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Abstract
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OBJECTIVE: It is well established that the combination of psychopharmacological treatment and psychosocial interventions, such as psychotherapy, family orientation and occupational therapy (OT), represent the best strategy for treating patients with schizophrenia. However, in terms of treatment-resistant schizophrenia (TRS) almost only psychopharmacological treatments are available and psychosocial interventions such as OT had not proved to be effective. The aim of this study is to investigate if OT is effective when added to a psychopharmacological treatment in TRS.
METHODS: Two groups of patients with TRS were compared: The experimental group (EG) received psychopharmacological treatment with clozapine plus sessions of occupational therapy (OT) and the control group (CG) received only clozapine. The Scale for Interactive Observation in Occupational Therapy (EOITO) was employed to evaluate the outcome. The duration of the study was 6 months and patients were rated at baseline and monthly totaling 7 assessments. EOITO was independently applied by two occupational therapists with high reliability rates (Kappa=0.90, p=0.001). Repeated measures of analyses of variance and the evaluation of the standardized effect sizes were used for statistical analyses.
RESULTS: The EG showed that the OT intervention was effective along the whole period of observation, mainly from the 4th month to the end of the study.
CONCLUSIONS: In patients with TRS the combination of OT and clozapine showed to be more effective than the use of clozapine alone. OT may represent an additional therapeutic option for patients with TRS.; FreeText:The Scale for Interactive Observation in Occupational Therapy (EOITO) was used to evaluate the outcome; it is a 14-item scale and divided in 4 factors: performance of the activity; psychotic symptoms; social interaction and personal care. Each item is assessed according to 3 severity levels (0, 1 and 2), which are mutually exclusive within each item and which indicate in increasing order the severity of the pathological manifestations. In items related to the expression of desirable behaviors the graduations imply: spontaneous occurrence (grade 0), occurrence after stimulation (grade 1), or non-occurrence even after stimulation (grade 2). Repeated measures of analyses of variance and the evaluation of the standardized effect sizes were used for statistical analyses.; Indications:26 patients with treatment resistant schizophrenia.; Patients:26 patients. OT plus Leponex group: 14 patients, 9 male and 5 female (mean age 33.71 years), 7 dropout. Leponex alone group: 12 patients, 10 male and 2 female (mean age 36.58 years), 1 dropout.; TypeofStudy:An open, prospective, randomized, controlled study comparing the effectiveness of combined occupational therapy (OT) and Leponex treatment with Leponex alone in patients with treatment-resistant schizophrenia (TRS).; DosageDuration:Dosage not stated. Duration: 6 months.; Results:Results of the analysis of variance showed a statistically significant difference between Leponex alone group and OT plus Leponex group (p=0.033). It shows that patients progressively benefited from OT intervention and patients who completed the study have also benefited, although the effect sizes were slightly lower. The high number of withdrawals 8/26 (30%) is very common fact in clinical studies particularly in cases of schizophrenia which is notoriously difficult to be managed. Regarding patients who completed the study, the comparison between EOITO's total means (sum of 14 items) at the study's beginning was also non-significant in the initial time [OT plus Leponex =(4.1), Leponex alone =(6); p=0.2)]. The calculation of effect sizes shows that the OT plus Leponex group benefited consistently from OT interventions, and the greatest effect sizes occurred at the treatment's end. The effect sizes started to grow from month 4 onwards and drop in month 5 that could be explained by patient suicide that affected intensely the OT plus Leponex group.; AdverseEffects:No adverse events were mentioned.; AuthorsConclusions:In patients with TRS the combination of OT and clozapine showed to be more effective than the use of clozapine alone. OT may represent an additional therapeutic option for patients with TRS.
Language: en |