An Cochrane review [Abstract] 1 included 60 studies with a total of 5992 patients with schizophrenia. Participants were recruited from inpatient, outpatient, or community settings. The CBT interventions varied between the studies. All studies compared CBT added to standard care with standard care alone. Standard care typically involved antipsychotics treatment, nursing care, community-based healthcare or rehabilitative activities, early intervention, medication monitoring by their psychiatrists, case management, psychoeducation and family support. Results for the main outcomes of interest (all long term: over 52 weeks since the onset of therapy) showed no clear difference between CBT and standard care for relapse (RR 0.78, 95% CI 0.61 to 1.00; 13 studies, n = 1538). Two trials reported global state improvement. More patients in the CBT groups showed clinically important improvement in global state (RR 0.57, 95% CI 0.39 to 0.84; 2 studies, n = 82). Five trials reported mental state improvement. No differences in mental state improvement were observed (RR 0.81, 95% CI 0.65 to 1.02; 5 studies, n = 501). In terms of safety, adding CBT to standard care may reduce the risk of having an adverse event (RR 0.44, 95% CI 0.27 to 0.72; 2 studies, n = 146) but appears to have no effect on long-term social functioning (MD 0.56, 95% CI -2.64 to 3.76; 2 studies, n = 295) nor on long-term quality of life (MD -3.60, 95% CI -11.32 to 4.12; 1 study, n = 71). It also has no effect on long-term satisfaction with treatment (measured as 'leaving the study early') (RR 0.93, 95% CI 0.77 to 1.12; 19 studies, n = 1945).
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes).
Another Cochrane-review [Abstract] 2 included 36 trials with a total of 3542 patients with schizophrenia. It compared CBT with a range of other psychosocial therapies that were classified as either active (A) (n = 14) or non active (NA) (n = 14). When CBT was compared with other psychosocial therapies, no difference in long-term (over 52 weeks since the onset of therapy) relapse was observed (RR 1.05, 95% CI 0.85 to 1.29; 5 trials, n = 375). Results showed no clear difference in long-term rehospitalisation (RR 0.96, 95% CI 0.82 to 1.14; 8 trials, n = 943) nor in long-term mental state (RR 0.82, 95% CI 0.67 to 1.01; 4 trials, n = 249). No long-term differences were observed for death (RR 1.57, 95% CI 0.62 to 3.98; 6 trials, n = 627). Social functioning scores were similar between groups (long term Social Functioning Scale (SFS): MD 8.80, 95% CI -4.07 to 21.67; 1 trial, n = 65), and quality of life scores were also similar (medium term Modular System for Quality of Life (MSQOL): MD -4.50, 95% CI -15.66 to 6.66; 1 trial, n = 64). There was a modest but clear difference favouring CBT for satisfaction with treatment measured as leaving the study early (RR 0.86, 95% CI 0.75 to 0.99; 26 trials, n = 2392).
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes).
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