Predicting schizophrenic outpatients' behavior by symptomatology and social skills

Nonverbal Synchrony in Social Interactions of Patients with Schizophrenia Indicates Socio-Communicative Deficits

BACKGROUND

Disordered interpersonal communication can be a serious problem in schizophrenia. Recent advances in computer-based measures allow reliable and objective quantification of nonverbal behavior. Research using these novel measures has shown that objective amounts of body and head movement in patients with schizophrenia during social interactions are closely related to the symptom profiles of these patients. In addition to and above mere amounts of movement, the degree of synchrony, or imitation, between patients and normal interactants may be indicative of core deficits underlying various problems in domains related to interpersonal communication, such as symptoms, social competence, and social functioning.

METHODS

Nonverbal synchrony was assessed objectively using Motion Energy Analysis (MEA) in 378 brief, videotaped role-play scenes involving 27 stabilized outpatients diagnosed with paranoid-type schizophrenia.

RESULTS

Low nonverbal synchrony was indicative of symptoms, low social competence, impaired social functioning, and low self-evaluation of competence. These relationships remained largely significant when correcting for the amounts of patients' movement. When patients showed reduced imitation of their interactants' movements, negative symptoms were likely to be prominent. Conversely, positive symptoms were more prominent in patients when their interaction partners' imitation of their movements was reduced.

CONCLUSIONS

Nonverbal synchrony can be an objective and sensitive indicator of the severity of patients' problems. Furthermore, quantitative analysis of nonverbal synchrony may provide novel insights into specific relationships between symptoms, cognition, and core communicative problems in schizophrenia.

Video-based quantification of body movement during social interaction indicates the severity of negative symptoms in patients with schizophrenia

In schizophrenia, nonverbal behavior, including body movement, is of theoretical and clinical importance. Although reduced nonverbal expressiveness is a major component of the negative symptoms encountered in schizophrenia, few studies have objectively assessed body movement during social interaction. In the present study, 378 brief, videotaped role-play scenes involving 27 stabilized outpatients diagnosed with paranoid-type schizophrenia were analyzed using Motion Energy Analysis (MEA). This method enables the objective measuring of body movement in conjunction with ordinary video recordings. Correlations between movement parameters (percentage of time in movement, movement speed) and symptom ratings from independent PANSS interviews were calculated. Movement parameters proved to be highly reliable. In keeping with predictions, reduced movement and movement speed correlated with negative symptoms. Accordingly, in patients who exhibited noticeable movement for less than 20% of the observation time, prominent negative symptoms were highly probable. As a control measure, the percentage of movement exhibited by the patients during role-play scenes was compared to that of their normal interactants. Patients with negative symptoms differed from normal interactants by showing significantly reduced head and body movement. Two specific positive symptoms were possibly related to movement parameters: suspiciousness tended to correlate with reduced head movement, and the expression of unusual thought content tended to relate to increased movement. Overall, a close and theoretically meaningful association between the objective movement parameters and the symptom profiles was found. MEA appears to be an objective, reliable and valid method for quantifying nonverbal behavior, an aspect which may furnish new insights into the processes related to reduced expressiveness in schizophrenia.

Biosocial pathways to functional outcome in schizophrenia

Biosocial models are preeminent in the study of schizophrenia, yet there has been little empirical testing of these models.

OBJECTIVE

This study provided the first test of a biosocial causal model of functional outcome in schizophrenia, using neurocognition, social cognition, social competence and social support as predictors of both global and specific domains of functional outcome.

METHOD

The design used baseline variables to predict both concurrent functional status and prospective 12-month functional outcome. Subjects were recruited upon admission to outpatient community-based psychosocial rehabilitation programs shown in previous studies to be effective in improving functional outcomes. 139 individuals diagnosed with schizophrenia or schizoaffective disorder participated in the study; 100 participants completed the 12-month assessments. Face-to-face interviews assessed neurocognitive functioning (with five neuropsychological measures), social cognition (as perception of emotion), social competence, social support, and functional outcome which consisted of items covering the domains of social, independent living, and work functioning.

RESULTS

Path analysis modeling showed that the proposed biosocial models had strong fit with the data, for both concurrent and 12-month global functional outcomes, with fit indices ranging from .95 to .98. The model explained 21% of the variance in concurrent global functional outcome, and 14% of the variance in 12-month prospective outcome.

CONCLUSIONS

The support for this model was strong, and it has implications for understanding the causal factors related to functional outcome, as well as for intervention strategies for improving functional outcomes in schizophrenia.

Rehabilitative residential treatment in patients with severe mental disorders: personality features associated with short-term outcome

The aims of this study were to evaluate the outcome of inpatients with severe psychiatric disorders after 6 months of multimodal residential treatment. Ninety-one subjects admitted to residential prolonged treatment at an Italian rehabilitative complex were included in the study. Within 6 months, the program of treatment was effective in reducing symptoms and improving the patients' psychosocial functioning. The study of personality can be useful to "dose" symptomatic (pharmacological and psychotherapeutic) and rehabilitative treatments in the therapy program.

Effects of social skills training on improving social skills of patients with schizophrenia

This study examined the effect of conversation and assertive skills training on social skills of schizophrenic patients. Patients who met the study criteria were randomly assigned to the experimental or control group. The experimental group received eight group training sessions and the control group received routine nursing care treatment. Data were collected at pretreatment (before group treatment), intratreatment (after fourth group treatment), posttreatment (after eighth group treatment), and follow-up (1 month after the end of group treatment). Conversation and assertive skills of the experimental group improved significantly with treatment and were superior to the control group at intratreatment, posttreatment, and follow-up. We suggest incorporating social skills training into treatment plans for patients with schizophrenia to improve their social skills ability.

Interpersonal distance in schizophrenic patients: relationship to negative syndrome

BACKGROUND

Personal space is the area individuals maintain around themselves into which others cannot intrude without arousing discomfort.

OBJECTIVE

We tested the hypotheses that psychological distancing of patients with schizophrenia would be a characteristic of 1) diagnosis and/or 2) syndrome.

METHODS

For this aim, 30 schizophrenic and 30 age matching normal males established comfortable interpersonal distances for 20 word-stimuli representing family members, significant others, self-images, emotionally neutral and threatening surroundings. The distances were assessed by a paper-and-pencil projective measure, the Comfortable Interpersonal Distance scale and the patients' psychopathological symptoms were quantified by the Positive and Negative Syndrome Scale. t-tests and correlational analyses were employed to examine the relationships between the parameters of interest.

RESULTS

The rank order (hierarchy) of preferable interpersonal distances of patients with schizophrenia was similar to that of normal subjects. At the same time, psychological distance from family members and themselves was substantially larger among the patients. There were no significant correlations between any kind of interpersonal distance and positive syndrome of schizophrenia, while negative syndrome showed significant inverse association with distances from emotionally neutral and threatening figures and positive correlation with family member and self-image distances.

CONCLUSION

The results suggest that the negative syndrome of schizophrenia attenuates the differences between interpersonal distances from generally close and distant persons.