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Biomedical subjects

A S Bellack

Publications and source records attributed to A S Bellack.

At least 37 records · Page 2Linked to original sources
PubMed1995

Family interactions of schizophrenic and schizoaffective patients: determinants of relatives' negativity.

Videotaped family problem-solving interactions of 57 schizophrenic or schizoaffective patients and their relatives were examined for predictors of negativity of their communication behavior. Ratings of patients' behaviors and independent assessments of patients' symptomatology were used to predict the negativity of relatives in the videotaped interaction. The results indicated that severity of symptomatology was not related to relatives' negativity. Patients' social skill, as independently assessed by a role-play test, also was not associated with relatives' negativity. The regression results suggest that with both members of a patient-relative dyad, the quality of communication in a discussion is related to the other participant's level of negativity.

Adolescent↗
PubMed1995

An empirical method for assessing social problem solving in schizophrenia.

The development of a multimethod social problem-solving battery for schizophrenia is described. The battery is unique in that empirical methods were used throughout its development. The battery includes components that tap skills for response generation and response evaluation. The behavioral components of social problem solving are assessed in an extended role-play format. Individuals with schizophrenia and bipolar disorder, as well as nonpatient controls, completed the social problem-solving battery and cognitive measures. Subjects in the schizophrenia group performed more poorly than controls on measures of the ability to generate and evaluate response alternatives, as well as on the role-play test. The two patient groups did not differ in performance on any of the social problem-solving components. Appropriateness of affect was the most powerful predictor of problem-solving effectiveness.

Adult↗
PubMed1994

Evaluation of social problem solving in schizophrenia.

We examined social problem solving in schizophrenia. Twenty-seven schizophrenic patients in an acute hospital, 19 patients with bipolar disease, and 17 demographically matched nonpatient controls were tested on an empirically developed problem-solving battery that assessed the ability to generate solutions to problems, the ability to evaluate the effectiveness of solutions, and the ability to implement solutions in a role-playing format. Schizophrenic Ss were impaired on all 3 problem-solving domains compared with the nonpatient controls, but bipolar Ss were equally impaired. Several alternative explanations for these findings were considered. The most compelling hypothesis is that the deficits resulted from different factors: cognitive impairment for schizophrenic Ss and acute illness for bipolar Ss. However, longitudinal studies are required to determine whether problem-solving deficits in schizophrenic patients persist during periods of remission. Implications for rehabilitation strategies are discussed.

Adult↗
PubMed1994

Affective and social-behavioral correlates of physical and social anhedonia in schizophrenia.

The association between scales measuring physical and social anhedonia, self-reports of affective response to emotion-eliciting films, and role play measures of social skill was evaluated in patients with schizophrenia, schizoaffective disorder, and bipolar affective disorder. We hypothesized that patients with schizophrenia would report significantly greater anhedonia than the bipolar patients and that higher scores on the anhedonia scales would be related to attenuated reports of the experience of positive affect and poorer social skill. Patients with schizophrenia and schizoaffective disorder did not differ in ratings of anhedonia, but both groups had higher physical and social anhedonia scores than did bipolar patients. Higher scores on the physical anhedonia scale, but not the social anhedonia scale, were related to attenuated reports of positive affect following viewing of affect-eliciting films in schizophrenia-schizoaffective disorder patients. Neither anhedonia scale was related to role play measures of social skill performance for any patient group.

Adolescent↗
PubMed1993

Expressed emotion, social skill, and response to negative affect in schizophrenia.

The social skills and social perception of schizophrenia patients in response to negative affect was examined as a function of family expressed emotion (EE). Patients participated in a role-play test, a social perception test, and a problem-solving discussion with a family member and were assessed on several measures of symptomatology. EE of family members was evaluated with the Camberwell Family Interview. On the role-play test, patients with less critical relatives became more assertive in response to increased negative affect from a confederate portraying either a family member or friend, but patients with highly critical relatives did not. Patients with highly critical relatives were also less assertive when confronted with negative affect from a confederate portraying a family member rather than a friend. The behaviors of both relatives and patients during a family problem-solving interaction were related to the EE dimensions of criticism, emotional overinvolvement, and warmth. Patient gender was also related to family problem solving but was independent of EE. Patient ratings of affect on a videotaped social perception task were not related to family EE, and there were few differences in psychopathology between patients with high and low EE relatives. The results support the validity of the EE construct as an index of relatives' affective behavior and suggest that patients' social skills, such as assertiveness, may mediate negative affective exchanges in their families.

Adaptation, Psychological↗
PubMed1993

Psychosocial treatment for schizophrenia.

This article addresses issues affecting the progress of research on the psychological treatment of schizophrenia, including the need for comprehensive and long-term treatment, individual differences in treatment needs, the role of the patient in the treatment process, and the limitations imposed by information-processing deficits. Despite these issues, research on psychological treatment has made significant progress over the last decade. Controlled trials of social skills training, the most widely studied intervention for individual patients, suggest some beneficial effects, although the results are mixed. Recent interest in cognitive rehabilitation or teaching patients how to manage cognitive deficits holds promise, but the feasibility and efficacy of these approaches remain to be demonstrated. Family intervention programs aimed at educating relatives and helping them cope more effectively with the patient's illness have shown positive effects on the course of schizophrenia, although treatment gains appear to be modest and of uncertain durability. The results of controlled research on psychological treatment suggest that intervention may improve the outcome of schizophrenia, but that many patients may require long-term treatment due to the chronic nature of the illness. Future avenues of research include the timing of psychological treatment, the integration of individual and family approaches, the interaction between novel antipsychotic medications and response to psychological treatment, and the development of new interventions for patients who abuse drugs and alcohol or who are nonresponsive to existing treatments.

Family Therapy↗
PubMed1992

Scientific rewards and conflicts of ethical choices in human subjects research.

The primary responsibility of the American Psychological Association's (APA) Committee on Standards in Research (CSR) is to advise the APA on issues and standards related to the protection of human participants in psychological research. A related goal is to enhance the use of good ethical practices by APA members. The purpose of this article is to foster the view of research ethics not as an affront to the integrity of sound research, but as opportunities for scientific rewards, including increased understanding of the meaning of data, enhanced recruitment, and the inclusion of more representative samples. Three ethical practices are discussed as examples of this general premise: respect for confidentiality, use of debriefing, and assurance that participants are noncoerced volunteers. The Committee's intent is to promote consideration of these issues, not to promulgate specific guidelines or procedures.

Advisory Committees↗
PubMed1992

Validity of the distinction between generalized social phobia and avoidant personality disorder.

Disorders of pervasive social anxiety and inhibition are divided into 2 categories, generalized social phobia (GSP) and avoidant personality disorder (APD). We explored the discriminative validity of this categorization by examining the comorbidity of GSP and APD and by comparing these groups on anxiety level, social skills, dysfunctional cognitions, impairment in functioning, and presence of concurrent disorders. Results from 23 subjects showed high comorbidity of the 2 diagnoses: All subjects who met criteria for APD also met criteria for GSP. APD was associated with greater social anxiety, impairment in functioning, and comorbidity with other psychopathology, but no differences in social skills or performance on an impromptu speech. GSP and APD seem to represent quantitatively different variants of the same spectrum of psychopathology rather than qualitatively distinct disorders. We also investigated a proposed social phobia subtyping scheme.

Adult↗
PubMed1992

Comorbidity of schizophrenia and substance abuse: implications for treatment.

The problem of substance abuse disorders in schizophrenia patients is reviewed, including the prevalence of co-morbid disorders, assessment, hypothesized mechanisms underlying abuse, and the clinical effects of abuse on the course of illness and cognitive functioning. The principles of treatment for dual-diagnosis schizophrenia patients are outlined, and the limitations of existing interventions are noted. Gaps in current knowledge about the impact of substance abuse on schizophrenia and its treatment are identified, and suggestions are made regarding promising avenues of research in this area.

Alcoholism↗
PubMed1992

Cognitive rehabilitation for schizophrenia: is it possible? Is it necessary?

Limitations of available psychosocial interventions combined with the increasing evidence that schizophrenia is characterized by diverse deficits in information processing has stimulated great interest in the possibility of cognitive rehabilitation. However, the current optimism seems unjustified. The precise role of information processing in the behavioral handicaps evidenced by schizophrenic patients is not clear, and the neuropsychologic and experimental psychopathology tasks used to assess information processing generally cannot specify precisely which cognitive functions are deficient. Thus, the choice of cognitive targets for rehabilitation is arbitrary. The strategies currently employed for rehabilitation emphasize an exercise model of treatment and the use of complex mnemonics. Neither approach has been successful in rehabilitating brain-injured patients, and preliminary results with schizophrenic patients are not very promising. It is concluded that the field might be better served by focusing on environmental change and compensatory strategies until we determine how and why schizophrenic patients fail.

Behavior Therapy↗
PubMed1992

Diagnostic and demographic correlates of substance abuse in schizophrenia and major affective disorder.

The relationship between history of specific types of substance abuse (alcohol, stimulants, cannabis, hallucinogens, narcotics) and demographic and diagnostic variables was evaluated in a large (n = 263) sample of schizophrenic, schizoaffective, major depression and bipolar disorder patients. Prevalence rates were also compared with rates observed in a previous study (1983-1986) conducted using the same methods. Demographic characteristics (gender, age, race, educational level) were strong predictors of type of substance abuse. Patients with a history of cocaine abuse had fewer prior hospitalizations, suggesting that less impaired psychiatric patients may be more prone to illicit substance abuse. Diagnoses were not related to most types of substance abuse, although there was a trend for bipolar patients to have a history of alcohol abuse. The results demonstrate the importance of matching groups on demographic characteristics when exploring diagnostic differences in preference to abuse specific types of substances.

Adolescent↗
PubMed1992

The ability of schizophrenics to perceive and cope with negative affect.

Thirty-four schizophrenic patients in an acute in-patient hospital were compared with 24 in-patients with major affective disorder and 19 non-patient controls on a role-play test of social skills and a test of affect perception. The role-play test consisted of 12 simulated conversations in which the subject was confronted by parents and friends expressing high-EE criticism or non-critical dissatisfaction. Schizophrenic patients lacked assertiveness and social skills in all conditions, but they did not show any differential impairment when presented with high EE. They consistently lied and denied errors rather than responding assertively or apologizing, whether confronted with high-EE or benign criticisms. On the affect perception test, schizophrenic patients consistently underestimated the intensity or negativeness of negative emotions, but they were not deficient in perception of positive emotional displays. The data do not support the hypothesis that schizophrenic patients are poor at dealing with high-EE behaviours, but do indicate that their ability to cope with even mild negative affect is impaired. Possible explanations for this impairment include limited attentional capacity, a neurologically based perceptual deficit, and a self-protective mechanism to reduce or avoid stress.

Adaptation, Psychological↗
PubMed1992

An assessment of the educational needs of chronic psychiatric patients and their relatives.

Both psychiatric patients and their relatives benefit from learning about mental illness and how to cope with it, but the specific interests of these consumers remain unclear. To determine specific educational needs and to compare the needs of different consumers, a questionnaire survey was conducted with a sample of patients with schizophrenia and affective disorder and their relatives. Both patients and relatives reported strong interest in learning more about psychiatric illness and strategies for coping with common problems, but patients with schizophrenia were less interested than patients with affective disorder and both sets of relatives. Discriminant analyses revealed that needs differed as a function of patient diagnosis, patient/relative status, and relatives' membership of a self-help and advocacy organisation. Consumers of mental health services are capable of specifying their own educational needs, and educational programmes should be tailored to meet these.

Adaptation, Psychological↗
PubMed1991

Prediction of social skill acquisition in schizophrenic and major affective disorder patients from memory and symptomatology.

Memory and symptomatology were examined as predictors of social skill acquisition in psychiatric inpatients participating in a social skills training program. Poor memory was related to pretreatment social skill impairments and slower rates of skill improvement during the intervention for patients with schizophrenia or schizoaffective disorder, but not affective disorder. Symptomatology was not consistently related to pretreatment social skill or changes in skill for either schizophrenic or affective disorder patients. The results suggest that cognitive deficits in schizophrenia are associated with impairments in social skill and that such deficits may limit the rate of skill acquisition and clinical response to social skills training interventions.

Adult↗
PubMed1991

Prevalence and stability of social skill deficits in schizophrenia.

The prevalence of social skill deficits in schizophrenia was examined by comparing patients assessed over a 1 year period with a group of non-patient controls recruited from the community. Social skills were assessed using a role play test and were considered deficient when they were below the range of the control sample. Approximately 50% of the patients were consistently unskilled over the one year, whereas 11% were consistently skilled. Deficits in specific social skills were relative rare. Consistent deficits were present for only one of six specific skills: 14% of the patients were consistently less appropriate in their conversational turn-taking (Meshing) than the controls. Patients' social skills were relatively stable over time. The implications of these results for the assessment and remediation of social skill impairments in schizophrenia are discussed.

Adolescent↗
PubMed1991

Assessment of enduring deficit and negative symptom subtypes in schizophrenia.

The clinical importance of subtypes based on enduring deficit or negative symptoms was examined in a group of schizophrenic patients who were assessed twice over a 1-year period. Subgroups of patients with high levels of enduring negative or deficit symptoms, based on the Scale for the Assessment of Negative Symptoms and the Quality of Life Scale, had a poorer prognosis and were consistently worse in social adjustment, quality of life, and thought disorder over the year than were patients with less severe negative symptoms. Subtypes based on Andreasen's negative schizophrenia classification and on enduring thought disorder were only weakly related to other symptoms and social adjustment. Social-skill deficits were weakly related to the enduring negative symptom subtype and Andreasen's negative schizophrenia. The results suggest that enduring negative and deficit symptoms may be associated with a poor outcome in schizophrenia, including more severe positive symptoms, lower levels of social adjustment, and a poorer quality of life.

Adult↗
PubMed1990

Social competence in schizophrenia: premorbid adjustment, social skill, and domains of functioning.

The relations between premorbid adjustment, social skill, and domains of functioning (symptoms, social adjustment) were examined in a group of 107 schizophrenic, schizoaffective, and affective disorder patients. Premorbid sexual adjustment was moderately correlated with social skill in the schizophrenic and schizoaffective patients. Schizophrenic patients had the lowest premorbid adjustment and social skill, followed by schizoaffectives, and then affective patients. Within the schizophrenic group, social skill was significantly related to both current social adjustment and negative symptoms, but not positive symptoms. Similar but weaker effects were found for premorbid adjustment. The results suggest that deficits in social skill are correlated with poor premorbid and morbid social adjustment of schizophrenics.

Adolescent↗