Current status of music therapy for schizophrenic patients

One can simply listen to music without moving the body. Therefore, music therapy can be applied to patients who have lost their will to move. Music therapy performed in a group session may lead patients to learn their roles in society, and may be regarded as one of psychosocial treatments. Scientific evidence showing the effectiveness of music therapy is limited, however. Music activities have influence on emotional and rewarding systems in the brain [1,2]. Those studies suggest that music therapy has some positive effects on psychiatric disorders. The following two reasons make it difficult to organize scientific investigations in a hospital. First, one have to overcome ethical problems if one would like to conduct investigations in a hospital, where they give top priority to providing proper medical treatments for patients. Second, modern medical treatment involves a team of professionals, including doctors, nurses, clinical psychologists, and occupational therapists; it is necessary to make adjustments in a way that each member of the team can agree with each other concerning how they select their candidates, when and where they administer medical treatments, and how they evaluate their intervention. Only a few studies on psychosocial treatment for psychiatric disorders exist. Jung and Newton [3] utilized the Cochrane Reviews and extracted 28 studies on psychosocial treatments against schizophrenics and other mental disorders. They categorized those studies into four levels. Four studies were classified as ‘‘strong support that merits application,’’ five as ‘‘moderate support that warrants consideration of application,’’ and the others as ‘‘not supported. ’’ Among four studies classified as ‘‘strong support that merits application,’’ just one report dealt with music therapy. Scientific reports on music therapy, which employ randomized controlled trials, are generally rare [4]; nevertheless, music therapy has been tried to be applied for a variety of mental disease, including schizophrenia. Schizophrenia [5] is a typical psychiatric disorder, which is characterized by clear changes of symptoms as the disease progresses (Fig. 1). Positive symptoms, such as auditory hallucination and delusion, appear in the acute phase. Following this phase, negative symptoms, typically blunted affect and emotional withdrawal, which are characterized by inactivity, develop in the chronic phase. Once the disease gets into this stage, usually a circle of recovery and recurrence is repeated over the long-term course. Treatments for schizophrenic patients consist of physical treatment, which is typically antipsychotic treatment, and psychosocial treatments, like behavioral therapy, occupational therapy, and music therapy. Although antipsychotics suppress some symptoms, they cannot cure deficits in social functions, such as communication disorders. The physical conditions of the patients should be ameliorated first by medication. Immediately after the medication takes effects on the physical conditions, psychosocial activities (for example, having interpersonal communications or hobbies) should be introduced to lead the patients to further recovery. Matsui [6] listed ten characteristics of music that are suitable when music is utilized in a treatment. One of the most important characteristics may be that music directly affects a person’s emotions without necessarily putting to use an intellectual process. In other words, neural codes conveying music go directly to the brainstem from the hearing organ. Since music therapy does not necessarily depend on patients’ verbal communication ability, it is often suitable for patients with chronic schizophrenia, who usually suffer from deficits in communication. The following section introduces reports examining therapeutic effects of music therapy. e-mail: asanom@hoku-iryo-u.ac. jp