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A psychosocial skills training approach in Mexican out-patients with schizophrenia

Published online by Cambridge University Press:  02 May 2007

MARCELO VALENCIA ,
MARIA LUISA RASCON ,
FRANCISCO JUAREZ  and
ESTHER MUROW
MARCELO VALENCIA*
Affiliation:
Division of Epidemiology and Psychosocial Research, National Institute of Psychiatry, Mexico City, Mexico
MARIA LUISA RASCON
Affiliation:
Division of Epidemiology and Psychosocial Research, National Institute of Psychiatry, Mexico City, Mexico
FRANCISCO JUAREZ
Affiliation:
Division of Epidemiology and Psychosocial Research, National Institute of Psychiatry, Mexico City, Mexico
ESTHER MUROW
Affiliation:
Division of Clinical Services, National Institute of Psychiatry, Mexico City, Mexico
*
*Address for correspondence: Dr Marcelo Valencia, Psychosocial Treatment Research Programme for Patients with Schizophrenia, Instituto Nacional de Psiquiatría Ramón de la Fuente, Calzada Mexico-Xochimilco 101, Colonia San Lorenzo Huipulco, Tlalpan, Mexico City, Mexico. (Email: [email protected])
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Abstract

Background

The effectiveness of a psychosocial skills training (PSST) approach applied to chronic out-patients with schizophrenia was examined. We hypothesized that the PSST programme, which included treatment as usual (TAU), PSST and family therapy (FT), would reduce positive and negative symptoms, prevent relapse and rehospitalization, and improve psychosocial functioning (PSF), global functioning and treatment adherence.

Method

Eighty-two patients were randomly assigned to receive either TAU [antipsychotic medication (AP); n=39] or the PSST approach (TAU+PSST+FT; n=43). The two groups were assessed at intake and after completion of 1 year of treatment.

Results

There were statistically significant differences between the two groups. Patients in the PSST group improved their symptomatology, psychosocial and global functioning (symptoms and psychological, social and occupational functioning), showed lower relapse, rehospitalization and drop-out rates, a higher level of compliance with AP medication, and a high level of therapeutic adherence in comparison with TAU patients, whose symptoms also improved although they showed no improvement in any of the clinical or psychosocial variables. A comparison of the standardized effect sizes showed a medium and a large effect size of PSF and global functioning for the PSST group and a non-effect size for the TAU group.

Conclusions

A higher level of effectiveness was demonstrated when combining TAU, PSST and FT in comparison with AP medication alone. The PSST approach should be recommended for clinical practice.

Type
Original Article
Information
Psychological Medicine , Volume 37 , Issue 10 , October 2007 , pp. 1393 - 1402
Copyright
Copyright © Cambridge University Press 2007

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References

REFERENCES

APA (1994). Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM-IV). American Psychiatric Association: Washington, DC.Google Scholar
Bellack, A. S. & Mueser, K. T. (1993). A comprehensive treatment program for schizophrenia and chronic mental illness. Community Mental Health Journal 22, 175–189.CrossRefGoogle Scholar
Benton, M. K. & Schroeder, H. E. (1990). Social skills training with schizophrenics: a meta-analytic evaluation. Journal of Consulting and Clinical Psychology 58, 741–747.CrossRefGoogle ScholarPubMed
Brenner, H. D. & Pfammatter, M. (2000). Psychological therapy in schizophrenia: what is the evidence? Acta Psychiatrica Scandinavica 102 (Suppl. 407), 74–77.CrossRefGoogle Scholar
Cohen, J. (1977). Statistical Power Analysis for the Behavioral Sciences. Academia Press: New York.Google Scholar
Corrigan, P. W. (1991). Social skills training in adult psychiatric populations: a meta-analysis. Journal of Behaviour Therapy and Experimental Psychiatry 22, 203–210.CrossRefGoogle ScholarPubMed
Díaz, R., Ortega, H., Leaños, C., Rodríguez, M. S., Rascón, M. L., Valencia, M., Gutierrez, M. L., Mares, M. E. & Sánchez, A. (2005). The rehabilitation of schizophrenic patients in Mexico. The model of the National Institute of Psychiatry: Group III. Salud Mental 28, 9–19.Google Scholar
Díaz, R., Rascón, M. L., Valencia, M., Unikel, C. & Murow, E. (1999). The rehabilitation program of schizophrenic patients of the Mexican Institute of Psychiatry. Salud Mental 22, 104–113.Google Scholar
Glynn, S. M., Marder, S. R., Liberman, R. P., Blair, K., Wirshing, D. A. & Mintz, J. (2002). Supplementing clinic based skills training for schizophrenia with manualized community support: effects on social adjustment. American Journal of Psychiatry 159, 829–837.CrossRefGoogle ScholarPubMed
Hayes, R. L., Halford, W. K. & Varghese, F. T. (1995). Social skills training with chronic schizophrenic patients: effects on negative symptoms and community functioning. Behavior Therapy 26, 433–449.CrossRefGoogle Scholar
Heinssen, R. K., Liberman, R. P. & Kopelowicz, A. (2000). Psychosocial skills training for schizophrenia: lessons from the laboratory. Schizophrenia Bulletin 26, 21–46.CrossRefGoogle ScholarPubMed
Hogarty, G. E. & Ulrich, R. F. (1998). The limitations of antipsychotic medication on schizophrenia relapse and adjustment and the contributions of psychosocial treatment. Journal of Psychiatric Research 32, 243–250.CrossRefGoogle ScholarPubMed
Huxley, N., Rendall, M. & Sederer, L. L. (2000). Psychosocial treatments in schizophrenia. A review of the past 20 years. Journal of Nervous and Mental Disease 188, 187–201.CrossRefGoogle ScholarPubMed
Kay, S. R., Fizbein, A., Vital-Herne, M. & Fuentes, L. S. (1990). The Positive and Negative Syndrome Scale – Spanish adaptation. Journal of Nervous and Mental Disease 178, 510–517.CrossRefGoogle ScholarPubMed
Kazdin, A. & Bass, D. (1999). Power to detect differences between alternative treatments in comparative psychotherapy outcome research. Journal of Consulting and Clinical Psychology 57, 138–147.CrossRefGoogle Scholar
Kopelowicz, A., Zarate, R., Gonzalez, V., Mintz, J. & Liberman, R. P. (2003). Disease management in Latinos with schizophrenia: a family-assisted, skills training approach. Schizophrenia Bulletin 29, 2, 211–227.CrossRefGoogle ScholarPubMed
Lauriello, J., Bustillo, J. & Keith, S. J. (1999). A critical review of research on psychosocial treatment of schizophrenia. Biological Psychiatry 46, 1409–1417.CrossRefGoogle ScholarPubMed
Lehman, A. F. & Steinwachs, D. M. (1998). Patterns of usual care for schizophrenia: initial results from the schizophrenia patient outcomes research team (PORT) client survey. Schizophrenia Bulletin 24, 11–20.CrossRefGoogle ScholarPubMed
Liberman, R. P. (1994). Psychosocial treatment for schizophrenia. Psychiatry 57, 104–114.CrossRefGoogle ScholarPubMed
Liberman, R. P. (1998 a). International perspectives on skills training for the mentally disabled. International Review of Psychiatry 10, 5–8.CrossRefGoogle Scholar
Liberman, R. P. (1998 b). Skills training versus psychosocial occupational therapy for persons with persistent schizophrenia. American Journal of Psychiatry 155, 1087–1091.CrossRefGoogle ScholarPubMed
Liberman, R. P. & Corrigan, P. W. (1993). Designing new psychosocial treatments for schizophrenia. Psychiatry 56, 238–249.CrossRefGoogle ScholarPubMed
Marder, S. R. (2000). Integrating pharmacological and psychosocial treatments for schizophrenia. Acta Psychiatrica Scandinavica 407, 87–90.Google Scholar
Marder, S. R., Wirshing, W. C., Mintz, J., McKenzie, J., Johnston, K., Eckman, T. A., Lebell, M., Zimmerman, K. & Liberman, R. P. (1996). Two-year outcome of social skills training and group psychotherapy for outpatients with schizophrenia. American Journal of Psychiatry 153, 1585–1592.Google ScholarPubMed
Mojtabai, R., Nicholson, R. & Carpenter, B. (1998). Role of psychosocial treatments in the management of schizophrenia: a meta-analytic review of controlled outcome studies. Schizophrenia Bulletin 24, 569–587.CrossRefGoogle ScholarPubMed
Robins, L. N., Wing, J. K., Wittchen, H. U., Helzer, J. E., Babor, T. F., Burke, J., Farmer, A., Jablenski, A., Pickens, R., Regier, D. A., Sartorius, N. & Towle, L. H. (1988). The Composite International Diagnostic Interview: an epidemiological instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Archives of General Psychiatry 45, 1069–1077.CrossRefGoogle ScholarPubMed
Valencia, M. (1996). Psychosocial management of schizophrenic patients. Psiquiatría 12, 72–86.Google Scholar
Valencia, M. (1999 a). A psychosocial intervention program for schizophrenic patients. Salud Mental 22, 128–137.Google Scholar
Valencia, M. (1999 b). Psychosocial treatment for patients with schizophrenia of The Mexican Institute of Psychiatry. Salud Mental 2, 31–40.Google Scholar
Valencia, M., Lara, M. C., Rascon, M. L. & Ortega, H. (2002 a). The importance of pharmacological and psychosocial treatments in patients with schizophrenia. Revista Latinoamericana de Psiquiatría 2, 6–21.Google Scholar
Valencia, M., Ortega, H., Rascon, M. L. & Gomez, L. (2002 b). Assessment of the combination of psychosocial and pharmacological treatments of patients with schizophrenia. Actas Españolas de Psiquiatría 30, 358–369.Google Scholar
Valencia, M., Ortega, H., Rodríguez, M. S. & Gómez, L. (2004 a). A comparative study of clinical and psychotherapeutic considerations in the biopsychosocial treatment of schizophrenia: I. Salud Mental 27 (3), 47–53.Google Scholar
Valencia, M., Ortega, H., Rodríguez, M. S. & Gómez, L. (2004 b). A comparative study of clinical and psychotherapeutic considerations in the biopsychosocial treatment of schizophrenia: II. Salud Mental 27 (4), 35–43.Google Scholar
Valencia, M. & Rascon, M. L. (1998). Psychotherapy of acute and chronic patients with schizophrenia. Revista Iberoamericana de Psicología 8, 18–33.Google Scholar
Valencia, M., Rascón, M. L. & Ortega, H. (2001). Psychosocial treatment in patients with schizophrenia. In Schizophrenia: Current Views and Perspectives (ed. Ortega, H. and Valencia, M.), pp. 399–454. National Institute of Psychiatry: Mexico City.Google Scholar
Valencia, M., Rascón, M. L. & Quiroga, H. (2003). Research contributions of psychosocial treatment and family therapy in patients with schizophrenia. Salud Mental 26, 1–18.Google Scholar
Valencia, M., Rojas, E., González, C., Ramos, L. & Villatoro, J. (1989). Psychosocial assessment of patients of a Mental Health Center. Salud Pública de México 31, 674–687.Google Scholar
Wallace, C. J., Liberman, R. P., MacKain, S. J., Blackwell, G. & Eckman, T. E. (1992). Effectiveness and replicability of modules for teaching social and instrumental skills to the severely mentally ill. American Journal of Psychiatry 149, 654–658.Google Scholar
Wallace, C. J., Liberman, R. P., Tauber, R. & Wallace, J. (2000). The independent living skills survey: a comprehensive measure of the community functioning of severely and persistently mentally ill individuals. Schizophrenia Bulletin 26, 631–658.CrossRefGoogle ScholarPubMed
Wykes, T., Tarrier, N. & Lewis, S. (1998). Outcome and Innovation in Psychological Treatment of Schizophrenia. Wiley: Chichester.Google Scholar