A Cochrane review [Abstract] 1 included 4 RCTs with 528 in-patients with schizophrenia. All trials used a psychodynamic approach; no trials using a psychoanalytic approach could be found.Information is poor about the design of psychodynamic therapies (PT) during the trials. Definitions of improvement varied and data on adverse effects were not collected. Study follow-up times varied between 20-36 months. For individual PT versus medication alone there were significantly more participants in the PT group who were unable to be discharged (RR 8.35, CI 2.0 to 34.3, NNH 3; n=92). There was no significant difference between groups in the number of re-hospitalisations (RR 0.63, CI 0.3 to 1.4, n=24) during long-term analyses. At 12 months, fewer participants in the PT groups needed additional medications compared with those who did receive medication (RR 0.64, CI 0.5 to 0.8, NNT 3; n=74), the same applies also at 3-year follow up (RR 0.85, CI 0.8 to 1.0, NNT 7; n=87). For individual PT plus medication versus medication alone there was no significant difference in suicide (RR 0.16, CI 0.01 to 2.9; n=92) or suitability for discharge (RR 1.09, CI 0.2 to 7.4; n=92). Also, re-hospitalisation rates in long-term analyses were equivocal (RR 1.00, CI 0.4 to 2.6; n=24). For individual PT versus group PT there was no significant difference in global state 'not improved' (RR 1.27, CI 1.0 to 1.7; n=100). For individual PT plus medication versus individual PT the rates of re-hospitalisation during long-term analyses were equivocal (RR 1.00, CI 0.4 to 2.6; n=24).
Comment: The quality of the evidence is downgraded by study quality (inadequate allocation concealment, lack of blinding, more than 20% loss to follow-up), inconsistency (heterogeneity in patients, interventions and outcomes), imprecise results (limited study size for each comparison) and indirectness of evidence (differences in studied patients and interventions).
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