Personality changes in chronic schizophrenic patients during five years' treatment with intensive psychotherapy in combination with depot neuroleptics I. Analysis of changes as measured by the Holtzman Inkblot Technique.

Abstract

Twelve schizophrenic inpatients (experimental group) from one department of psychiatry were treated in an integrated programme lasting for at least 5 years (1967--1972). Two more patients participated during the last 4 years of the study. The treatment included depot neuroleptics in combination with individual and group psychotherapy. During the first 3 years of the investigation, the patients of the experimental group were urged to participate in individual and group psychotherapy twice a week. During the last 2 years patients were only offered group psychotherapy once a week. A matched sample of 13 schizophrenics (control group) was selected from other departments at the hospital. The main aim of this study was to describe and measure personality changes after this treatment programme as measured by the Holtzman Inkblot Technique. During the first 3 years of the investigation, a stable and continuously improved intellectual capacity and less disordered through processes were found, as measured by the Holtzman test. After a further 2 years a slight decrease in variables measuring intellectual capacity and more disordered thinking was found. Compared to the control group not receiving psychotherapy, the experimental group spent more days outside hospital during the observation period 1968--1975. The difference was not statistically significant, however. After 2 years of treatment the experimental group's of patients Activities of Daily Living (ADL performance) was increased -- at 5% level of statistical significance -- and it remained at about the same level throughout this investigation. The level of work performance, however, was not changed in this study. The patients in the experimental group were compared with two American reference groups; average adults and schizophrenics. After 3 years' treatment the experimental group had become more similar to the average adults than to the schizophrenics. Two years later a slight deterioration was found. Although psychotherapy seemed to have had additive positive effects in chronic schizophrenia, measures to prevent relapse must be considered.