Multidisciplinary Rehabilitation Program for Treatment-Resistant Psychotic Forensic Patients: A Comparative Study

Oman Ministry of Health20 enrolled

Overview

This study employs a quasi-experimental design to evaluate the effectiveness of a 6-month multidisciplinary rehabilitation program integrating psychodynamic group therapy, art therapy, music therapy, and cognitive stimulation compared to standard rehabilitation (physiotherapy and occupational therapy). It will be done between a group of a total of 20 patients are divided into an intervention group and a control group from the forensic psychiatric department in Al Masarra Hospital.

Forensic psychiatric patients with treatment-resistant psychotic symptoms often experience persistent cognitive, functional, and social deficits, posing significant challenges to rehabilitation. Traditional approaches may not adequately address these complex needs, highlighting the importance of innovative, multidisciplinary interventions. This study employs a quasi-experimental design to evaluate the effectiveness of a 6-month multidisciplinary rehabilitation program integrating psychodynamic group therapy, art therapy, music therapy, and cognitive stimulation compared to standard rehabilitation (physiotherapy and occupational therapy). A total of 20 patients are divided into an intervention group (n=10) and a control group (n=10) using convenience sampling from the forensic psychiatric department in Al Masarra Hospital. Data is collected using the Positive and Negative Syndrome Scale (PANSS) to assess psychotic symptoms and the Montreal Cognitive Assessment (MoCA) to evaluate cognitive function, administered at baseline and post-intervention. Data is analyzed using descriptive statistics (median, interquartile range) and non-parametric tests, including the Wilcoxon Signed-Rank Test for within-group comparisons and the Mann-Whitney U Test for between-group comparisons. Effect sizes are calculated using Cliff's Delta to assess the practical significance of the findings. The null hypothesis states that there will be no significant difference in PANSS and MoCA scores between the intervention and control groups post-intervention. If the null hypothesis is rejected, the findings will provide evidence for integrating creative and psychotherapeutic interventions into forensic psychiatric rehabilitation, offering a scalable model for similar settings.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

Interventions

MoCA: Montreal Cognitive Assessment (MoCA) and Positive and Negative Syndrome Scale (PANSS)DIAGNOSTIC_TEST

MoCA: A 30-point screening tool assessing attention, memory, language, visuospatial and executive functions; quick and sensitive to mild cognitive deficits. PANSS: A 30-item scale rating positive, negative, and general psychopathology symptoms in psychotic disorders; widely used to track severity and change.

Rehabilitation program in the form of : psychodynamic group therapy, music and art therapy , cognitive stimulation techniquesBEHAVIORAL

Participants received a structured 6-month program designed to address persistent psychotic symptoms and associated deficits. The intervention included: Art Therapy: Weekly sessions promoting self-expression, emotional regulation, and enhancement of social interaction. Cognitive Stimulation: Structured group exercises aimed at improving attention, memory, executive functions, and problem-solving. The program was delivered by a multidisciplinary team in a group of 10 patients, ensuring active participation, individualized support, and integration of therapeutic modalities.

Eligibility

Sex: MALEMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Diagnosis of chronic psychotic disorder (e.g., schizophrenia or schizoaffective disorder) confirmed by psychiatric assessment and medical records. 2. Presence of residual psychotic symptoms (positive symptoms such as hallucinations, delusions; and/or negative symptoms such as blunted affect, social withdrawal) despite ongoing psychotropic treatment. 3. Medically stable and deemed suitable for participation by the treating psychiatrist or healthcare team. 4. Patients who provide informed consent to participate in the rehabilitation program and research study. Exclusion Criteria: 1. Acute medical or psychiatric conditions requiring immediate intervention. 2. Developmental or intellectual disabilities that significantly impair participation in the rehabilitation program or assessments. 3. Current substance dependence that would interfere with participation. 4. Significant risk of harm to self or others, based on clinical assessment or history of violence/aggression. 5. Contraindications to specific rehabilitation program components (e.g., physical exercise, group activities) as determined by medical evaluation. 6. Inability to comprehend study requirements or provide informed consent due to language barriers, cognitive impairment, or other factors.

Outcomes

Primary Outcomes

Change in Psychotic Symptoms Measured by the Positive and Negative Syndrome Scale (PANSS)

Psychotic symptom severity will be assessed using the Positive and Negative Syndrome Scale (PANSS). Scores range from 30 to 210, with higher scores indicating greater severity. The unit of measure is score change from baseline to post-intervention.

Time frame: Baseline (pre-intervention) and 6 months (post-intervention).

Secondary Outcomes

Change in Cognitive Function Measured by the Montreal Cognitive Assessment (MoCA) scale

Cognitive function will be assessed using the Montreal Cognitive Assessment (MoCA) scale. Scores range from 0 to 30, with higher scores indicating better cognitive performance. The unit of measure is score change from baseline to post-intervention.

Time frame: Baseline (pre-intervention) and 6 months (post intervention).