Mössler Karin, Chen Xijing, Heldal Tor Olav, Gold Christian
GAMUT, University of Bergen, Lars Hilles Gt. 3, Bergen, Norway.
Cochrane Database Syst Rev. 2011 Dec 7(12):CD004025. doi: 10.1002/14651858.CD004025.pub3.
Music therapy is a therapeutic method that uses musical interaction as a means of communication and expression. The aim of the therapy is to help people with serious mental disorders to develop relationships and to address issues they may not be able to using words alone.
To review the effects of music therapy, or music therapy added to standard care, compared with 'placebo' therapy, standard care or no treatment for people with serious mental disorders such as schizophrenia.
We searched the Cochrane Schizophrenia Group Trials Register (December 2010) and supplemented this by contacting relevant study authors, handsearching of music therapy journals and manual searches of reference lists.
All randomised controlled trials (RCTs) that compared music therapy with standard care, placebo therapy, or no treatment.
Studies were reliably selected, quality assessed and data extracted. We excluded data where more than 30% of participants in any group were lost to follow-up. We synthesised non-skewed continuous endpoint data from valid scales using a standardised mean difference (SMD). If statistical heterogeneity was found, we examined treatment 'dosage' and treatment approach as possible sources of heterogeneity.
We included eight studies (total 483 participants). These examined effects of music therapy over the short- to medium-term (one to four months), with treatment 'dosage' varying from seven to 78 sessions. Music therapy added to standard care was superior to standard care for global state (medium-term, 1 RCT, n = 72, RR 0.10 95% CI 0.03 to 0.31, NNT 2 95% CI 1.2 to 2.2). Continuous data identified good effects on negative symptoms (4 RCTs, n = 240, SMD average endpoint Scale for the Assessment of Negative Symptoms (SANS) -0.74 95% CI -1.00 to -0.47); general mental state (1 RCT, n = 69, SMD average endpoint Positive and Negative Symptoms Scale (PANSS) -0.36 95% CI -0.85 to 0.12; 2 RCTs, n=100, SMD average endpoint Brief Psychiatric Rating Scale (BPRS) -0.73 95% CI -1.16 to -0.31); depression (2 RCTs, n = 90, SMD average endpoint Self-Rating Depression Scale (SDS) -0.63 95% CI -1.06 to -0.21; 1 RCT, n = 30, SMD average endpoint Hamilton Depression Scale (Ham-D) -0.52 95% CI -1.25 to -0.21 ); and anxiety (1 RCT, n = 60, SMD average endpoint SAS -0.61 95% CI -1.13 to -0.09). Positive effects were also found for social functioning (1 RCT, n = 70, SMD average endpoint Social Disability Schedule for Inpatients (SDSI) score -0.78 95% CI -1.27 to -0.28). Furthermore, some aspects of cognitive functioning and behaviour seem to develop positively through music therapy. Effects, however, were inconsistent across studies and depended on the number of music therapy sessions as well as the quality of the music therapy provided.
AUTHORS' CONCLUSIONS: Music therapy as an addition to standard care helps people with schizophrenia to improve their global state, mental state (including negative symptoms) and social functioning if a sufficient number of music therapy sessions are provided by qualified music therapists. Further research should especially address the long-term effects of music therapy, dose-response relationships, as well as the relevance of outcomes measures in relation to music therapy.
音乐疗法是一种利用音乐互动作为沟通和表达手段的治疗方法。该疗法的目的是帮助患有严重精神障碍的人建立人际关系，并解决他们可能无法仅用言语表达的问题。
比较音乐疗法或在标准护理基础上加用音乐疗法与“安慰剂”疗法、标准护理或不治疗对患有精神分裂症等严重精神障碍患者的效果。
我们检索了Cochrane精神分裂症研究组试验注册库（2010年12月），并通过联系相关研究作者、手工检索音乐疗法期刊以及手动检索参考文献列表进行补充。
所有比较音乐疗法与标准护理、安慰剂疗法或不治疗的随机对照试验（RCT）。
可靠地选择研究、评估质量并提取数据。我们排除了任何组中超过30%的参与者失访的数据。我们使用标准化均数差（SMD）综合来自有效量表的非偏态连续终点数据。如果发现统计学异质性，我们将检查治疗“剂量”和治疗方法作为可能的异质性来源。
我们纳入了八项研究（共483名参与者）。这些研究考察了音乐疗法在短期至中期（一至四个月）的效果，治疗“剂量”从七次到78次不等。在标准护理基础上加用音乐疗法在整体状态方面优于标准护理（中期，1项RCT，n = 72，RR 0.10，95%CI 0.03至0.31，NNT 2，95%CI 由1.2至2.2）。连续数据显示对阴性症状有良好效果（4项RCT，n = 240，SMD 阴性症状评估量表（SANS）平均终点 -0.74，95%CI -1.00至 -0.47）；一般精神状态（1项RCT，n = 69，SMD 阳性和阴性症状量表（PANSS）平均终点 -0.36，95%CI -0.85至0.12；2项RCT，n = 100，SMD 简明精神病评定量表（BPRS）平均终点 -0.73，95%CI -1.16至 -0.31）；抑郁（2项RCT，n = 90，SMD 自评抑郁量表（SDS）平均终点 -0.63，95%CI -1.06至 -0.21；1项RCT，n = 30，SMD 汉密尔顿抑郁量表（Ham-D）平均终点 -0.52，95%CI -1.25至 -0.21）；以及焦虑（1项RCT，n = 60，SMD 焦虑自评量表（SAS）平均终点 -0.61，95%CI -1.13至 -0.09）。在社会功能方面也发现了积极效果（1项RCT，n = 70，SMD 住院患者社会残疾评定量表（SDSI）评分平均终点 -0.78，95%CI -1.27至 -0.28）。此外，认知功能和行为的某些方面似乎通过音乐疗法得到积极改善。然而，各研究结果不一致，且取决于音乐疗法的疗程数量以及所提供音乐疗法的质量。
如果由合格的音乐治疗师提供足够数量的音乐疗法疗程，那么在标准护理基础上加用音乐疗法有助于精神分裂症患者改善其整体状态、精神状态（包括阴性症状）和社会功能。进一步的研究应特别关注音乐疗法的长期效果、剂量 - 反应关系以及与音乐疗法相关的结局测量指标的相关性。
