Horticultural therapy plus standard care compared with standard care alone[1]
Summary
Based on the current very low quality data, there is insufficient evidence to draw any conclusions on benefits or harms of horticultural therapy for people with schizophrenia. This therapy remains unproven and more and larger randomized trials are needed to increase high quality evidence in this area.[1]
Average scale score (Personal Wellbeing Index - PWI-C). Scale from: 0 to 77 (low = poor)
For people given horticultural therapy plus standard care the well-being and quality of life outcome was a little worse compared to those given standard care alone. There was no clear difference between the two groups and this finding is based on data of very limited quality.
Horticultural therapy plus standard care may increase loss to follow up, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited.
Average scale score (DASS21). Scale from: 0 to 84 (high = poor)
For people given horticultural therapy plus standard care the score on this mental state measure was better compared to those given standard care alone. There was a clear difference between the two groups but this finding is based on data of very limited quality.
No study reported any data on outcomes such as adverse effects, clinical global response, general functioning and information relating to physical fitness
Life skills programmes for chronic mental illnesses[edit]
Life skills programme compared to standard care[2]
Summary
Currently there is no good evidence to suggest life skills programmes are effective for people with chronic mental illnesses. More robust data are needed from studies that are adequately powered to determine whether life skills training is beneficial for people with chronic mental health problems.[2]
- in household activity skills. Follow-up: mean 12 weeks
Life skills programmes may reduce the risk of not improving in day-to-day functioning for general household activity skills when compared with standard care, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited.
Life skills programmes may reduce the risk of not improving in day-to-day functioning for laundry skills when compared with standard care, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited.
Life skills programmes make no difference to self-care when compared with standard care, but, at present it is not possible to be confident about the difference between these two treatments. This finding is based on data of very limited quality.
Life skills programme make no clear difference to the risk of loss to follow up compared with standard care. Data supporting this finding are very limited.
Average score (Quality of Well-Being Scale index). Follow-up: mean 24 weeks
On average, people receiving life skills programme scored 0.02 lower than people treated with standard care. There was no clear difference between the groups and this finding is based on data of very limited quality.*
Supportive therapy versus any other psychological or psychosocial treatment[3]
Summary
There are few data to identify clear differences in a series of outcomes between supportive therapy and more sophisticated therapies for people with schizophrenia.[3]
Outcome
Findings in words
Findings in numbers
Quality of evidence
Global state
Relapse. Follow-up: 2 to 3 years
Supportive therapy is not better - or worse - for making a difference to the risk of relapse when compared with other psychological treatments, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited.
No clinically important improvement. Follow-up: 1 to 2 years
Supportive therapy may increase the chance of experiencing 'no improvement' in mental state, but, at present there is only very limited data supporting this finding.
Supportive therapy probably causes little or no increase to the chance of being lost to follow up or finding treatment unacceptable or being withdrawn from treatment, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence.
Recipient of care not satisfied with treatment. Follow-up: 1 years
Compared with other therapies, supportive therapy may increase the chance of be unsatisfied with treatment, but, at present there are only very limited data supporting this finding.
On average, people receiving supportive therapy scored a little lower than people treated with any other psychological or psycho-social treatment but there was no clear difference between the groups. The meaning of this in day-to-day care is unclear and data supporting this finding are very limited.
The token economy approach may have effects on the 'negative symptoms' such as apathy and poverty of thought, but it is unclear if these results are reproducible, clinically meaningful and are maintained beyond the treatment programme. Token economy remains worthy of careful evaluation in modern well-designed, conducted and reported randomized trials.[4]
Outcome
Findings in words
Findings in numbers
Quality of evidence
Global outcome
Leaving the study early Follow-up: up to 6 months
Token economy does not have a convincing effect on the outcome of leaving the study early or loss to follow-up, but, at present data supporting this finding are very limited.
Average score (SANS, high=poor) Follow-up: up to 8 weeks
On average, people receiving token economy scored better than people treated with standard care. There was a clear difference between the groups, but, at present the meaning of this finding in day-to-day care is unclear.
Cannabis reduction therapy and schizophrenia[edit]
Cannabis reduction: adjunct psychological therapy versus treatment as usual[5]
Summary
Results are limited and inconclusive because of the small number and size of randomized controlled trials available and quality of data reporting within these trials. More research is needed to explore the effects of adjunct psychological therapy that is specifically about cannabis and psychosis as currently there is no evidence for any novel intervention being better than standard treatment, for those that both use cannabis and have schizophrenia[5]
Outcome
Findings in words
Findings in numbers
Quality of evidence
Behavior
Frequency of cannabis use (group-based therapy) Follow up: 1 year
People in the intervention groups scored a little lower compared to people receiving treatment as usual but there was no clear difference between the therapy groups and standard care. This finding is based on data of moderate quality.
Average score (PANSS) - positive symptoms Follow up: 12 months
On average, people receiving cannabis reduction therapy scored lower than people treated with treatment as usual but there was no clear difference between groups. This finding is based on data of moderate quality.
Average score (WHO QOL questionnaire) Follow up: 1 years
On average, people receiving cannabis reduction therapy scored higher compared to people in the control group receiving treatment as usual. There was, however, no clear difference between the groups and these findings are based on data of moderate quality.
There is some, albeit preliminary, evidence that asenapine provides an improvement in positive, negative, and depressive symptoms, whilst having few adverse effects. However, due to the low-quality and limited quantity of evidence, it remains difficult to recommend the use of asenapine for people with schizophrenia. There is need for large-scale, longer-term, better-designed and conducted randomized controlled trials investigating the clinical effects and safety of asenapine.[6]
Outcome
Findings in words
Findings in numbers
Quality of evidence
Global state
No clinically important change (CGI-I). Follow-up: up to 12 weeks
Asenapine may reduce the chance of experiencing 'no change' in global state when compared with placebo. Data are based on low quality evidence.
No clinically important change (PANSS) Follow-up: up to 12 weeks
Asenapine may reduce the chance of experiencing 'no change' in mental state when compared with placebo, but, at present there is only very limited data supporting this finding.
Average change score in negative symptoms. (PANSS, Marder negative factor score). Follow-up: up to 12 weeks
On average, people receiving asenapine scored a little lower (better) than people treated with placebo. There was no clear difference between the groups. The meaning of this finding in day-to-day care is unclear.
Asenapine may reduce the risk of adverse effects/events when compared with placebo, but, at present there is only very limited data supporting this finding.
Asenapine may reduce the chance of leaving the study or finding treatment unacceptable or being withdrawn from treatment outcome, but, at present the difference between people given asenapine and those receiving placebo is not clear and data supporting this finding are very limited.
Aripiprazole versus other atypical antipsychotics[edit]
Aripiprazole versus risperidone for schizophrenia[7]
Summary
Information is of limited quality, is incomplete and problematic to apply clinically, with few long-term data and quality of evidence is all low or very low. Aripiprazole is an antipsychotic drug with an important adverse effect profile.[7]
Outcome
Findings in words
Findings in numbers
Quality of evidence
Global state
No clinically significant response (as defined by the original studies)
Aripiprazole may very slightly increase the chance of experiencing 'no response' in the global state outcome, but, there is no clear difference between people given aripiprazole and those receiving risperidone. These findings are based on data of low quality.
Aripiprazole may increase the chance of finding treatment unacceptable or being withdrawn from treatment outcome, but, at present it is not possible to be confident about the difference between people given aripiprazole and those receiving risperidone and data supporting this finding are very limited.
The important outcomes of 'General functioning in life skills', 'service use (e.g. hospitalization), and quality of life were not measured/reported in the included studies.
Paliperidone palmitate versus risperidone for schizophrenia[edit]
Paliperidone palmitate long-acting injection compared to risperidone[8]
Summary
In short-term studies, paliperidone palmitate - the longer-acting injection - is an antipsychotic drug with a similar adverse effect profile to related compounds such as oral risperidone. No difference was found in the [high] incidence of reported adverse sexual outcomes and paliperidone palmitate is associated with substantial increases in serum prolactin. When flexibly dosed with an average dose of approximately 70-110 mg every four weeks, paliperidone palmitate appears comparable in efficacy and tolerability to risperidone.[8]
Outcome
Findings in words
Findings in numbers
Quality of evidence
Global state: No clinically important change
No 30% improvement on PANSS score. Follow-up: 13-53 weeks
There is no clear difference between people given paliperidone palmitate and those receiving risperidone for this outcome. These findings are based on data of low quality.
Recurrence of psychotic symptoms. Follow up: 13-53 weeks
There is no clear difference between people given paliperidone palmitate and those receiving risperidone for the outcome of 'relapse'. Data supporting this finding are based on moderate quality evidence.
- Because of lack of efficacy. Follow up: 13-53 weeks
Paliperidone palmitate may increase the risk of finding treatment unacceptable or being withdrawn from treatment outcome for the reason of perceived lack of efficacy compared with risperidone. Data are based on moderate quality evidence.
There was no clear difference between people given paliperidone palmitate and those receiving risperidone for this rare outcome. These findings are based on data of low quality.
Experiencing 'intensified symptoms' Follow-up: average 16 weeks
At present it is not possible to be confident about the difference between trifluoperazine and placebo for this outcome and data supporting this finding are very limited.
- Because of any reason Follow-up: average 5 months
Trifluoperazine may reduce loss to Follow-up, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited.
Add-on antioxidants for schizophrenia versus placebo[10]
Summary
Although 22 trials provide some limited evidence, the data are limited with short duration follow-up and mostly not relevant to clinicians or consumers. There is a need for larger trials with longer periods of follow-up and outcomes meaningful for people with schizophrenia.[10]
Adding antioxidants on top of antipsychotic drugs does not show clear advantage over adding on a placebo for people with schizophrenia. These findings are based on data of low quality.
On average, people receiving add-on antioxidants for schizophrenia scored lower (better) than people treated with add-on placebo. This finding is based on data of very limited quality.
On average, people receiving add-on antioxidants for schizophrenia scored lower (better) than people treated with placebo on this scale. There was a clear difference between the groups. This finding is based on data of low quality.
The average functioning in the antioxidant groups was scored a little lower but there was no clear difference between the groups. This finding is based on data of low quality.
The average general functioning across a longer period of follow up was a little higher in the antioxidant group. The difference was not clear difference between the groups. This finding is based on data of high quality.
Add-on antioxidants for schizophrenia probably causes little or no decrease to the chance of experiencing the treatment outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence.
Add-on antioxidants for schizophrenia may slightly decrease to the chance of experiencing an adverse effect but there is no clear difference between people given the add-on antioxidants for schizophrenia and those receiving add-on placebo. These findings are based on data of low quality.
