Treatment Effect of Antipsychotics in Combination with Horticultural Therapy on Patients with Schizophrenia: A Randomized, Double-blind, Placebo-controlled Study

BACKGROUND: As a newly developed treatment method for schizophrenia, horticultural therapy is gaining more attention. However, there is as of now little research investigating this topic as well as a general lack of studies adopting into standard treatment plans. AIMS: Investigate treatment effect of horticultural therapy on patients with schizophrenia and its possibility of standardized application in psychiatric hospitals. METHODS: 110 patients with schizophrenia who met the inclusion criteria and provided informed consent were selected from the rehabilitation ward of the Minhang District Mental Health Center from September 2015 to December 2015. We used random-number methods to classify patients into either the intervention group or the control group. While the two groups both received normal medications, the intervention group also attended horticultural therapy. Patients in the intervention group were led by a rehabilitation therapist who had obtained the level II psychological counselor qualification (the standard qualification for counselors in China). The treatment period lasted for 12 weeks. Treatment was held 3 times every week and each session lasted for 90 minutes. The specific contents included ridging, planting, watering, fertilizing and pruning of flowers; plowing, sowing, watering, fertilizing, weeding and catching pests for gardens; appreciating, collecting vegetables, cooking and tasting for flowers and grasses. During the final 10 minutes of every session, patients mutually expressed their thoughts and experiences and the rehabilitation therapist concluded the session. The two groups were measured by the Positive and Negative Syndrome Scale (PANSS) at baseline, the end of the 4(th) week and the end of the 12(th) week. RESULTS: There was no statistically significant difference in gender, age, course of disease, marital status, mean dosage of antipsychotic medications and PANSS score before the intervention among two groups. The PANSS score in the intervention group was statistically significant lower than in the control group both at the end of the 4(th) week (t=-4.03, p<0.001) and at the end of the 12(th) week (t=-5.57, p<0.001). There were statistically significant differences before and after intervention in the intervention group (F=253.03, p<0.001); there was statistically significant differences before and after intervention in the control group (F=67.66, p<0.001). There was statistically significant difference in the positive scale score among the two groups both at the end of the 4(th) week (t=-3.69, p<0.001) and the end of the 12(th) week (t=-3.55, p<0.001); there was a statistically significant difference in the general psychopathology scale score among the two groups both at the end of the 4(th) week (t=-3.67, p<0.001) and the end of the 12(th) week (t=-3.34, p<0.001). Likewise, there were statistically significant differences in the positive scale scores at baseline, end of the 4(th) week and the end of the 12(th) week both among the intervention group (F=13.76, p<0.001) and the control group (F=5.12, p=0.02); there were statistically significant differences in the general psychopathology scale scores at the baseline, the end of the 4(th) weekand the end of the 12(th) week both among the intervention group (F=156.40, p<0.001) and the control group (F=56.72, p<0.001). There was statistically significant differences in the negative scale score at the end of the 12(th) week among the two groups (t=-2.76, p<0.001). There were statistically significant differences in the positive scale scores at the baseline, the end of the 4(th) week and the end of the 12(th) week both among the intervention group (F=103.94, p<0.001) and the control group (F=34.03, p<0.001). CONCLUSIONS: Although antipsychotic medications can alleviate the psychiatric symptoms of patients with schizophrenia, the treatment effect for both positive and negative symptoms would be even more effective if it is combined with horticultural therapy.