Schizophrenic patients with severe negative symptoms may have an impaired capacity to benefit from social skills training (SST), and their negative symptoms may show little change as a result of SST. The present study, employing a multiple-baseline design across-behaviors with three patients who had prominent negative schizophrenic symptoms, combined nonverbal skills training with the Stacking the Deck social skills game. Further, the study examined changes in both social skills (assessed using role-play and conversation tests) and negative symptoms. Depression, extrapyramidal side effects, and positive symptoms were also monitored. Modest improvements in social skills and negative symptoms were achieved. There was little evidence of a training effect. The unstable baselines may have contributed to this finding. It is important for further research to employ comprehensive patient-assessment procedures.
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References
1.
American Psychiatric Association . (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: Author.
2.
Andreasen, N. C. (1982). Negative symptoms in schizophrenia: Definition and reliability. Archives of General Psychiatry, 39, 784-788.
3.
Andreasen, N. C. (1983). Scale for the Assessment of Negative Symptoms.University of Iowa, Iowa City.
4.
Andreasen, N. C. (1984). Scale for the Assessment of Positive Symptoms.University of Iowa, Iowa City.
5.
Andreasen, N. C. (1985). Positive and negative schizophrenia: A critical evaluation. Schizophrenia Bulletin, 11, 380-389.
6.
Andreasen, N. C. , & Olsen, S. (1982). Negative v. positive schizophrenia: Definition and validation. Archives of General Psychiatry, 39, 389-394.
7.
Bellack, A. S. (1983). Recurrent problems in the behavioural assessment of social skill. Behaviour Research and Therapy, 21, 29-42.
8.
Bellack, A. S. , Hersen, M., & Turner, S. M. (1976). Generalization effects of social skills training in chronic schizophrenics: An experimental analysis. Behavior Therapy, 14, 391-398.
9.
Bellack, A. S. , & Morrison, A. S. (1987, May). The nature of social skills in schizophrenia. Paper presented at the 140th Annual Meeting of the American Psychiatric Association, Chicago.
10.
Bellack, A. S. , Turner, S. M., Hersen, M., & Luber, R. F. (1984). An examination of the efficacy of social skills training for chronic schizophrenic patients. Hospital and Community Psychiatry, 35, 1023-1028.
11.
Crow, T. J. (1980). Molecular pathology of schizophrenia: More than one disease process?British Medical Journal, 29, 361-366.
12.
Crow, T. J. (1985). The two-syndrome concept: Origins and current status. Schizophrenia Bulletin, 11, 471-485.
13.
Curran, J. P. (1982). A procedure for the assessment of social skills: The Simulated Social Situation Interaction Test. In J. P. Curran & P. M. Monti (Eds.), Social sklls training: A practical handbook for assessment and treatment (pp. 348-373). New York: Guilford.
14.
Curran, J. P. , Monti, P. M., & Corriveau, D. P. (1982). The treatment of schizophrenia. In A. S. Bellack, M. Hersen, & A. E. Kazdin (Eds.), International handbook of behavior modification and therapy (pp. 433-466). New York: Plenum.
15.
Foxx, R. M. , & McMorrow, M. J. (1983). Stacking the Deck: A social skills game for retarded adults. Champaign, IL: Research Press.
16.
Foxx, R. M. , McMorrow, M. J., Bittle, R. G., & Fenlon, S. J. (1985). Teaching social skills to psychiatric inpatients. Behaviour Research and Therapy, 23, 531-537.
17.
Goldberg, S. G. (1985). Negative and deficit symptoms in schizophrenia do respond to neuroleptics. Schizophrenia Bulletin, 11, 453-457.
18.
Hamilton, M. (1960). A rating scale for depression. Journal of Neurological and Neurosurgical Psychiatry, 23, 56-62.
19.
Itil, T. M. , Keskiner, A., & Fink, A. (1966). Therapeutic studies in "therapy resistant" schizophrenic patients. Comprehensive Psychiatry, 7, 488-493.
20.
Jackson, H. J. , & Minas, I. H. (1985). Subtypes of schizophrenia and their implications for social skills training. Proceedings of the Eighth Annual Conference of the Australian Behaviour Modification Association, Melbourne.
21.
Jackson, H. J. , Minas, I. H., Burgess, P. M., Joshua, S. O., Charisiou, J., & Campbell, I. M. (1989). Is social skills performance a correlate of schizophrenia subtypes?Schizophrenia Research, 2, 301-309.
22.
Johnstone, E. C. , Crow, T. J., Frith, C. D., Carney, M.W.P., & Price, J. S. (1978, April). Mechanism of the antipsychotic effect in the treatment of acute schizophrenia. Lancet, pp. 848-851.
23.
Johnstone, E. C. , Owens, D.G.C., Gold, A., Crow, A. J., & Macmillan, F. J. (1981). In-stitutionalisation and the defects of schizophrenia. British Journal of Psychiatry, 139, 195-203.
24.
Kazdin, A. E. (1976). Statistical analysis for single-case experimental designs. In D. H. Barlow & M. Hersen (Eds.), Single-case experimental designs (pp. 265-316). New York: Pergamon.
25.
Kolakowska, T. , Williams, A. O., Arden, M., Revely, M. A., Jambor, K., Gelder, M. G., & Mandelbrote, B. M. (1985). Schizophrenia and good and poor outcome: I. Early clinical features, response to neuroleptics and signs of organic dysfunction. British Journal of Psychiatry, 146, 229-246.
26.
Liberman, R. P. , Lillie, F.,Falloon, I.R.H., Harpin, R. E., Hutchinson, W., & Stoute, B. (1984). Social skills training with relapsing schizophrenics: An experimental analysis. Behavior Modification, 8, 155-179.
27.
Liberman, R. P. , Massel, H. F., Mosk, M. D., & Wong, S. E. (1985). Social skills training for chronic mental patients. Hospital and Community Psychiatry, 36, 396-403.
28.
Morrison, R. L. , & Bellack, A. S. (1984). Social skills training. In A. S. Bellack (Ed.), Schizophrenia: Treatment, management, and rehabilitation. New York: Grune & Stratton.
29.
Payne, P. , & Halford, K. (1987). Social skills training with chronic schizophrenic patients in a cmmunity setting. Paper presented at the 10th Annual Conference of the Australian Behaviour Modification Association, Gold Coast, Queensland.
30.
Pfohl, B. , & Winokur, G. (1983). The micropsychopathology of hebephrenic/catatonic schizophrenia. Journal of Nervous and Mental Disease, 171, 296-300.
31.
Pogue-Geile, M. F. , & Harrow, M. (1984). Negative symptoms in schizophrenia and depression: A follow-up. Schizophrenic Buletin, 10, 371-387.
32.
Prosser, E. S. , Csernansky, J. G., Kaplan, J., Thiemann, S., Becker, T. J., & Hollister, L. E. (1987). Depression, Parkinsonian symptoms, and negative symptoms in schizophrenics treated with neuroleptics. Journal of Nervous and Mental Disease, 175, 100-105.
33.
Revusky, S. H. (1967). Some statistical treatments compatible with individual organism methodology. Journal of the ExperimentalAnalysis ofBehaviow, 10, 319-330.
34.
Simpson, G. M. , & Angus, J.W.S. (1970). A rating scale for extrapyramidal side effects. Acta Psychiatrica Scandinavia, (vol. 46, Suppl. 212), 11-19.
35.
Spencer, P. G. , Gillespie, C. R., & Ekisa, E. G. (1983). A controlled comparison of the effects of social skills training and remedial drama on the conversation skills of chronic schizophrenia inpatients. British Journal ofPsychiaty, 143, 165-172.
36.
Spitzer, R. L. , Williams, J.B.W., & Gibbon, M. (1986). Structured Clinical Interview for DSM-III-R -Patient Version [SCID-P, 8/1/86]. Albany: New York Biometrics Research Department, New York State Psychiatric Institute.
37.
Strauss, J. S. , & Carpenter, W. T. (1974). Characteristic symptoms and outcome in schizophrenia. Archives of General Psychiaty, 30, 429-434.
38.
Strauss, J. S. , & Carpenter, W. T. (1977). Prediction of outcome in schizophrenia m: Five-year outcome and its predictors. Archives of General Psychiatry, 34, 159-163.
39.
Sulzer-Azaroff, B. , & Mayer, G. R. (1977). Applying behavior-analysisprocedures with children and youdLNew York: Holt, Rinehart & Winston.
40.
Sylph, I. A. , Ross, H. E., & Kedward, H. B. (1977). Social disability in chronic psychiatric patients. American Journal of Psychiatry, 134, 1391-1394.
41.
Trower, P. , Bryant, B., & Argyle, M. (1978). Social skills and mental healthLondon: Methuen.
42.
Tryon, W. W. (1982). A simplified time-series analysis for evaluating treatment interventions. Journal ofApplied BehaviorAnalysis, 15, 423-429.
43.
Wallace, C J. , Nelson, C. J., Uberman, R. P., Aitchison, R. A., Lukof, D., Elder, J. P., & Ferris, C. (1980). A review and citique of social skills training with schizophrenic patients. Schizophrenia Bulletin, 6, 42-63.
44.
Watson, J. E. , & Singh, N. N. (1985). Social skills training for schizophrenic patients. Behaviour Change2, 94-101.
45.
Zigler, F. , & Phillips, L. (1961). Social competence and outcome in psychiatric disorder. Journal of Abnormal and Social Psychology, 63, 264-271.
