Skills training versus psychosocial occupational therapy for persons with persistent schizophrenia

OBJECTIVE: The authors compared the community functioning of outpatients with persistent forms of schizophrenia after treatment with psychosocial occupational therapy or social skills training, with the latter conducted by paraprofessionals. METHOD: Eighty outpatients with persistent forms of schizophrenia were randomly assigned to receive either psychosocial occupational therapy or skills training for 12 hours weekly for 6 months, followed by 18 months of follow-up with case management in the community. Antipsychotic medication was prescribed through "doctor's choice" by psychiatrists who were blind to the psychosocial treatment assignments. RESULTS: Patients who received skills training showed significantly greater independent living skills during a 2-year follow-up of everyday community functioning. CONCLUSIONS: Skills training can be effectively conducted by paraprofessionals, with durability and generalization of the skills greater than that achieved by occupational therapists who provide their patients with psychosocial occupational therapy.     

Characteristics predicting social functioning and treatment response in clients impaired by extreme shyness: Age of onset and the public/private shyness distinction.

52 adults that were functionally impaired by extreme shyness participated in an interview that assessed factors surrounding shyness onset, social functioning, strategies for coping with shyness, and behavioral skill in social interactions. 34 Ss then participated in an 8-wk behavioral treatment program that provided training in social skills. Ss reporting early onset also described their parents as shy, while Ss reporting later onset had a childhood history of emotional or physical abuse. Ss with observable behavioral deficits were more likely to benefit from the behavioral treatment program than were shy Ss with few overt symptoms. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A strategy for improving patient satisfaction by the intensive training of residents in psychosocial medicine: a controlled, randomized study

PURPOSE: To use a controlled, randomized design to assess the effect on patient satisfaction of an intensive psychosocial training program for residents. METHOD: Twenty-six first-year residents, in two internal medicine and family practice community-based programs affiliated with the Michigan State University College of Human Medicine, were randomly assigned during 1991 and 1992 to a control group or a one-month intensive training program. Experiential teaching focused on many psychosocial skills required in primary care. A 29-item questionnaire administered before and after the residents' training evaluated their patients' satisfaction regarding patient disclosure, physician empathy, confidence in physician, general satisfaction, and comparison of the physician with other physicians. Analyses of covariance with groups and gender as factors and pre-training patient satisfaction scores as the covariate evaluated the effect of the training. RESULTS: The patients of the trained residents expressed more confidence in their physicians (p = .01) and more general satisfaction (p = .02) than did the patients of controls. The effect of training on patient satisfaction with patient disclosure (p < .01) and physician empathy (p < .05) was greater for female than for male residents. CONCLUSION: The intensive psychosocial training program for residents improved their patients' satisfaction.     

Anxious children in adulthood: a prospective study of adjustment

OBJECTIVE: To prospectively examine psychosocial functioning in young adulthood for children and adolescents with anxiety disorders. METHOD: This 8-year prospective study compared psychosocial functioning in young adults (mean age 22 years) who had histories of early-onset anxiety disorders, comorbid anxiety and depressive disorders, or no history of psychiatric illness (NPI). Follow-up interviews assessed subjects' residential, educational, occupational, and marital status; utilization of mental health services; and psychological status RESULTS: Anxious subjects without histories of depression were less likely than NPI controls to be living independently. Anxious-depressed subjects were less likely than controls to be working or in school; more likely than purely anxious subjects to utilize mental health services; and more likely than both anxious and control subjects to report psychological problems, most frequently depression. CONCLUSIONS: Overall, results suggest that children with anxiety disorders are relatively well adjusted in young adulthood. However, a history of comorbid depression is prognostic of a more negative outcome.     

A nursing rehabilitation program for women with breast cancer receiving adjuvant chemotherapy

PURPOSE/OBJECTIVES: To examine the effects of a comprehensive rehabilitation program on facilitating physical and psychosocial adaptation of women with breast cancer who are receiving adjuvant chemotherapy. DESIGN: Experimental. SETTING: Breast evaluation clinics of two New England medical centers with comprehensive cancer treatment programs. SAMPLE: 14 women (mean age = 44 years) receiving adjuvant chemotherapy for breast cancer (86% stage II) following surgical treatment. METHODS: Subjects were assigned randomly to the experimental group or the usual care group. Experimental group members began a structured exercise program of walking and attended support group meetings. All subjects were tested before beginning chemotherapy, during the course of chemotherapy, and one month following chemotherapy completion. MAIN RESEARCH VARIABLES: Performance status, physical functioning, psychosocial adjustment, self-concept and body image, and 12 symptoms (e.g., fatigue, nausea, anxiety). FINDINGS: Measures of physical performance, psychosocial adjustment, and symptom intensity revealed improved adaptation in subjects who completed the walking/support group program. CONCLUSIONS: Physical and psychosocial benefits from a modest walking exercise program and a support group are possible for patients receiving adjuvant chemotherapy. IMPLICATIONS FOR NURSING PRACTICE: Although more detailed research is necessary to answer some of the questions raised by this study, implementing the walking program and forming a support group are achievable in an outpatient setting.     

Meta-analytic evaluation of skills training research for individuals with severe mental illness.

A meta-analysis of 68 studies examined the effectiveness of skills training for individuals with severe mental illness and the influence of such factors as methodological rigor, choice of outcome measures, and service settings. The methodological quality of these studies was generally very good. Skills training was found to be moderately to strongly effective in increasing skill acquisition and reducing psychiatric symptoms. However, effect size varied by type of outcome measure, with situationally specific measures yielding larger effects than measures of skill usage and role functioning. Studies rarely examined whether acquired skills were used outside the training setting. Surprisingly, most studies were confined to inpatient settings, and most focused exclusively on social skills. Implications are discussed for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The treatment of depression in older adults in the primary care setting: An evidence-based review.

The objective of this study was to conduct an evidence-based review of treatments for depression in older adults in the primary care setting. A literature search was conducted using PsycINFO and Medline to identify relevant, English language studies published from January 1994 to April 2004 with samples aged 55 and older. Studies were required to be randomized controlled trials that compared psychosocial interventions conducted within the primary care setting with "usual care" conditions. Eight studies with older adult samples met inclusion criteria and were included in the review. Two treatment models were evident: Geriatric Evaluation Management (GEM) clinics and an approach labeled integrated health care models. Support was found for each model, with improvement in depressive symptoms and better outcomes than usual care; however, findings varied by depression severity, and interventions were difficult to compare. Further efforts to improve research and clinical care of depression in the primary care setting for older adults are needed. The authors recommend the use of interdisciplinary teams and more implementation of psychosocial treatments shown to be effective for older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Hartford Study of Supported Employment for Persons With Severe Mental Illness.

The authors compared 3 approaches to vocational rehabilitation for severe mental illness (SMI): the individual placement and support (IPS) model of supported employment, a psychosocial rehabilitation (PSR) program, and standard services. Two hundred four unemployed clients (46% African American, 30% Latino) with SMI were randomly assigned to IPS, PSR, or standard services and followed for 2 years. Clients in IPS had significantly better employment outcomes than clients in PSR and standard services, including more competitive work (73.9% vs. 18.2% vs. 27.5%, respectively) and any paid work (73.9% vs. 34.8% vs. 53.6%, respectively). There were few differences in nonvocational outcomes between programs. IPS is a more effective model than PSR or standard brokered vocational services for improving employment outcomes in clients with SMI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparing memory skill maintenance across the life span: Preservation in adults, increase in children.

The authors examined life-span differences in the maintenance of skilled episodic memory performance by assessing 100 individuals (10 -11, 12-13, 21-26, and 66-79 years old) 11 months after termination of an intensive multisession mnemonic training program (Y. Brehmer, S.-C. Li, V. Müller, T. von Oertzen, & U. Lindenberger, 2007). Skill maintenance was tested in 2 follow-up sessions, the first without and the second with mnemonic reinstruction. Younger and older adults' average performance levels were stable across time. In contrast, both younger and older children's memory performance improved beyond originally attained levels. Older adults' performance improved from the first to the second follow-up session, presumably profiting from instruction-induced skill reactivation. Results suggest that (a) skill maintenance is largely intact in healthy older adults, (b) older adults need environmental support to fully reactivate their former skill levels (cf. F. I. M. Craik, 1983), and (c) children adapt a skill learned 11 months ago to their increasing cognitive capabilities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective four-year follow-up study of children at risk for ADHD: psychiatric, neuropsychological, and psychosocial outcome

BACKGROUND: Attention-deficit hyperactivity disorder (ADHD) is a familial disorder that places the siblings of ADHD children at high risk for ADHD, conduct, mood, and anxiety disorders. Although the pattern of psychiatric risk has been well documented by prior family studies, neither the short- nor long-term outcome of these high-risk siblings has been prospectively examined. OBJECTIVE: To document the 4-year psychiatric, psychosocial, and neuropsychological outcome of the siblings of children with ADHD. METHOD: DSM-III-R structured diagnostic interviews and blind raters were used to conduct a 4-year follow-up of siblings from ADHD and control families. The siblings were also evaluated for cognitive, achievement, social, school, and family functioning. RESULTS: At follow-up, significant elevations of behavioral, mood, and anxiety disorders were found among the siblings of ADHD children. The high-risk siblings had high rates of school failure and showed evidence of neuropsychological and psychosocial dysfunction. These impairments aggregated among the siblings who had ADHD. CONCLUSIONS: The siblings of ADHD children are at high risk for clinically meaningful levels of psychopathology and functional impairment. In addition to supporting hypotheses about the familial transmission of ADHD, the results suggest that the high-risk siblings might be appropriate targets for primary preventive interventions.     

Psychosocial adjustment among cancer survivors: Findings from a national survey of health and well-being.

Objective: The current study examined whether cancer survivors showed impairment, resilience, or growth responses relative to a sociodemographically matched sample in four domains: mental health and mood, psychological well-being, social well-being, and spirituality. The impact of aging on psychosocial adjustment was also investigated. Design: Participants were 398 cancer survivors who were participants in the MIDUS survey (Midlife in the United States) and 796 matched respondents with no cancer history. Psychosocial assessments were completed in 1995–1996 and 2004–2006. Main Outcome Measures: Outcomes including self-report measures of mental health and mood, psychological well-being, social well-being, and spirituality. Results: Findings indicated that cancer survivors demonstrated impairment relative to the comparison group in mental health, mood, and some aspects of psychological well-being. Longitudinal analyses spanning pre- and postdiagnosis clarified that while mental health declined after a cancer diagnosis, poorer functioning in other domains existed prior to diagnosis. However, survivors exhibited resilient social well-being, spirituality, and personal growth. Moreover, age appeared to confer resiliency; older survivors were more likely than younger adults to show psychosocial functioning equivalent to their peers. Conclusion: While younger survivors may be at risk for disturbances in mental health and mood, cancer survivors show resilience in other important domains of psychosocial adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Aspects of social and emotional competence in adult attention-deficit/hyperactivity disorder.

Social and emotional competence were evaluated using self-report and behavioral measures in adults with attention-deficit/hyperactivity disorder (ADHD) and controls. Adults with ADHD viewed themselves as less socially competent but more sensitive toward violations of social norms than controls. Films depicting emotional interactions were used to assess linguistic properties of free recall and perceived emotional intensity. Although adults with ADHD used more words to describe the scenes, they used fewer emotion-related words, despite rating the emotions depicted as more intense than did controls. In contrast, no group differences for words depicting social or cognitive processes were observed. Overall, adults with ADHD appear more aware of their problems in social versus emotional skills. Findings may have implications for improving the psychosocial functioning of these adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Welfare participation and social support in late life.

The purpose of this study was to examine the relationships among participation in welfare programs, gender, and change in social support in adults aged 65 and older. It was hypothesized that older men receiving public assistance would encounter more social network problems than older women on welfare. The findings reveal that during the 7-year study older men in receipt of welfare benefits, compared with older women on welfare, received less social support from others, were more dissatisfied with the assistance they got, and encountered more negative interaction from informal social network members (i.e., family and friends). The results suggest that those who administer welfare programs, as well as public policymakers, should consider developing interventions that address the wider psychosocial problems associated with receiving public assistance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social networks as assets and liabilities in recovery from stroke by geriatric patients.

Interactions in the social networks of 48 elderly stroke patients were examined as factors influencing outcomes after hospital discharge. Structured interviews assessed the frequency of perceived positive and negative interactions, as well as patients' behavioral independence, time use, personal adjustment, and cognitive functioning. Negative interactions occurred less frequently than positive ones. After controlling for status at hospital discharge, negative and positive interactions differentially explained variance in morale, psychiatric symptoms, and cognitive functioning. Although negative interactions were associated with poorer morale and greater psychiatric symptoms, positive interactions were associated with less mental confusion. Patients' reporting and not reporting negative interactions did not differ significantly on a variety of social and demographic variables previously shown to predict social interactions and well-being. Findings indicate that social interactions may both impede and facilitate rehabilitation for older adults and have implications for both theories of social support and the design of therapeutic interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting the one-year course of adolescent major depression

OBJECTIVE: To identify specific clinical and social functioning variables that predict persistence of major depression over a 1-year period of follow-up. METHOD: The sample consisted of 67 adolescents with major depression, drawn from consecutive referrals to psychiatric clinics in a defined, geographic catchment area. Clinical interviews and questionnaires measuring behaviors, symptoms, and social functioning were administered to both the adolescent and a parent at inception and at follow-up. Discriminant function analyses were used to identify inception variables that predicted clinical course independent of severity of depressive symptoms and global functioning. RESULTS: At 1-year follow-up, major depression remitted in 66% of subjects. Persisters were characterized at inception as older, more likely to have substance use or anxiety disorders, less involved with fathers, and less responsive to mother's discipline compared with remitters. The effect of these prognostic factors was independent of symptom severity and global functioning. CONCLUSION: These variables appear to reflect perpetuating and ameliorating factors influencing the short-term course of major depression. The findings suggest that treatments for adolescent depression that aim to enhance parent-adolescent relationships, and that specifically target coexisting disorders, should be evaluated for effectiveness.     

A cognitive-social learning approach to social skill training with low-status preschool children.

Changes in the behavior and peer acceptance of low-status preschool children as a result of social skill training were examined. Children who had low sociometric status and were also low in classroom use of social skills were randomly assigned to a skill training group (n?=?18) or to an attention control group (n?=?15). Children in the training group were coached in 4 skills: leading peers, asking questions of peers, making comments to peers, and supporting peers. Trained children showed a significant increase in their use of the trained skills comments and leads from pretest to posttest, whereas control-group children showed no change. Neither control nor skill-trained children changed significantly on sociometric measures from pretest to posttest. Increases in skill use in the classroom with peers was correlated with improvements in children's knowledge of friendly social strategies from pre- to posttest. Results are interpreted as evidence of a social skill basis for peer acceptance and of the need to develop procedures to assess the mechanisms of change during social skills training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Practice makes perfect? The role of participant modeling in sexual abuse prevention programs.

We tested the prediction that a sexual abuse prevention program that included participant modeling (PM) would result in superior skill acquisition compared with a symbolic modeling (SM) program. Twenty-six kindergarten children were assigned to one of the two programs after being matched for initial skill level. The PM program taught self-protective skills through modeling and active rehearsal; the SM program taught the same skills, but the children watched as skills were modeled by the experimenter. Results provided evidence for the greater efficacy of PM relative to SM for the learning of personal safety skills and, thus, support the inclusion of active rehearsal in prevention programs for young children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental illness in late life: Socioeconomic conditions, psychiatric symptoms, and adjustment of long-term sufferers.

The relationships between social and economic conditions and psychiatric disorder among 346 older adults with severe mental illness living in the community are examined in this article. Measures included socioeconomic indexes, symptoms, diagnoses, and adjustment. As expected, socioeconomic and illness factors were interrelated in this sample. Diagnosis was related to both functioning and socioeconomic factors. As a rule, participants were financially impoverished but socially integrated into social networks consisting largely of kin. In spite of impoverishment and presence of significant symptoms, most were maintaining themselves in the community with at least marginal functioning, though they received very little support from the mental health system beyond medication. Compared with the younger cohort, the older cohort was functioning better, had fewer symptoms, and had better global adjustment. Those with coexisting psychotic and affective syndromes were most at risk. Future analyses with this data set will need to develop complex multivariate models to predict the primary influences on functioning and short-term stability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive outcome in children and adolescents following severe traumatic brain injury: influence of psychosocial, psychiatric, and injury-related variables

Previous studies of childhood traumatic brain injury (TBI) have emphasized injury-related variables rather than psychiatric or psychosocial factors as correlates of cognitive outcomes. We addressed this concern by recruiting a consecutive series (N = 24) of children age 5 through 14 years who suffered a severe TBI, a matched group who sustained a mild TBI, and a second matched group who sustained an orthopedic injury. Standardized intellectual, memory, psychiatric, family functioning, family psychiatric history, neurological, and neuroimaging assessments were conducted at an average of 2 years following injury. Severe TBI, when compared to mild TBI and orthopedic injury, was associated with significant decrements in intellectual and memory function. A principal components analysis of independent variables that showed significant (p < .05) bivariate correlations with the outcome measures yielded a neuropsychiatric factor encompassing severity of TBI indices and postinjury psychiatric disorders and a psychosocial disadvantage factor. Both factors were independently and significantly related to intellectual and memory function outcome. Postinjury psychiatric disorders added significantly to severity indices and family functioning and family psychiatric history added significantly to socioeconomic status in explaining several specific cognitive outcomes. These results may help to define subgroups of children who will require more intensive services following their injuries.     

A meta-analysis of controlled research on social skills training for schizophrenia.

A meta-analysis of randomized, controlled trials of social skills training for schizophrenia was conducted. Outcome measures from 22 studies including 1,521 clients were categorized according to a proximal-distal continuum in relation to the presumed site of action of skills training interventions, with content mastery tests and performance-based measures of skills assumed to be most proximal, community functioning and negative symptoms intermediate, and general symptoms and relapse most distal. Results reveal a large weighted mean effect size for content-mastery exams (d = 1.20), a moderate mean effect size for performance-based measures of social and daily living skills (d = 0.52), moderate mean effect sizes for community functioning (d = 0.52) and negative symptoms (d = 0.40), and small mean effect sizes for other symptoms (d = 0.15) and relapse (d = 0.23). These results support the efficacy of social skills training for improving psychosocial functioning in schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)