CPG for Psychosocial Interventions in Severe Mental ... - GuíaSalud

4. Interpretation must be used with precaution.
5. The objectives of this type of interventions include: the experience of the self-object as
two separate and independent entities that are, at the same time, related to each other; the stabilisation
of the limits of the self and identity; the integration of psychotic experience.
6. The frequency of the sessions must not exceed three sessions a week, and must last for at
least two years.
7. Therapists need a high level of tolerance to frustration and independence of the narcissistic
reward.
Question to be answered
• Are psychodynamic psychotherapy and the psychoanalytic approaches effective in the
treatment of people with SMI?
The benefit of psychodynamic or psychoanalytical interventions to treat schizophrenia has
been and is still being discussed in depth due to the fact that the existing scientific evidence is very
scarce and of low quality.
In the United States, in an attempt to improve the quality of health interventions and promote
the adoption of treatments that have scientifically proven their effectiveness, some years ago
the Department of Health and Human Services, through the Agency for Health Care Policy and
Research (AHCPR), known as the Agency for Healthcare Research and Quality (AHRQ) started
up the programme.
Patient Outcomes Research Team (PORT). The PORT schizophrenia programme compiles
scientific literature on the efficiency of treatments and examines the practices and implications
of their variability in health quality. The PORT recommendation on psychodynamic intervention,
in people with schizophrenia and based on very low quality and non-conclusive studies, is that
psychodynamic intervention should not be applied to people with schizophrenia, due to the lack
of evidence and to the high cost of the intervention 49 .
There is a SR by Malmberg & Fenton67 (3 RCTs, n = 492)68-70 which compares the effects
of individual psychodynamic psychotherapy or psychoanalysis with standard treatment (which
may include just medication, reality-adapted psychotherapy or group psychotherapy) and with no
intervention in people with schizophrenia or SMI. Considerable variations have been found in this
review during the treatment, in the follow-up and in the phase of the disease when the intervention
is applied (first episode and subsequent ones), in the results and the intervention comparator, with
biases in the randomisation and blinding in the studies. This study does not provide any result on
the effectiveness or not of this intervention.
Leichsenring et al 71 publish a metanalysis that assesses the effectiveness of long-term psychodynamic
psychotherapy. 11 RCTs and 12 observational studies are included in this study, and
the mental disorders included are eating disorders, personality disorders, depression and anxiety
and heterogeneous disorders. No data are provided on psychosis or bipolar disorder which is the
study population in this guideline.
Summary of evidence
Sufficient evidence has not been found to make recommendations related to psychodynamic
psychotherapy or the psychoanalytic approach in the treatment of people with SMI.
50 CLINICAL PRACTICE GUIDELINES IN THE SPANISH NHS