Nidotherapy for Schizophrenia

Schizophrenia Bulletin vol. 39 no. 1 pp. 17–21, 2013 doi:10.1093/schbul/sbs131 Advance Access publication November 30, 2012 Cochrane Corner Nidotherapy for Schizophrenia Ian J. Chamberlain1 and Stephanie Sampson*,2 Faculty of Medicine and Health Sciences, The University of Nottingham, Nottingham, UK; 2The Cochrane Schizophrenia Group, The University of Nottingham, Nottingham, UK 1 Background presented in tables as “other data,” which acknowledge mean and standard deviation. Nidotherapy is a therapeutic method that principally aims to modify the environment of people with schizophrenia and other serious mental illnesses, whilst working in conjunction with or alongside other treatments. Rather than focusing on direct treatments or interventions, the aim is to help the individual identify the need for, and work to effect, environmental change with the aim of minimizing the impact of any form of mental disorder on the individual and society. Main Results We included only one study that compared nidotherapyenhanced standard care with standard treatment or care alone (total 52 participants); this study was classified by its authors as a “pilot study.” The duration of the included study was 18 months in total. The single study examined the short-term (up to 6 months) and mediumterm (between 6 and 12 months) effects of nidotherapy-enhanced standard care versus standard treatment or care. Nidotherapy-enhanced standard care was favored over standard treatment or care for social functioning in both the short term (n = 50, 1 RCT, MD −2.10, 95% CI −4.66–0.46) and medium term (n = 37, 1 RCT, MD −1.70, 95% CI −4.60–1.20); however, these results did not reach statistical significance (figure 1). Results concerning engagement with non-inpatient services favored the intervention group in both the short term (n = 50, 1 RCT, MD 2.00, 95% CI 0.13–3.87) and medium term (n = 37, 1 RCT, MD 1.70, 95% CI −0.09 to 3.49), with statistical significance evident in the short term but not in the medium term (figure 1). Results of people leaving the study early favored the intervention in the short term (n = 52, 1 RCT, RR 0.86, 95% CI 0.06– 12.98), with slight favor of the control group at medium term (n = 50, 1 RCT, RR 0.99, 95% CI 0.39–2.54); again, these results did not reach statistical significance. Results for the adverse effects/events of death (measured by 12 months) favored the intervention (n = 52, 1 RCT, RR 0.29, 95% CI 0.01–6.74) but with no statistical significance. Skewed results were available for mental state, service use, and economic outcomes, and present a mixed picture of the benefits of nidotherapy (table 1). Objectives To review the effects of nidotherapy added to standard care, compared with standard care or no treatment for people with schizophrenia or related disorders. Search Methods We searched the Cochrane Schizophrenia Group Trials Register (December 2011) and supplemented this by contacting relevant study authors, hand searching nidotherapy articles and manually searching reference lists. Selection Criteria All randomized controlled trials (RCTs) that compared nidotherapy with standard care or no treatment. Data Collection and Analysis The identified trial study was reliably selected, quality assessed and data extracted. For non-skewed continuous endpoint data extracted from valid scales, we estimated mean difference (MD) between groups. We calculated risk ratios (RR) and 95% confidence intervals (CI) of homogeneous dichotomous data. Skewed data have been © The Author 2012. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: 17 *To whom correspondence should be addressed; Stephanie Sampson, Division of Psychiatry, Cochrane Schizophrenia Group, Institute of Mental Health, C floor, University of Nottingham Innovation Park, Nottingham, Nottinghamshire NG7 2TU, UK; tel: 01158231286, e-mail: I. J. Chamberlain & S. Sampson 18 Fig. 1. Forest plots. Standard Care Nidotherapy-enhanced Standard Care Corresponding risk Not estimable See comment The mean economic outcomes— total costs (12 months) in the intervention groups was 0 higher (from 0 to 0 higher) Economic outcomes—total costs (12 months) NHS Reference Costs and unit costs Follow-up: 12 months 48 (1 study) 0 (0) ⊕⊕⊝⊝ lowc,f See comment See comment No study reported this outcome Highly skewed data— economic outcomes over 12 months reported in “Data and Analysis”— direct costs; indirect costs; total costs Highly skewed data— mental state average scores reported in “Data and Analysis”—short term (<6 months) medium term (6–12 months) No study reported this outcome ⊕⊕⊝⊝ lowc,e 37 (1 study) – No study reported this outcome See comment ⊕⊝⊝⊝ very lowb,c,dc 37 (1 study) Comments – Quality of the evidence (GRADE) No. of participants (studies) The mean economic outcomes—total costs (12 months) in the control groups was 0 Not estimable See comment Not estimable Relative effect (95% CI) Quality of life—no important See comment change—medium term (6–12 months)—not measured Satisfaction with treatment See comment The mean functioning— The mean functioning— Functioning—specific— specific—social—change specific—social— social—change in average in average score—medium change in average score—medium term term (6–12 months) in the score—medium term (6–12 months) Social intervention groups was (6–12 months) in the Functioning Questionnaire— 1.70 lower (from 4.6 lower control groups was 13.2 Key Worker (SFQ-KW). to 1.2 higher) points Scale: from 0 to 24. Follow-up: 12 months Functioning—general—no See comment See comment important change—medium term (6–12 months)—not measured The mean mental The mean mental state—no Mental state—no important state - no important important change—medium change—medium term change—medium term term (6–12 months) in the (6–12 months) Brief (6–12 months) in the intervention groups was 0 Psychiatric Rating Scale control groups was 0 higher (from 0 to 0 higher) (BPRS). Scale: from 0 to 96. Follow-up: 12 months Outcomes Assumed risk Illustrative comparative risksa (95% CI) Patient or Population: Patients with People with Schizophrenia Settings: Intervention: Nidotherapy-enhanced Standard Care Comparison: Standard Care Nidotherapy-enhanced Standard Care compared with Standard Care for people with schizophrenia Table 1. Summary of Findings Table Nidotherapy for Schizophrenia 19 Standard Care 12 per 1000 (from 0 to 281) Nidotherapy-enhanced Standard Care Corresponding risk No. of participants (studies) RR 0.29 52 (1 study) (from 0.01 to 6.74) Relative effect (95% CI) ⊕⊝⊝⊝ very lowc,,g,h Quality of the evidence (GRADE) Comments Note: GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in th (...truncated)