Drama therapy is one of the creative therapies suggested to be of value as an adjunctive treatment for people with schizophrenia or schizophrenia-like illnesses. Randomised studies have been successfully conducted in this area but poor study reporting meant that no conclusions could be drawn from them. The benefits or harms of the use of drama therapy in schizophrenia are therefore unclear and further large, high quality studies are required to determine the true value of drama therapy for schizophrenia or schizophrenia-like illnesses.
[Show abstract][Hide abstract] ABSTRACT: A proportion of people with mental health problems require longer term care in a psychiatric or social care institution. However, there are no internationally agreed quality standards for institutional care and no method to assess common care standards across countries. We aimed to identify the key components of institutional care for people with longer term mental health problems and the effectiveness of these components.
We undertook a systematic review of the literature using comprehensive search terms in 11 electronic databases and identified 12,182 titles. We viewed 550 abstracts, reviewed 223 papers and included 110 of these. A "critical interpretative synthesis" of the evidence was used to identify domains of institutional care that are key to service users' recovery.
We identified eight domains of institutional care that were key to service users' recovery: living conditions; interventions for schizophrenia; physical health; restraint and seclusion; staff training and support; therapeutic relationship; autonomy and service user involvement; and clinical governance. Evidence was strongest for specific interventions for the treatment of schizophrenia (family psychoeducation, cognitive behavioural therapy (CBT) and vocational rehabilitation).
Institutions should, ideally, be community based, operate a flexible regime, maintain a low density of residents and maximise residents' privacy. For service users with a diagnosis of schizophrenia, specific interventions (CBT, family interventions involving psychoeducation, and supported employment) should be provided through integrated programmes. Restraint and seclusion should be avoided wherever possible and staff should have adequate training in de-escalation techniques. Regular staff supervision should be provided and this should support service user involvement in decision making and positive therapeutic relationships between staff and service users. There should be clear lines of clinical governance that ensure adherence to evidence-based guidelines and attention should be paid to service users' physical health through regular screening.
[Show abstract][Hide abstract] ABSTRACT: Künstlerische Therapien bilden neben anderen psychosozialen Interventionen ein wichtiges Element im Rahmen multimodaler Behandlungskonzepte für Menschen mit psychischen Störungen. Der Beitrag fasst die systematisch recherchierte Evidenz zusammen und stellt die Empfehlungen dar, die im Rahmen der S3-Leitlinie „Psychosoziale Therapien bei Menschen mit schweren psychischen Störungen“ der Deutschen Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN) erarbeitet wurden. Die Studien zeigen, dass die zusätzliche Anwendung künstlerischer Therapien insbesondere die Negativsymptomatik bei Menschen mit schizophrenen Erkrankungen reduziert. Die aussagekräftigste Befundlage existiert dabei für die Musiktherapie. In der Behandlung schwerer depressiver Erkrankungen gibt es Hinweise, dass eine zusätzliche musiktherapeutische Intervention die depressive Symptomatik reduziert. Künstlerische Therapien werden im Rahmen der Leitlinie mit einem Empfehlungsgrad B empfohlen.
Der Nervenarzt 07/2012; 83(7). DOI:10.1007/s00115-011-3472-7 · 0.79 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The majority of people with schizophrenia have a pattern of illness where they relapse and then have a remission. A significant number of these people become less able to look after themselves after each relapse and their lack of self-care and poorer functioning causes them to become more disabled and isolated. One possible way of helping these people, alongside medication, is to teach them life skills, the components of which are communication and financial awareness, competence in domestic tasks and personal self-care. This review looks at trials comparing life skills programmes to a control group who have access to occupational therapy, or a peer support group, where people who have a chronic mental illness were facilitated to help each other. Four trials were found with a total of 318 participants most of whom had a diagnosis of schizophrenia or schizophrenia like disorders. The longest trial was 24 weeks and the shortest was 7 weeks. The outcomes measured were improvement of general and specific skills, improvement of symptoms and a better quality of life. None of these outcomes were significantly different between the life skills, peer support and control groups although the four trials were often measuring them in different ways, making comparison difficult. In addition, the number of people in two of the studies was very small, making it unlikely that differences would be seen between the two groups. To assess whether life skills programmes are beneficial to those with chronic mental health problems a large trial should be done using well researched scales to measure the outcomes. (Plain language summary prepared for this review by Janey Antoniou of RETHINK, UK www.rethink.org)
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