[Lyubimova]

GUIDELINE TITLE Schizophrenia

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B - Supportive individual and group psychotherapy in combination with medications can reduce relapses and enhance occupational and vocational functioning (Scott & Dixon, 1995). (Grade B, Level IIb)
A - Cognitive Behavioural Therapy is beneficial in reducing the symptoms (especially the positive symptoms) of schizophrenia (Garety, Fowler, & Kuipers, 2000). (Grade A, Level Ia)
A - Psychoeducation and family intervention can help reduce relapse rates. (Grade A, Level Ib)
A - Social skills training improves social adjustment and coping skills, thereby reducing relapse rates (Benton & Schroeder, 1990; Corrigan, 1991). (Grade A, Level Ib)
A - Vocational training is likely to benefit those who a) see competitive employment as a personal goal, b) have a history of prior competitive employment, c) have a minimal history of psychiatric hospitalization, and d) have been assessed to have good work skills (Lehman, 1995). (Grade A, Level Ib)

PRACTICE GUIDELINE FOR THE Treatment of Patients With Schizophrenia
AMERICAN PSYCHIATRIC ASSOCIATION
STEERING COMMITTEE ON PRACTICE GUIDELINES
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2. Psychosocial treatments in the stable phase
For most persons with schizophrenia in the stable phase, treatment programs that combinemedications with a range of psychosocial services are associated with improved outcomes.Knowledge and research regarding how best to combine treatments to optimize outcome arescarce. Nonetheless, provision of such packages of services likely reduces the need for crisis-oriented care hospitalizations and emergency department visits and enables greater recovery.A number of psychosocial treatments have demonstrated effectiveness. These treatments in-clude family interventions (31, 157, 158), supported employment (159–162), assertive commu-nity treatment (163–166), social skills training (167–169), and cognitive behaviorally oriented psychotherapy (158, 170).

Individual psychodynamic psychotherapy and psychoanalysis for schizophrenia and severe mental illness

Malmberg L, Fenton M
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Main results
No trials of a psychoanalytic approach were identified. Data are sparse for all comparisons involving a psychodynamic approach. There is no evidence of any positive effect of psychodynamic therapy and the possibility of adverse effects seems never to have been considered. The psychodynamic approach may be more acceptable to people than a more cognitive reality-adaptive therapy.
Authors' conclusions
Current data do not support the use of psychodynamic psychotherapy techniques for hospitalised people with schizophrenia. If psychoanalytic therapy is being used for people with schizophrenia there is an urgent need for trials.

Core interventions in the treatment and management of schizophrenia in primary and secondary care
Clinical Guideline 1December 2002
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1.3.3 Early post-acute period
Psychological treatments
1.3.3.4 Cognitive behavioural therapy (CBT) should be available as a
treatment option for people with schizophrenia. A
1.3.3.5 Family interventions should be available to the families of
people with schizophrenia who are living with or who are in
close contact with the service user.A
1.3.3.6 Counselling and supportive psychotherapy are not
recommended as discrete interventions in the routine care
of people with schizophrenia where other psychological
interventions of proven efficacy are indicated and available.
However, service user preferences should be taken into
account, especially if other more efficacious psychological
treatments are not locally available. C
1.4 Promoting recovery
1.4.4 Psychological interventions
Psychological treatments should be an indispensable part of the
treatment options available for service users and their families in
the effort to promote recovery. Those with the best evidence of
effectiveness are cognitive behavioural therapy and family
interventions. These should be used to prevent relapse, to reduce
symptoms, increase insight and promote adherence to medication.
Relapse prevention and symptom reduction: cognitive behavioural
therapy and family interventions
1.4.4.1 Cognitive behavioural therapy should be available as a
treatment option for people with schizophrenia. A
1.4.4.2 In particular, cognitive behavioural therapy should be
offered to people with schizophrenia who are experiencing
persisting psychotic symptoms.A
1.4.4.3 Cognitive behavioural therapy should be considered as a
treatment option to assist in the development of insight.B
1.4.4.4 Cognitive behavioural therapy may be considered as a
treatment option in the management of poor treatment
adherence.C
1.4.4.5 Longer treatments with cognitive behavioural therapy
are significantly more effective than shorter ones, which
may improve depressive symptoms but are unlikely to
improve psychotic symptoms. An adequate course of
cognitive behavioural therapy to generate improvements in
psychotic symptoms in these circumstances should be of
more than 6 months' duration and include more than ten
planned sessions. B
1.4.4.6 Family interventions should be available to the families of
people with schizophrenia who are living with or who are in
close contact with the service user. A
1.4.4.7 In particular, family interventions should be offered to the
families of people with schizophrenia who have recently
relapsed or who are considered at risk of relapse.A
1.4.4.8 Also in particular, family interventions should be offered to
the families of people with schizophrenia who have
persisting symptoms.A
1.4.4.9 When providing family interventions, the length of the
family intervention programme should normally be longer
than 6 months’ duration and include more than ten sessions
of treatment.B
1.4.4.10 When providing family interventions, the service user
should normally be included in the sessions, as doing so
significantly improves the outcome. Sometimes, however,
this is not practicable. B
1.4.4.11 When providing family interventions, service users and their
carers may prefer single-family interventions rather than
multi-family group interventions.A
etc...