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Systematic reviews are supposed to help answer clinical questions but more often than not they just seem to raise more questions. This is largely a result of the poor quality of the primary studies: garbage in, garbage out. The Cochrane reviewers have been scouring the archives, looking for evidence to support the use of benzodiazepines and supportive therapy in schizophrenia. It will come as no surprise to hear that benzodiazepines have a sedative effect that may be helpful in calming agitated patients (Cochrane Database Syst Rev 2007;1:CD006391). The effectiveness of supportive therapy is an important question given that, according to the reviewers, it’s the most commonly practiced intervention in mental health (Cochrane Database Syst Rev 2007;1:CD004716). I was bemused by their comparison of supportive therapy with standard care, having thought that they were one and the same. That is, until I came across this definition of supportive therapy: a dyadic treatment characterised by the use of direct means to ameliorate symptoms and to maintain, restore, or improve self-esteem, adaptive skills and ego function. A bit more sophisticated than checking compliance and passing comment on the weather. Once again, most of the studies reviewed were short and small, but one finding was striking: the lack of any significant difference between supportive therapy and other psychological therapies such as CBT, which flies in the face of recent guidelines exhorting their use in schizophrenia.
What CATIE did next: another …
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