title: Supplementing clinic-based skills training with manual-based community support sessions: effects on social adjustment of patients with schizophrenia.
abstract: OBJECTIVE
  Although skills training is a validated psychosocial treatment for schizophrenia, generalization of the skills to everyday life has not been optimal. This study evaluated a behaviorally oriented method of augmenting clinic-based skills training in the community with the aim of improving opportunities, encouragement, and reinforcement for outpatients to use their skills in their natural environment.
  
  
  METHODS
  Sixty-three individuals with schizophrenia were randomly assigned to 60 weeks of clinic-based skills training alone or of clinic-based skills training supplemented with manual-based generalization sessions in the community. Patients were also randomly assigned to receive either haloperidol or risperidone. Therapists' fidelity to the manuals was measured. Patients' acquisition of the skills from pre- to posttraining was evaluated. The primary outcome measures were the Social Adjustment Scale-II and the Quality of Life Scale.
  
  
  RESULTS
  Seventy-one percent of the patients completed the trial. Only six participants experienced psychotic exacerbations during the trial. There was no evidence of a differential medication effect on social functioning. Social functioning improved modestly in both psychosocial conditions over time; participants who received augmented skills training in the community showed significantly greater and/or quicker improvements.
  
  
  CONCLUSIONS
  Given judicious and effective antipsychotic medication that limited exacerbations to less than 10% during the trial, a wide range of outpatients with schizophrenia demonstrated substantial learning of illness management and social skills in the clinic. When clinic-based skills training was augmented by in vivo training and consultation, transfer of the skills to everyday life was enhanced. These benefits were established regardless of the medications prescribed.
authors: Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles and Veteran Affairs Greater Los Angeles Healthcare System, 90073, USA. sglynn@ucla.edu
authors: Shirley M
authors: SM
authors: Glynn
authors: Stephen R
authors: SR
authors: Marder
authors: Robert P
authors: RP
authors: Liberman
authors: Karen
authors: K
authors: Blair
authors: William C
authors: WC
authors: Wirshing
authors: Donna A
authors: DA
authors: Wirshing
authors: Doreen
authors: D
authors: Ross
authors: Jim
authors: J
authors: Mintz
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000553:Ambulatory Care / Q000379:methods; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001521:Behavior Therapy / Q000379:methods*; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D005260:Female; D006220:Haloperidol / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008370:Manuals as Topic; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D018967:Risperidone / Q000627:therapeutic use; D012559:Schizophrenia / Q000188:drug therapy / Q000534:rehabilitation / Q000628:therapy*; D012917:Social Adjustment; D012944:Social Support; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D006220:Haloperidol; D018967:Risperidone