- Design
- Single-centre, assessor-blinded, parallel-group randomised controlled trial
- Population
- 130 outpatients aged 18–64 with schizophrenia or schizoaffective disorder in Berlin
- Primary outcome
- Psychosocial functioning (Mini-ICF-APP) at 24 and 36 months
- Effect
- −3.45 (95% CI −5.51 to −1.40) at 24 months; −4.07 (−6.19 to −1.94) at 36 months
This single-centre, assessor-blinded trial in Berlin randomised 130 outpatients with schizophrenia or schizoaffective disorder to modified psychodynamic psychotherapy for schizophrenia (MPP-S, a manualised therapy of at least 30 sessions focused on interpersonal vulnerability) plus usual care, or to usual care alone. Published in early October, it followed participants for 36 months.
Psychosocial functioning, the primary outcome, improved more with therapy. Adjusted between-group differences on the Mini-ICF-APP, where lower scores mean less impairment, were −3.45 (95% CI −5.51 to −1.40) at 24 months and −4.07 (−6.19 to −1.94) at 36 months. Adverse events were similar. Two participants died by suicide, one in each arm; the one in the therapy arm had not started therapy.
Psychodynamic approaches have had little trial evidence in psychosis, and guidelines favour cognitive behavioural therapy and family intervention. This trial gives the first controlled signal of durable benefit on everyday functioning. It is one centre, participants and therapists were not blinded, and people with substance misuse were excluded, which leaves out many patients seen in Indian services. Guidelines have not changed on the strength of it.
- Consider structured psychotherapy as part of care for people with stable schizophrenia whose functioning lags behind symptom control.
- Where psychodynamic therapists are available, this trial supports referral alongside, not instead of, antipsychotic treatment.
- Measure functioning, not just symptoms, when reviewing progress in outpatient psychosis care.
- Note that people with substance misuse were excluded, so results may not apply to them.
Why it matters
Functioning is what patients and families notice most, and few treatments in schizophrenia have shown durable gains in it.
Don't overread it
One single-centre trial with unblinded participants does not change guidelines that favour CBT and family intervention.
The statistics, in plain English
The confidence intervals stay clear of zero at both time points, so the benefit is unlikely to be chance. The gain grew slightly after therapy ended, which suggests it persisted. Whether a difference of about 3 to 4 points on this scale is large enough to change daily life is a judgement the trial does not settle on its own.
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