Randomized controlled trial of occupational therapy in patients with treatment-resistant schizophrenia

It is well established that the combination of psychopharmacological treatment and psychosocial interventions, such as psychotherapy, family orientation and occupational therapy (OT), represent the best strategy for treating patients with schizophrenia. However, in terms of treatment-resistant schizophrenia (TRS) almost only psychopharmacological treatments are available and psychosocial interventions such as OT had not proved to be effective. The aim of this study is to investigate if OT is effective when added to a psychopharmacological treatment in TRS.

Two groups of patients with TRS were compared: The experimental group (EG) received psychopharmacological treatment with clozapine plus sessions of occupational therapy (OT) and the control group (CG) received only clozapine. The Scale for Interactive Observation in Occupational Therapy (EOITO) was employed to evaluate the outcome. The duration of the study was 6 months and patients were rated at baseline and monthly totaling 7 assessments. EOITO was independently applied by two occupational therapists with high reliability rates (Kappa=0.90, p=0.001). Repeated measures of analyses of variance and the evaluation of the standardized effect sizes were used for statistical analyses.

The EG showed that the OT intervention was effective along the whole period of observation, mainly from the 4th month to the end of the study.

In patients with TRS the combination of OT and clozapine showed to be more effective than the use of clozapine alone. OT may represent an additional therapeutic option for patients with TRS.