Social Support
D014150:Antipsychotic Agents