Integrated psychological therapy: effectiveness in schizophrenia inpatient settings related to patients' age

Elderly people with schizophrenia often suffer from cognitive impairments, which affect their social functioning. Today, only a few therapy approaches for middle-aged and older patients are available. The Integrated Psychological Therapy (IPT) combines neurocognitive and social cognitive interventions with social skills approaches. The aim of this study was to evaluate (1) whether IPT is effective in younger patients (age < 40 years) and middle-aged patients (age ≥ 40 years) and (2) whether control conditions (treatment as usual or unspecific group activities) reveal some change in outcome depending on age.

A total of 15 controlled IPT studies with 632 inpatients with schizophrenia were evaluated in a standard meta-analytic procedure. Studies were categorized into two age categories.

Significant medium to large effect sizes (ES) were evident for IPT independent of age on the global cognitive score (mean score of all cognitive variables), on neurocognition, social cognition, social functioning, psychopathology, and the global therapy effect (mean of all variables). The IPT effects in middle-aged patients were significantly larger on the global cognitive score, on neurocognition, and on social cognition compared with younger patients. Opposite results could be observed in control conditions. Only younger patients participating in the control conditions showed small but significant ES on these variables, but almost middle-aged control patients did not. However, none of the differences in the control conditions were significant between the two age categories. A moderator analysis obtained no evidence for a strong impact of IPT variations, therapy setting, patient characteristics, and methodologic rigor of the research design.

These results support evidence for the efficacy of IPT independent of age. Results further indicate the need of goal-oriented specific psychological interventions for middle-aged and older patients with schizophrenia.