How Does Cognitive Behavioral Therapy (CBT) and Antipsychotics Compare to Antipsychotics Alone Impact Inpatient Length of Stay: A Scoping Review

Abstract

Background Psychosis in adults is a serious psychiatric condition that often necessitates inpatient hospitalization for stabilization and the initiation of medication. Untreated psychosis can lead to poor outcomes, including longer hospital stays, loss of occupational functioning, and a decreased quality of life. While antipsychotic medications are typically the first line of treatment, they can have severe side effects, which may lead to patients discontinuing their use. Cognitive Behavioral Therapy (CBT) for psychosis is an evidence-based intervention that targets maladaptive behaviors associated with the condition. CBT may improve treatment responses when used alongside antipsychotic medication. However, there is limited research on the effects  of combining CBT with antipsychotics in inpatient settings. The purpose of this scoping review is to evaluate whether the combination of CBT with antipsychotic medication, compared to antipsychotics alone, affects the length of inpatient stays and clinical outcomes in adults diagnosed with psychosis Methods This scoping review utilized a structured literature search of the UTHSC library databases, including CINAHL, EBSCOhost, Elsevier, Google Scholar, and PubMed, covering publications from 2015 to 2025. Studies comparing cognitive behavioral therapy combined with antipsychotics versus antipsychotics alone in hospitalized adults were screened using predefined inclusion criteria to evaluate the impact on length of stay. Results The literature search identified 1,213 articles. Five studies met inclusion criteria. Overall, results were mixed; however, several studies supported improved psychotic symptom control when cognitive behavioral therapy (CBT) was used in combination with antipsychotic medication. Although length of stay was not directly measured, improvements in symptoms and patient engagement suggest a likely reduction in hospitalization time. Implications for Nursing Practice Evidence supports that including CBT in combination with antipsychotics in treatment planning for inpatients with psychosis would allow nurses to deliver higher quality patient- centered care and positively impact patient outcomes by reducing symptom severity and length of stay