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Am J Psychiatry 1996; 153:1585-1592
Copyright © 1996 by American Psychiatric Association
Two-year outcome of social skills training and group psychotherapy for outpatients with schizophrenia
SR Marder, WC Wirshing, J Mintz, J McKenzie, K Johnston, TA Eckman, M Lebell, K Zimmerman and RP Liberman
West Los Angeles VA Medical Center, CA 90073, USA. marder@ucla.edu
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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