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Objective: To identify correlates of self-reported substance use and problems associated with that use in people with schizophrenia., Methods: A sample of 404 patients with schizophrenia, schizoaffective disorder, or schizophreniform disorder and longitudinal assessments of substance use were examined. Three groups were formed according to consistency of substance use over time: No/Low Alcohol, Alcohol Only, and Drug Use (with or without alcohol use). Similar groups were formed regarding problems associated with alcohol use. Groups were compared on demographics, psychiatric history, psychopathology, medication side effects, and social functioning., Results: Substance users were more likely to be young, male, and to have lower levels of education. Substance users generally had fewer negative symptoms, more social contacts, and better social-leisure functioning. However, substance users, especially drug users, also were rated as having more interpersonal and family problems, had an earlier age at first psychiatric hospitalization, and were more likely to have been recently hospitalized. Patients reporting problems with alcohol use reported more frequent alcohol and drug use, greater severity of akathisia, and problems in interpersonal, family, and self-efficacy domains., Conclusions: Many of the same variables that correlate with substance use disorder also correlated with moderate substance use in this sample of people with schizophrenia. Although moderate users of alcohol and drugs may have better social functioning in some areas, they also are likely to have substantial problems in interpersonal relationships, especially those involving family members.

The effects of 2 family intervention programs (supportive family management [SFM], including monthly support groups for 2 years; or applied family management [AFM], including 1 year of behavioral family therapy plus support groups for 2 years), and 3 different neuroleptic dosage strategies (standard, low, targeted) on social functioning of patients with schizophrenia. their relatives' attitudes, and family burden were examined. AFM was associated with lower rejecting attitudes by relatives toward patients and less friction in the family perceived by patients. Patients in both AFM and SFM improved in social functioning but did not differ, whereas family burden was unchanged. Medication strategy had few effects, nor did it interact with family intervention. The addition of time-limited behavioral family therapy to monthly support groups improved family atmosphere, but did not influence patient social functioning or family burden.

This study examines the relationship between anhedonia and the trait dimensions of positive affect (PA) and negative affect (NA) in schizophrenia. The relationship between poor social functioning in schizophrenia and these individual differences in affectivity is also examined. Schizophrenia outpatients (n = 37) and normal controls (n = 15) were assessed at a baseline evaluation and again approximately 90 days later. Consistent with the hypothesized decrease in hedonic capacity in schizophrenia, patients reported significantly greater physical and social anhedonia and less PA than controls. However, the schizophrenia group also reported significantly greater NA and social anxiety than did controls. In support of the dispositional view of these individual differences in affectivity, trait measures demonstrated test-retest reliability, and group differences between the schizophrenia group and controls were stable over the 90-day followup period. Within the schizophrenia group, physical and social anhedonia were comparably negatively correlated with trait PA; however, social but not physical anhedonia was significantly positively correlated with NA and social anxiety. Poor social functioning in the schizophrenia group was associated with greater physical and social anhedonia and greater NA and social anxiety. Alternatively, greater trait PA was related to better social functioning. These findings indicate that schizophrenia is characterized by both low PA and elevated NA and that these affective characteristics are a stable feature of the illness. The results also suggest important links between affect and social functioning in schizophrenia.

Geriatric chronic psychiatric inpatients often remain in a chronic psychiatric hospital because of serious deficits in adaptive life functions. Because the additional complications and adaptive changes associated with aging have not been considered in previous scales, the Social-Adaptive Functioning Evaluation (SAFE) was developed. The items in the scale measure social-interpersonal, instrumental, and life skills functioning and are designed to be rated by observation, caregiver contact, and interaction with the subject if possible. Interrater and test-retest reliability were examined (n = 60) and convergent and discriminant validity were rated against other relevant measures (n = 50) in separate studies, with all being found adequate. The factor structure of the scale was examined with exploratory factor analysis, revealing a three-factor structure. Finally, predictive validity was examined in a preliminary study of 140 patients, 45 of whom were discharged after the assessment. The results indicate that patients who remained hospitalized could be discriminated from those who were sent to nursing homes or community care on the basis of certain SAFE items and subscales. These results support the use of this instrument in later studies of geriatric psychiatric patients.

The role of social skill in mediating perceived physical attractiveness among individuals with chronic schizophrenia was investigated. Twenty five inpatients participated in an unstructured role play. The physical attractiveness of the individuals was rated both before and after observation of the role play by two pairs of raters. Social skill was rated by a third pair of raters. The two ratings of physical attractiveness were only weakly correlated with one another. Social skill contributed variance independent of initial attractiveness to post-role-play attractiveness. Practical implications of the findings (i.e., stigma issues and social skills training) are discussed.

Objectives: The purpose of this study was to investigate the relationship between cognitive disability and social skills in an acute care adult inpatient psychiatric population (n = 55)., Method: Independent ratings of patient's social skills were made during a semistructured interview using the Social Interaction Test (SIT), followed by measurement of cognitive disability using the revised Allen Cognitive Level Test (ACL-90). Reliability of the assessments was established., Results: Significant correlations were found between the ACL-90 and SIT scores: patients with greater cognitive disability had poorer social skills. ACL-90 scores were not related to gender or diagnosis. A gender difference was found for SIT scores with women having better social skills than men., Conclusion: These findings suggest there is a relationship between cognitive disability and social skills in adult psychiatric inpatients. Implications for occupational therapy treatment include better integration of the grading of the cognitive and social requirements of tasks to achieve optimal functioning.

Previous research on social skills training has demonstrated its usefulness as an adjunct treatment for a variety of psychiatric disorders. At the Medical College of Pennsylvania at Eastern Pennsylvania Psychiatric Institute, an acute-care psychiatric hospital, a social skills training group has been in operation for over 3 years. The group is unique in its format in several ways that are described in this article. Data collected over the 3-year period are also presented. The major findings indicate that even over a very brief period of time during an acute hospitalization, patients can learn basic conflict resolution skills. Some predictors of skill acquisition were also identified.

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.

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.

Two studies were conducted to evaluate the clinical efficacy of intensive social skills training in medicated schizophrenic inpatients at risk for relapse. In study 1, three patients were treated; two showed reductions in psychopathology and rehospitalization and improved social functioning 9 months following discharge. In study 2, social skills training was compared with holistic health treatment in 28 patients. Both groups showed reduced psychopathology 2 years after discharge; patients treated with social skills training had better social functioning, spent less time hospitalized, and had fewer symptomatic relapses. The results support the utility of social skills training as a psychosocial treatment for schizophrenia.

Social skill and role functioning were assessed in matched groups of patients with DSM-III-R schizoaffective disorder, bipolar disorder, and schizophrenia. Schizophrenics were categorized as negative syndrome or non-negative on the basis of the SANS. The negative schizophrenics were significantly more impaired on almost every measure of social functioning. The other three groups were not consistently different from one another. The results suggest that when patients are comparable on dimensions such as duration and severity of illness, schizoaffectives do not occupy an intermediate position between schizophrenics without negative syndrome and bipolar patients. Rather, the three groups exhibit similar degrees of social disability. In contrast, negative syndrome schizophrenics were more impaired even when they were similar in chronicity and severity.

The relationship between urinary excretion of 3-methoxy-4-hydroxyphenylglycol (MHPG) and overt behaviors emitted in two hospital environments was examined in a group of 27 drug-free psychiatric patients. Depressed patients with high MHPG excretion ate less and engaged in less visual activity in the lunch environment. Schizophrenic patients but not depressive patients with high MHPG tended to have greater body activity during the gym environment. The implications of these findings for the identification of subtypes of depression and schizophrenia, and for an improved methodology in investigation of biobehavioral relations in clinical populations, are discussed.

The recent literature on social skills training has placed an increasing emphasis on the role of cognitive factors in social failure, as opposed to deficits in motoric skills. It has been hypothesized that schizophrenic patients are markedly deficient in social problem-solving abilities, and several programs have been developed to teach problem-solving skills. Despite high face validity, there is little empirical support for these training programs or the problem-solving model on which they are based. Research on information processing and problem solving in nonpatient populations is discussed, and it is concluded that the model used in these treatment programs is not a good representation of the problem-solving process. In particular, means-ends analysis is not an appropriate strategy for dealing with most interpersonal problems and conflicts. The difficulties experienced by schizophrenic patients in social situations might be due to a number of factors other than deficits in problem-solving skill, including sensitivity to negative affect and disordered communication. It is concluded that further research on problem-solving training programs is clearly warranted but that the validity of the problem-solving model and the utility of the training is uncertain.

Social skills training methods represent a major strategy for psychiatric rehabilitation. Building skills in patients with schizophrenic and other major mental disorders is based on the assumption that coping and competence can override stress and vulnerability in reducing relapses and improving psychosocial functioning. For maximum efficiency, skills training needs to incorporate procedures and principles of human learning and information processing. Several models for skills training have been designed and evaluated, each of which has proved to be effective in raising the social competence of chronic mental patients. The "basic" model involves role playing by the patient and modeling, prompting, feedback, and reinforcement by the therapist. A "problem-solving" model of training provides general strategies for dealing with a wide variety of social situations. This model uses role playing to enhance behavioral performance but also highlights the patient's abilities to perceive and process incoming social messages and meanings. It is essential that social skills training be imbedded in a comprehensive program of rehabilitation that features continuity of care, supportive community services, therapeutic relationships, and judicious prescription of psychotropic drugs.

With chronic institutionalized psychiatric patients, an intensive social learning program resulted in greater increases in adaptive functioning, reductions in bizarre behavior, less prescribed medication, and over 98 percent of patients being successfully discharged into the community. The social-learning program was more cost-effective than custodial hospital care, and nonprofessional staff were able to apply the treatment with a high degree of competence. Especially effective elements of the social-learning program included integrated procedures emphasizing the acquisition of patient skills and the reduction of bizarre, inappropriate behavior; a token economy structure; and consistent pacing and generalization training. More recent research in the area has sought to identify the remediative aspects of social-learning programs, to specify patient variables that are related to improvement in a token economy, and to offer patients more specialized interventions (e.g., social skills training) in conjunction with a standard token economy. With the demonstrated and operationalized efficacy of social-learning procedures, the rehabilitation of chronic psychiatric patients has become more feasible.