A twelve-week randomized controlled study of the cognitive-behavioral Integrated Psychological Therapy program : positive effect on the social functioning of schizophrenic patients

Abstract

Objetivos: O presente estudo foi designado para avaliar o efeito de 12 sessões semanais do programa cognitivo-comportamental IPT (Integrated Psychological Therapy – Integriertes psychologisches Therapieprogramm für schizophrene Patienten – Terapia Psicológica Integrada), comparado ao tratamento usual sobre o funcionamento cognitivo, ajustamento social e qualidade de vida em pacientes ambulatoriais com esquizofrenia. Método: Cinqüenta e seis pacientes ambulatoriais adultos (idade entre 18 e 65 anos) com diagnóstico de esquizofrenia pela CID-10, foram aleatoriamente designados para dois grupos: intervenção ativa (IPT) e tratamento usual (grupo controle). As diferenças de medidas de resultados foram em qualidade de vida (WHOQOL-bref), cognição (Mini-Mental State Examination e word-span), funcionamento global (Global Assessment of Functioning-DMS-IV), funcionamento social (Social and Occupational Functioning Assessment Scale-DSM-IV) e ajustamento social (Social Adjustment Scale). Resultados: Os achados sugerem que 12 sessões do programa IPT mostraram um efeito positivo sobre várias medidas de resultado comparado ao grupo controle (tratamento usual): cognição nos domínios de orientação no tempo e no espaço (p = 0,045) e memória (p = 0,031); ajustamento social geral (p = 0,037), lazer e vida social (p = 0,051), relações familiares (p = 0,008); funcionamento global (p = 0,000); funcionamento sócio-ocupacional (p = 0,000); e qualidade de vida no domínio psicológico (p = 0,021). Conclusão: A intervenção cognitivo-comportamental de 12 sessões do IPT demonstrou superioridade de efeito sobre cognição, ajustamento social e qualidade de vida comparado ao tratamento usual. Estudos com amostras maiores, maior tempo de seguimento (follow-up) e medidas adicionais de desfechos são necessários para avaliar efeitos específicos sobre dimensões de funcionamento cognitivo, social e qualidade de vida em esquizofrênicos.

Objectives: The present study was designed to evaluate the effect of twelve weekly sessions of the cognitive-behavioral program originally known as the Integriertes Psychologisches Therapieprogramm für Schizophrene Patienten, designated the Integrated Psychological Therapy (IPT) program in English, on cognition, social adjustment and quality of life in schizophrenic outpatients, comparing it to the effect of treating such patients as usual. Method: Fifty-six adult outpatients (from 18 to 65 years of age) with ICD-10-based diagnoses of schizophrenia were randomly assigned to two different groups: active intervention (IPT group); and treatment as usual (control group). Outcome measures were quality of life (as determined using the WHOQOL-Bref), cognition (Mini- Mental State Examination and Word Recall Test), global functioning (DSM-IV Global Assessment of Functioning Scale), social functioning (Social and Occupational Functioning Assessment Scale) and social adjustment (Social Adjustment Scale). Results: The findings suggest that, in comparison with treatment as usual (control group), the twelve-session IPT program had a positive effect on several outcome measures: cognition in the domains of spatiotemporal orientation (p = 0.051) and memory (p = 0.031); overall social adjustment (p = 0.037), leisure/social life (p = 0.051) and family relations (p = 0.008); overall functioning (p = 0.000); social-occupational functioning (p = 0.000); and quality of life in the psychological domain (p = 0.021). Conclusion: The twelvesession cognitive-behavioral IPT intervention demonstrated superiority over treatment as usual in its effects on cognition, social adjustment and quality of life. Studies involving larger samples, longer follow-up periods and additional outcome measures are needed in order to assess the specific effects on dimensions of social functioning, cognitive functioning and quality of life in patients with schizophrenia.