Marder S R, Wirshing W C, Mintz J, McKenzie J, Johnston K, Eckman T A, Lebell M, Zimmerman K, Liberman R P
West Los Angeles VA Medical Center, CA 90073, USA.
Am J Psychiatry. 1996 Dec;153(12):1585-92. doi: 10.1176/ajp.153.12.1585.
The authors evaluated the effectiveness of behaviorally oriented social skills training and supportive group therapy for improving the social adjustment of schizophrenic patients living in the community and for protecting them against psychotic relapse.
Eighty male outpatients with schizophrenia were stabilized with a low dose of fluphenazine decanoate (5 to 10 mg every 14 days), which was supplemented with oral fluphenazine (5 mg twice daily) or a placebo when they first met criteria for a prodromal period. (Half of the patients did so at some time during the study.) Patients were randomly assigned to receive either social skills training or supportive group therapy twice weekly for 6 months and then weekly for the next 18 months. Rates of psychotic exacerbation were monitored, as were scores on the Social Adjustment Scale II.
There were significant main effects favoring social skills training over supportive group therapy on two of the six Social Adjustment Scale II cluster totals examined (personal well-being and total) and significant interactions between psychosocial treatment and drug treatment for three items (external family, social and leisure activities, and total). In each case, these interactions indicated that the advantage of social skills training over supportive group therapy was greatest when it was combined with active drug supplementation. Social skills training did not significantly decrease the risk of psychotic exacerbation in the full group, but an advantage was observed (post hoc) among patients who received placebo supplementation.
These findings suggest that social skills training resulted in greater improvement in certain measures of social adjustment than supportive group therapy. The greatest improvement in social outcomes occurred when social skills training was combined with a pharmacological strategy of active drug supplementation at the time prodromal worsening of psychotic symptoms was first observed. However, these improvements were modest in absolute terms and confined to certain subgroups of patients.
作者评估了以行为为导向的社交技能训练和支持性团体治疗对改善社区精神分裂症患者的社会适应能力以及预防其精神病复发的效果。
80名男性精神分裂症门诊患者使用低剂量癸酸氟奋乃静（每14天5至10毫克）进行病情稳定治疗，当他们首次符合前驱期标准时，补充口服氟奋乃静（每日两次，每次5毫克）或安慰剂。（一半患者在研究期间的某个时间点出现这种情况。）患者被随机分配，接受为期6个月、每周两次的社交技能训练或支持性团体治疗，之后18个月改为每周一次。监测精神病恶化率以及社会适应量表II的得分。
在六个社会适应量表II集群总分中的两项（个人幸福感和总分）上，社交技能训练比支持性团体治疗有显著的主效应优势，并且在三个项目（家庭外部、社交和休闲活动以及总分）上，心理社会治疗与药物治疗之间存在显著交互作用。在每种情况下，这些交互作用表明，当社交技能训练与积极的药物补充相结合时，其相对于支持性团体治疗的优势最大。社交技能训练在整个组中并未显著降低精神病恶化的风险，但在接受安慰剂补充的患者中观察到了优势（事后分析）。
这些发现表明，社交技能训练在某些社会适应指标上比支持性团体治疗带来了更大的改善。当在首次观察到精神病症状前驱期恶化时，社交技能训练与积极药物补充的药理学策略相结合时，社会结果的改善最为显著。然而，从绝对意义上讲，这些改善是适度的，并且仅限于某些患者亚组。
