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Two-year outcome of social skills training and group psychotherapy for outpatients with schizophrenia.

Abstract

OBJECTIVE

The authors evaluated the effectiveness of behaviorally oriented social skills training and supportive group therapy for improving the social adjustment of schizophrenic patients living in the community and for protecting them against psychotic relapse.

METHOD

Eighty male outpatients with schizophrenia were stabilized with a low dose of fluphenazine decanoate (5 to 10 mg every 14 days), which was supplemented with oral fluphenazine (5 mg twice daily) or a placebo when they first met criteria for a prodromal period. (Half of the patients did so at some time during the study.) Patients were randomly assigned to receive either social skills training or supportive group therapy twice weekly for 6 months and then weekly for the next 18 months. Rates of psychotic exacerbation were monitored, as were scores on the Social Adjustment Scale II.

RESULTS

There were significant main effects favoring social skills training over supportive group therapy on two of the six Social Adjustment Scale II cluster totals examined (personal well-being and total) and significant interactions between psychosocial treatment and drug treatment for three items (external family, social and leisure activities, and total). In each case, these interactions indicated that the advantage of social skills training over supportive group therapy was greatest when it was combined with active drug supplementation. Social skills training did not significantly decrease the risk of psychotic exacerbation in the full group, but an advantage was observed (post hoc) among patients who received placebo supplementation.

CONCLUSIONS

These findings suggest that social skills training resulted in greater improvement in certain measures of social adjustment than supportive group therapy. The greatest improvement in social outcomes occurred when social skills training was combined with a pharmacological strategy of active drug supplementation at the time prodromal worsening of psychotic symptoms was first observed. However, these improvements were modest in absolute terms and confined to certain subgroups of patients.

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  • Authors+Show Affiliations

    ,

    West Los Angeles VA Medical Center, CA 90073, USA. marder@ucla.edu

    , , , , , , ,

    Source

    The American journal of psychiatry 153:12 1996 Dec pg 1585-92

    MeSH

    Adult
    Age of Onset
    Ambulatory Care
    Behavior Therapy
    Combined Modality Therapy
    Fluphenazine
    Humans
    Male
    Psychiatric Status Rating Scales
    Psychotherapy, Group
    Reinforcement, Social
    Role Playing
    Schizophrenia
    Social Adjustment
    Social Support
    Treatment Outcome

    Pub Type(s)

    Clinical Trial
    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    8942455

    Citation

    Marder, S R., et al. "Two-year Outcome of Social Skills Training and Group Psychotherapy for Outpatients With Schizophrenia." The American Journal of Psychiatry, vol. 153, no. 12, 1996, pp. 1585-92.
    Marder SR, Wirshing WC, Mintz J, et al. Two-year outcome of social skills training and group psychotherapy for outpatients with schizophrenia. Am J Psychiatry. 1996;153(12):1585-92.
    Marder, S. R., Wirshing, W. C., Mintz, J., McKenzie, J., Johnston, K., Eckman, T. A., ... Liberman, R. P. (1996). Two-year outcome of social skills training and group psychotherapy for outpatients with schizophrenia. The American Journal of Psychiatry, 153(12), pp. 1585-92.
    Marder SR, et al. Two-year Outcome of Social Skills Training and Group Psychotherapy for Outpatients With Schizophrenia. Am J Psychiatry. 1996;153(12):1585-92. PubMed PMID: 8942455.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Two-year outcome of social skills training and group psychotherapy for outpatients with schizophrenia. AU - Marder,S R, AU - Wirshing,W C, AU - Mintz,J, AU - McKenzie,J, AU - Johnston,K, AU - Eckman,T A, AU - Lebell,M, AU - Zimmerman,K, AU - Liberman,R P, PY - 1996/12/1/pubmed PY - 1996/12/1/medline PY - 1996/12/1/entrez SP - 1585 EP - 92 JF - The American journal of psychiatry JO - Am J Psychiatry VL - 153 IS - 12 N2 - OBJECTIVE: The authors evaluated the effectiveness of behaviorally oriented social skills training and supportive group therapy for improving the social adjustment of schizophrenic patients living in the community and for protecting them against psychotic relapse. METHOD: Eighty male outpatients with schizophrenia were stabilized with a low dose of fluphenazine decanoate (5 to 10 mg every 14 days), which was supplemented with oral fluphenazine (5 mg twice daily) or a placebo when they first met criteria for a prodromal period. (Half of the patients did so at some time during the study.) Patients were randomly assigned to receive either social skills training or supportive group therapy twice weekly for 6 months and then weekly for the next 18 months. Rates of psychotic exacerbation were monitored, as were scores on the Social Adjustment Scale II. RESULTS: There were significant main effects favoring social skills training over supportive group therapy on two of the six Social Adjustment Scale II cluster totals examined (personal well-being and total) and significant interactions between psychosocial treatment and drug treatment for three items (external family, social and leisure activities, and total). In each case, these interactions indicated that the advantage of social skills training over supportive group therapy was greatest when it was combined with active drug supplementation. Social skills training did not significantly decrease the risk of psychotic exacerbation in the full group, but an advantage was observed (post hoc) among patients who received placebo supplementation. CONCLUSIONS: These findings suggest that social skills training resulted in greater improvement in certain measures of social adjustment than supportive group therapy. The greatest improvement in social outcomes occurred when social skills training was combined with a pharmacological strategy of active drug supplementation at the time prodromal worsening of psychotic symptoms was first observed. However, these improvements were modest in absolute terms and confined to certain subgroups of patients. SN - 0002-953X UR - https://www.unboundmedicine.com/medline/citation/8942455/full_citation L2 - https://ajp.psychiatryonline.org/doi/full/10.1176/ajp.153.12.1585?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -