Psychosocial factors in schizophrenia: Implications for rehabilitation and community care

Current Opinion in Psychiatry

Volumn 9, Issue 1, 1996, Pages 68-72

  Wykes, Til ^a   Carson, Jerome ^a  

^a KING'S COLLEGE LONDON   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

COMMUNITY CARE; EMOTION; FAMILY; HOMELESSNESS; HOSPITAL BED UTILIZATION; HUMAN; LIFE EVENT; SCHIZOPHRENIA; SHORT SURVEY; SOCIAL INTERACTION; SOCIAL PSYCHOLOGY;

EID: 0030062975     PISSN: 09517367     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001504-199601000-00013     Document Type: Short Survey

References (46)

1. Wing JK: The measurement of social disablement. The MRC social behaviour and social role performance schedules. Soc Psychiatry Psychiatr Epidemiol 1989, 42:2-8.
2. Halford W, Hayes R: Social skills in schizophrenia: assessing the relationship between social skills, psychopathology and community functioning. Soc Psychiatry Psychiatr Epidemiol 1995, 30:14-19. The authors used structural equation modelling to confirm a model of the independence of symptoms and social functioning. The narrow range of positive symptoms, however, may not have allowed subtle associations to be measured.
3. Penn DL, Mueser K, Spaulding W, Hope D, Reed DA: Information processing and social competence in chronic schizophrenia. Schizophr Bull 1995, 21:269-281. Behavioural measures of social anxiety related to negative symptoms and positive symptoms related to self-report measures were assessed. Unfortunately, no data were provided on the relationship between the two different measures and a cognitive measure failed to provide any external validity for either measure. It is not yet clear whether anxiety is specific or general.
4. Bowen L, Wallace C, Glynn S, Neuchterlein K, Lutzker J, Kuehnel T: Schizophrenic individuals' cognitive functioning and performance in interpersonal interactions and skills training procedures. J Psychiatr Res 1994, 28:289-301.
5. Corrigan P, Addis I: Effects of extraneous stimuli on social cue perception in schizophrenia. Psychiatr Res 1995, 56:111-120. A report on how a simple modification in the environmental demands improved the sensitivity to abstract social cues. The stimulus characteristics for the enhancement of perception still need defining but these sorts of techniques may aid the skills-teaching technology of psychiatric rehabilitation.
6. Corrigan P, Green M, Toomey R: Cognitive correlates to social cue perception in schizophrenia. Psychiatry Res 1994, 53:141-151.
7. Leff J, Thornicroft G, Coxhead N, Crawford C: The TAPS project 22: a five year follow-up of long stay psychiatric patients discharged into the community [supplement]. Br J Psychiatry Suppl 1994, 25:13-17. One of a series of reports following up patients after a hospital closure. Not much clinical or social change was observed but there were improvements in social networks with more patients nominating individuals as friends.
8. Wykes T: Predicting symptomatic and behavioural outcomes of community care. Br J Psychiatry 1994, 165:486-492. The first long-term study indicating the importance of cognitive factors for rehabilitation outcome. There were few average changes unless patients had been in the community for at least 3 years but baseline cognitive functioning interacted with community care. If patients with deficits were transferred to settings with more information processing demands, they deteriorated.
9. Arns PG, Linney JA: Relating functional skills of severely mentally ill clients subjective and societal benefits. Psychiatr Serv 1995, 46: 260-265.
10. Marks IM, Connolly J, Muijen M, Audini B, McNamee G, Lawrence R: Home based versus hospital based care for people with a serious mental illness. Br J Psychiatry 1994, 165:179-194. Assertive community treatment was found to be better than usual care after 20 months but the data are complicated and improvements disappeared later (see also [18•]). Apart from evaluation data, the authors also discuss the problems of implementing such a programme which can affect service delivery.
11. Ruggeri M: Patients' and relatives' satisfaction with psychiatric services: the state of the art and its measurement. Soc Psychiatry Psychiatr Epidemiol 1994, 29:212-227.
12. Corrigan P, Buican B: The construct validity of subjective quality of life for the severely mentally ill. J Nerv Ment Dis 1995, 183:281-285.
13. Dick N, Shepherd G: Work and mental health: a preliminary test of Warr's model in sheltered workshops for the mentally ill. J Ment Health 1994 3:387-400.
14. Carson J, Dowling F, Glynn T, Oliver N: The role of normalization in psychiatric rehabilitation: an empirical investigation. Care in Place 1994, 1:231-243.
15. Wykes T: Social functioning in residential and institutional settings. In Handbook of social functioning in schizophrenia. Edited by Mueser K, Tarrier N (eds). New York: Wiley; 1996 (in press).
16. Penn D, Hope O, Spaulding W, Kucera J: Social anxiety in schizophrenia. Schizophr Res 1994, 11:277-284.
17. Marshall M, Lockwood A, Gath D: Social services case management for long term mental disorder: a randomised control trial. Lancet 1995, 345:409-412.
18. Audini B, Marks IM, Lawrence R, Connolly J, Watts V: Home based versus outpatient/inpatient care for people with serious mental illness. Phase II of a controlled study. Br J Psychiatry 1994, 165:204-210. After follow-up, patients in the home-based treatment group (see also [10••]) were randomized to a further trial. The authors found loss of treatment gains in both the treated and usual care group. Some leakage of assertive care to usual care occurred, however, as patients continued to contact the treatment team. Possible explanations for the fall off of treatment gains are discussed.
19. Luo K, Yu D: Enterprise based workshops in Nanjing: a new model for the community rehabilitation of mentally ill workers. Br J Psychiatry Suppl 1994, 24:89-95. A report from China of rehabilitation methods. Treatment was as outpatients or in a sheltered workshop within a factory for approximately 4 months. At 2-year follow-up, people from the workshop functioned better than the outpatients. There may be some bias in the choice of control group.
20. Nienhuis F, Giel R, Kluiter H, Ruphan M, Wiersma D: Efficacy of psychiatric day treatment: course and outcome of psychiatric disorders in a randomised control trial. Eur Arch Clin Neuropsychiatry 1994, 244:73-80.
21. Brooker C, Falloon I, Butterworth A, Golberg D, Graham-Hole G, Hillier V: The outcome of training community psychiatric nurses to deliver psychosocial treatments. Br J Psychiatry 1994, 165:222-230.
22. Muijen M, Cooney M, Strathdee G, Bell R, Hudson A: Community psychiatric nurse teams: intensive support versus generic care. Br J Psychiatry 1994, 165:211-217. Intensive support included a wide range of interventions and more patient contact. Despite these interventions, there were no differences between the groups.
23. Okin RL, Borus JF, Baer L, Jones AL: Long term outcome of state hospital patients discharged into structured community residential settings. Psychiatr Serv 1995, 46:73-78.
24. Stein LI, Test MA: Alternatives to mental hospital treatment: I a conceptual model, treatment programme and clinical evaluation. Arch Gen Psychiatry 1980, 37:392-397.
25. Hoult J, Reynolds I, Charboneau-Powis M, Weekes P, Briggs J: Psychiatric hospital vs community treatment: a randomised trial. Aust N Z J Psychiatry 1983, 17:160-167.
26. Bond GR, McGrew JH, Feketee DM: Assertive outreach for frequent users of psychiatric services: a meta-analysis. J Ment Health Admin 1995, 22:4-16.
27. Burns T, Beadsmore A, Bhat AV, Oliver A, Mathers C: A trial of home-based psychiatric services. Br J Psychiatry 1993, 163:49-61.
28. Merson S, Tryer P, Onyett S, Lack S, Birkett P, Lynch S, Johnson T: Early intervention in psychiatric emergencies: a controlled clinical trial. Lancet 1992, 339:1311-1314.
29. Lelliot P, Wing JK, Clifford P: National audit of new long stay psychiatric patients: I method and description of the cohort. Br J Psychiatry 1994, 165:160-169.
30. Estroff S, Zimmer C, Lachicotte WS, Benoit J: The influence of social networks and social support on violence by persons with severe mental illness. Hosp Community Psychiatry 1994, 45:669-678. A prospective study of community violence over 18 months. Mothers who lived with their offspring were at a higher risk of being a target of violence. Patients' perceptions of threat and being socially isolated were also predictors.
31. Bebbington P, Kuipers L: The predictive utility of expressed emotion in schizophrenia: an aggregate analysis. Psychol Med 1994, 24:707-718.
32. Mari JJ, Streiner DL: An overview of family interventions and relapse on schizophrenia: meta-analysis of research findings. Psychol Med 1994, 24:565-578.
33. Tarrier N, Barrowclough C, Porceddu K, Fitzpatrick E: The Salford family intervention project: relapse rates of schizophrenia at five and eight years. Br J Psychiatry 1994, 165:829-832. This is long-term follow-up of the effect of family intervention on expressed emotion. Relapse rates were lower in the treated group at 5 and 8 years after therapy.
34. Sorenson-Snyder K, Wallace C, Moe K, Liberman RP: Expressed emotion by residential care operators and residents symptoms and quality of life. Hosp Community Psychiatry 1994, 45:1141-1143. The authors of a preliminary follow-up study showed a positive relationship between care workers, critical comments and residents quality of life and symptoms. They investigated only stable residents, therefore, staff expressed emotion may have a more potent toxic effect on new residents, some of whom will not be able to continue with their community tenure.
35. Ball R, Moore E, Kuipers L: EE in community care facilities: a comparison of patient outcome in a nine month follow-up of two residential hostels. Soc Psychiatry Psychiatr Epidemiol 1992, 27:35-39.
36. van Os J, Fahy TA, Bebbington P, Jones P, Wilkins S, Sham P, Russell A, Gilvarry K, Lewis S, Toone B, Murray R: The influence of life events on the subsequent course of psychotic illness. A prospective follow-up of the Camberwell collaborative psychosis study. Psychol Med 1994, 24:503-513.
37. Weller BGA, Weller MPI, Coker E, Mohamed S: Crisis at Christmas 1986. Lancet 1987, 8532:553-554.
38. Abdul-Hamid W, Wykes T, Stansfield S: The social disablement of men in hostels for homeless people: I reliability and prevalence. Br J Psychiatry 1995, 166:806-808.
39. Abdul-Hamid W, Wykes T, Stansfield S: The social disablement of men in hostels for homeless people: II a comparison with patients from long stay wards. Br J Psychiatry 1995, 166:809-812. A random survey of residents of hostels for homeless men showed that levels of disability were low. Patients who had psychotic symptoms or behaviours had disability levels as poor as those of patients in long-term hospital care.
40. Newton JR, Geddes JR, Bailed S, Freeman C, McAleavy A, Young GC: Mental health problems of the Edinburgh 'Roofless'. Br J Psychiatry 1994, 165:537-540.
41. Wykes T, Dunn G: Cognitive deficit and the prediction of rehabilitation success after three years: the use of social symptomatic and cognitive variables. Psychol Med 1992, 22:389-398.
42. Rund BR: The relationship between psychosocial and cognitive functioning in schizophrenic patients and expressed emotion and communication deviance in their parents. Acta Psychiatr Scand 1994, 93:133-140. When parents changed their expressed emotion in a 2-year treatment programme, there was an increase in social functioning. Patients' scores on a backward-masking task at baseline distinguished between those relatives who improved in an expressed emotion treatment programme from relatives showing no improvements.
43. Mueser KT, Bellack A, Douglas MS, Wade JH: Prediction of social skill acquisition in schizophrenia and major affective disorders patients from memory and symptomatology. Psychiatry Res 1991, 37:281-296.
44. Delahunty A, Morice R, Frost B: Specific cognitive flexibility rehabilitation in schizophrenia. Psychol Med 1993, 23:221-227.
45. Hodel B, Brenner HD: Cognitive therapy with schizophrenia patients: conceptual basis, present state and future directions [Suppl]. Acta Psychiatr Scand 1994, 90(suppl 384):108-115. The author reported that social interventions prevented early in treatment were more effecive than cognitive interventions. Not much experimental detail was reported; therefore, it is difficult to assess the differences in impact of the two conditions but it is clear that the authors do not support a pervasive effect of cognitive remediation on social functioning.
46. Lewis A: Rehabilitation programmes in England. Proc Millbank Mem Fund Ann Conf 1955, 9:196-206.