Social skills training for schizophrenia?
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Aftercare↗
Biomedical subjects
A S Bellack
Publications and source records attributed to A S Bellack.
Scientific rewards and conflicts of ethical choices in human subjects research.
The primary responsibility of the American Psychological Association's (APA) Committee on Standards in Research (CSR) is to advise the APA on issues and standards related to the protection of human participants in psychological research. A related goal is to enhance the use of good ethical practices by APA members. The purpose of this article is to foster the view of research ethics not as an affront to the integrity of sound research, but as opportunities for scientific rewards, including increased understanding of the meaning of data, enhanced recruitment, and the inclusion of more representative samples. Three ethical practices are discussed as examples of this general premise: respect for confidentiality, use of debriefing, and assurance that participants are noncoerced volunteers. The Committee's intent is to promote consideration of these issues, not to promulgate specific guidelines or procedures.
Advisory Committees↗
Validity of the distinction between generalized social phobia and avoidant personality disorder.
Disorders of pervasive social anxiety and inhibition are divided into 2 categories, generalized social phobia (GSP) and avoidant personality disorder (APD). We explored the discriminative validity of this categorization by examining the comorbidity of GSP and APD and by comparing these groups on anxiety level, social skills, dysfunctional cognitions, impairment in functioning, and presence of concurrent disorders. Results from 23 subjects showed high comorbidity of the 2 diagnoses: All subjects who met criteria for APD also met criteria for GSP. APD was associated with greater social anxiety, impairment in functioning, and comorbidity with other psychopathology, but no differences in social skills or performance on an impromptu speech. GSP and APD seem to represent quantitatively different variants of the same spectrum of psychopathology rather than qualitatively distinct disorders. We also investigated a proposed social phobia subtyping scheme.
Adult↗
Comorbidity of schizophrenia and substance abuse: implications for treatment.
The problem of substance abuse disorders in schizophrenia patients is reviewed, including the prevalence of co-morbid disorders, assessment, hypothesized mechanisms underlying abuse, and the clinical effects of abuse on the course of illness and cognitive functioning. The principles of treatment for dual-diagnosis schizophrenia patients are outlined, and the limitations of existing interventions are noted. Gaps in current knowledge about the impact of substance abuse on schizophrenia and its treatment are identified, and suggestions are made regarding promising avenues of research in this area.
Alcoholism↗
Cognitive rehabilitation for schizophrenia: is it possible? Is it necessary?
Limitations of available psychosocial interventions combined with the increasing evidence that schizophrenia is characterized by diverse deficits in information processing has stimulated great interest in the possibility of cognitive rehabilitation. However, the current optimism seems unjustified. The precise role of information processing in the behavioral handicaps evidenced by schizophrenic patients is not clear, and the neuropsychologic and experimental psychopathology tasks used to assess information processing generally cannot specify precisely which cognitive functions are deficient. Thus, the choice of cognitive targets for rehabilitation is arbitrary. The strategies currently employed for rehabilitation emphasize an exercise model of treatment and the use of complex mnemonics. Neither approach has been successful in rehabilitating brain-injured patients, and preliminary results with schizophrenic patients are not very promising. It is concluded that the field might be better served by focusing on environmental change and compensatory strategies until we determine how and why schizophrenic patients fail.
Behavior Therapy↗
Diagnostic and demographic correlates of substance abuse in schizophrenia and major affective disorder.
The relationship between history of specific types of substance abuse (alcohol, stimulants, cannabis, hallucinogens, narcotics) and demographic and diagnostic variables was evaluated in a large (n = 263) sample of schizophrenic, schizoaffective, major depression and bipolar disorder patients. Prevalence rates were also compared with rates observed in a previous study (1983-1986) conducted using the same methods. Demographic characteristics (gender, age, race, educational level) were strong predictors of type of substance abuse. Patients with a history of cocaine abuse had fewer prior hospitalizations, suggesting that less impaired psychiatric patients may be more prone to illicit substance abuse. Diagnoses were not related to most types of substance abuse, although there was a trend for bipolar patients to have a history of alcohol abuse. The results demonstrate the importance of matching groups on demographic characteristics when exploring diagnostic differences in preference to abuse specific types of substances.
Adolescent↗
The ability of schizophrenics to perceive and cope with negative affect.
Thirty-four schizophrenic patients in an acute in-patient hospital were compared with 24 in-patients with major affective disorder and 19 non-patient controls on a role-play test of social skills and a test of affect perception. The role-play test consisted of 12 simulated conversations in which the subject was confronted by parents and friends expressing high-EE criticism or non-critical dissatisfaction. Schizophrenic patients lacked assertiveness and social skills in all conditions, but they did not show any differential impairment when presented with high EE. They consistently lied and denied errors rather than responding assertively or apologizing, whether confronted with high-EE or benign criticisms. On the affect perception test, schizophrenic patients consistently underestimated the intensity or negativeness of negative emotions, but they were not deficient in perception of positive emotional displays. The data do not support the hypothesis that schizophrenic patients are poor at dealing with high-EE behaviours, but do indicate that their ability to cope with even mild negative affect is impaired. Possible explanations for this impairment include limited attentional capacity, a neurologically based perceptual deficit, and a self-protective mechanism to reduce or avoid stress.
Adaptation, Psychological↗
An assessment of the educational needs of chronic psychiatric patients and their relatives.
Both psychiatric patients and their relatives benefit from learning about mental illness and how to cope with it, but the specific interests of these consumers remain unclear. To determine specific educational needs and to compare the needs of different consumers, a questionnaire survey was conducted with a sample of patients with schizophrenia and affective disorder and their relatives. Both patients and relatives reported strong interest in learning more about psychiatric illness and strategies for coping with common problems, but patients with schizophrenia were less interested than patients with affective disorder and both sets of relatives. Discriminant analyses revealed that needs differed as a function of patient diagnosis, patient/relative status, and relatives' membership of a self-help and advocacy organisation. Consumers of mental health services are capable of specifying their own educational needs, and educational programmes should be tailored to meet these.
Adaptation, Psychological↗
Prediction of social skill acquisition in schizophrenic and major affective disorder patients from memory and symptomatology.
Memory and symptomatology were examined as predictors of social skill acquisition in psychiatric inpatients participating in a social skills training program. Poor memory was related to pretreatment social skill impairments and slower rates of skill improvement during the intervention for patients with schizophrenia or schizoaffective disorder, but not affective disorder. Symptomatology was not consistently related to pretreatment social skill or changes in skill for either schizophrenic or affective disorder patients. The results suggest that cognitive deficits in schizophrenia are associated with impairments in social skill and that such deficits may limit the rate of skill acquisition and clinical response to social skills training interventions.
Adult↗
Prevalence and stability of social skill deficits in schizophrenia.
The prevalence of social skill deficits in schizophrenia was examined by comparing patients assessed over a 1 year period with a group of non-patient controls recruited from the community. Social skills were assessed using a role play test and were considered deficient when they were below the range of the control sample. Approximately 50% of the patients were consistently unskilled over the one year, whereas 11% were consistently skilled. Deficits in specific social skills were relative rare. Consistent deficits were present for only one of six specific skills: 14% of the patients were consistently less appropriate in their conversational turn-taking (Meshing) than the controls. Patients' social skills were relatively stable over time. The implications of these results for the assessment and remediation of social skill impairments in schizophrenia are discussed.
Adolescent↗
Assessment of enduring deficit and negative symptom subtypes in schizophrenia.
The clinical importance of subtypes based on enduring deficit or negative symptoms was examined in a group of schizophrenic patients who were assessed twice over a 1-year period. Subgroups of patients with high levels of enduring negative or deficit symptoms, based on the Scale for the Assessment of Negative Symptoms and the Quality of Life Scale, had a poorer prognosis and were consistently worse in social adjustment, quality of life, and thought disorder over the year than were patients with less severe negative symptoms. Subtypes based on Andreasen's negative schizophrenia classification and on enduring thought disorder were only weakly related to other symptoms and social adjustment. Social-skill deficits were weakly related to the enduring negative symptom subtype and Andreasen's negative schizophrenia. The results suggest that enduring negative and deficit symptoms may be associated with a poor outcome in schizophrenia, including more severe positive symptoms, lower levels of social adjustment, and a poorer quality of life.
Adult↗
Social competence in schizophrenia: premorbid adjustment, social skill, and domains of functioning.
The relations between premorbid adjustment, social skill, and domains of functioning (symptoms, social adjustment) were examined in a group of 107 schizophrenic, schizoaffective, and affective disorder patients. Premorbid sexual adjustment was moderately correlated with social skill in the schizophrenic and schizoaffective patients. Schizophrenic patients had the lowest premorbid adjustment and social skill, followed by schizoaffectives, and then affective patients. Within the schizophrenic group, social skill was significantly related to both current social adjustment and negative symptoms, but not positive symptoms. Similar but weaker effects were found for premorbid adjustment. The results suggest that deficits in social skill are correlated with poor premorbid and morbid social adjustment of schizophrenics.
Adolescent↗
Gender, social competence, and symptomatology in schizophrenia: a longitudinal analysis.
The relationship between gender and social skill measured by performance on a role play test was examined in a sample of 57 schizophrenics, 33 affective disorder patients, and 20 nonpatient controls. Female schizophrenics were more skilled than male schizophrenics, but no gender differences were present in the affective patients or the controls. Longitudinal analyses conducted on the schizophrenic group indicated that the superior social skill of women was stable over the year following a symptom exacerbation. Symptoms and social adjustment improved for both men and women over the year, but did not differ according to gender. The implications of the results for gender differences in the long-term outcome of schizophrenia are discussed.
Adolescent↗
Prevalence of substance abuse in schizophrenia: demographic and clinical correlates.
Methodological issues involved in assessing the prevalence of substance abuse in schizophrenia are discussed, and previous research in this area is comprehensively reviewed. Many studies suffer from methodological shortcomings, including the lack of diagnostic rigor, adequate sample sizes, and simultaneous assessment of different types of substance abuse (e.g., stimulants, sedatives). In general, the evidence suggests that the prevalence of substance abuse in schizophrenia is comparable to that in the general population, with the possible exceptions of stimulant and hallucinogen abuse, which may be greater in patients with schizophrenia. Data are presented on the association of substance abuse with demographics, diagnosis, history of illness, and symptoms in 149 recently hospitalized DSM-III-R schizophrenic, schizophreniform, and schizoaffective disorder patients. Demographic characteristics were strong predictors of substance abuse, with gender, age, race, and socioeconomic status being most important. Stimulant abusers tended to have their first hospitalization at an earlier age and were more often diagnosed as having schizophrenia, but did not differ in their symptoms from nonabusers. A history of cannabis abuse was related to fewer symptoms and previous hospitalizations, suggesting that more socially competent patients were prone to cannabis use. The findings show that environmental factors may be important determinants of substance abuse among schizophrenic-spectrum patients and that clinical differences related to abuse vary with different types of drugs.
Adolescent↗
Positive and negative symptoms in schizophrenia. A cluster-analytic approach.
The relationships between positive and negative symptoms of schizophrenia and between negative symptoms and social dysfunction were investigated using cluster analysis. Clustering across schizophrenic subjects produced three distinct groups, each characterized by some mix of positive and negative symptoms. Clustering across symptoms and behavioral variables produced a cluster comprising negative symptoms and measures of social adjustment and an additional cluster comprising only measures of social skill. A series of correlations revealed a positive relationship between positive and negative symptom measures. chi 2 analysis revealed a significant relationship between the cluster solution across subjects and classification of patients according to negative symptoms based on previously published criteria. Results are discussed in terms of the implications for the further development and refinement of subclassification schemes for schizophrenia.
Adult↗
Hallucinations in schizophrenia.
The prevalence of different types of hallucinations and their clinical correlates were examined in 117 DSM-III-R schizophrenic or schizoaffective disorder patients. Auditory hallucinations were by far the most common, followed by visual hallucinations, and then by tactile and olfactory or gustatory hallucinations. Auditory hallucinations were associated with an earlier age of first hospitalization among the schizophrenics. Global severity of the illness for schizophrenics was related to the presence of visual hallucinations, but not other types of hallucinations. Tactile and olfactory or gustatory hallucinations were strongly correlated with each other and with the severity of delusions for both schizophrenic and schizoaffective patients. The results suggest that important clinical differences exist between patients with different types of hallucinations, and that these clinical variables need to be controlled for in cross-cultural studies of hallucinations.
Adolescent↗
Remediation of cognitive deficits in schizophrenia.
Studies have suggested that schizophrenia is characterized by an impairment in the dorsolateral prefrontal cortex that prevents learning of some elementary information processing tasks. To test this hypothesis, the authors administered the Wisconsin Card Sorting Test to 16 schizophrenic inpatients with standard instructions and either contingent or noncontingent reinforcement. Performance was markedly impaired under each condition. A second cohort (N = 12) was tested after receiving instructions plus rehearsal and feedback. These subjects' performance was comparable to nonpatient norms and was maintained on a subsequent day. The results indicate that deficits in performance on the Wisconsin Card Sorting Test are remediable, whether or not they are due to neurological impairment.
Adult↗
Social skills training for acute psychiatric inpatients.
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Acute Disease↗