Symptomatology and the prediction of social skills acquisition in schizophrenia

[Social psychiatry and neurobiology : A long overdue convergence exemplified by schizophrenia]

BACKGROUND

The proliferation of biological psychiatry has greatly increased over the last two decades. With the possibility to carry out brain research using modern technical methods, it seemed that social influencing factors would lose importance in the development of mental diseases; however, in actual fact this does not seem to be justified. It is necessary to overcome this separation, in that social factors are incorporated into a conceptual framework in the development of mental diseases, which simultaneously also takes the results of current neurobiological research into consideration.

OBJECTIVES AND METHODS

The aims of this review article are to summarize the current state of sociopsychiatric research and to emphasize the perspectives of the biological principles and their validity with respect to the social dimensions of psychiatry, as exemplified by schizophrenic disorders. The article presents the options for a biosocial approach in social psychiatry and gives an overview of the currently available literature.

RESULTS AND CONCLUSION

There is an abundance of neurobiological research approaches, which are closely associated with sociopsychiatric topics, such as social cognition. Social psychiatry and biological psychiatry should no longer be considered as diametrically opposed subdisciplines. On the contrary, the options which could emerge from a synthesis must be used in research and clinical practice.

New Developments in Social Skills Training

Social skills training (SST) has emerged as one of the most widely practiced methods of psychiatric rehabilitation. The purposes of this article are to review the research about its effects, propose guidelines for its practice, and discuss several related methodological and clinical issues such as promoting generalisation, predicting the degree of benefit, and integrating training with other rehabilitation services. The research suggests that SST, when conducted using appropriate curricula and teaching techniques, helps individuals with schizophrenia acquire relevant interpersonal and instrumental skills. Generalisation of these skills can be promoted by simultaneously linking training to the opportunities, prompts, and consequences needed to perform the skills in the extra-training environments. Long-term SST appears to be necessary in order to produce significant improvements in community functioning. The article concludes with suggestions for future clinical research.

Development of specific social skills training programmes for schizophrenia patients: results of a multicentre study

OBJECTIVE

The efficacy of three newly developed cognitive social skills training programmes for residential, vocational and recreational functioning (experimental groups) were compared with a traditional social skills training programme (control group) referring to cognitive and social abilities, psychopathology and generalisation effects.

METHOD

One hundred and five patients with a diagnosis of schizophrenia or schizoaffective disorder according to ICD-10 criteria were selected and assigned to the different treatment groups, using a matching procedure. The treatment phase lasted 6 months. A follow-up assessment was carried out after 1 year.

RESULTS

Higher global therapy effects were obtained on almost all dependent variables in the experimental groups. Analyses of variance and covariance indicated higher symptom reduction for the experimental groups, but significantly greater improvements in some cognitive variables for the control group. Correlation analysis suggested associations between improvement of social behaviour with symptom reduction and improvements of cognitive skills.

CONCLUSION

In view of these favourable effects, the developed cognitive social skills training programmes might facilitate the abilities of schizophrenia patients for their integration in the community.

Training schizophrenic patients to manage their symptoms: predictors of treatment response to the German version of the Symptom Management Module

This study examined whether patient demographic and clinical characteristics were predictors of differential treatment response in a sample of 57 schizophrenic patients who received the German version of the Symptom Management Module. Psychopathology, global functioning and knowledge about schizophrenia were assessed as dependent variables. Overall, patients improved over the treatment period on most dimensions of psychopathology as well as knowledge about psychosis. There was little evidence of differential treatment response as a function of either sociodemographic or clinical variables. However, gender was related to changes in psychopathology from pre- to posttreatment, with females improving less than males. Possible implications of these findings were discussed.

Assertion training therapy in psychiatric milieus

The current investigation involved an attempt to develop a clinical procedure to decrease anxiety and increase responsiveness (assertion) of psychiatric inpatients of both sexes in mixed diagnostic categories and to evaluate the effectiveness of the procedure. Using a Solomon Four-Group Design, patients, matched on age, sex, and diagnosis, were assigned to one of the following conditions: (1) pretest, treatment, posttest; (2) pretest, no treatment, posttest; (3) treatment, posttest; or (4) no treatment, posttest. The Gambrill-Richey Assertive Inventory was used to assess patient Degree of Discomfort and Response Probability with and without assertion training therapy. Results indicated that (1) patients receiving assertion training therapy were less anxious and more responsive after treatment than before, (2) patients receiving assertion training therapy were less anxious and more responsive than were matched control subjects, (3) control subjects who received no assertion training therapy and who were pretested showed moderate significant gains on the posttest measure, (4) patients reported a greater reduction of anxiety than they did an increase in responsiveness, and (5) pretesting did not significantly influence posttest scores.

What influences social skills in patients with schizophrenia? Preliminary study using the role play test, WAIS-R and event-related potential

Persons with schizophrenia exhibit disabilities which profoundly affect their social and independent living skills, and social skills training is expected to be an effective treatment for reducing the level of severity of disabilities. Many factors may influence usage and learning of social skills; little is definitively known regarding which disabilities related to schizophrenia compromise social skills. The present report deals with factors affecting social skills. Twenty persons with schizophrenia (DSM-III-R) were tested using a Japanese version of the role play test, the reliability and validity of which were verified. Subjects were also tested using BPRS, auditory event-related potential (ERP) and WAIS-R. Nonverbal skills showed significant positive correlation with the amplitude of the N1 ERP component and age of onset, and 59% of the variance of nonverbal skills was accounted for by these factors using multiple regression analysis. Nonverbal skills are at least partially based on either automatic discriminating processes or selective attention, reflected in N1A. Information receiving and processing skills showed significant positive correlation with Performance IQ and Global Assessment of Functioning, and 61% of the variance of receiving and processing skills was accounted for by BPRS score, PIQ score and age. These skills are not directly related to elementary cognitive function as assessed by analyzing, for example, the ERP P3 component, but are based on more complex neuropsychological function.