Neuropsychological Investigation of the Effects of Psychiatric Rehabilitation Strategies for Schizophrenia

摘要

Several studies have found a relationship between cognitive functioning and social skills in schizophrenia. The results are generally consistent with the hypothesis that poor cognitive functioning contributes to social skill impairment. In a series of studies on the efficacy of social skill training, improvement by training was stressed, but the difficulty of generalization of skills inquired by training is still controversial. The impairments not improved through skill training, however, may provide cues or hints for additional rehabilitation strategies. Several clinical neuropsychological tests, behavioral assessment by rehabilitation evaluation (REHAB), and psychiatric symptoms assessment by the Brief Psychiatric Rating Scale (BPRS) were administered to patients with schizophrenia before and after 22 hours of social skill training (SST) sessions. SST was performed in a day treatment program for outpatients with stable psychiatric symptoms. Trained staffs conducted a 1-hour program every week for a total 22 sessions, in addition to standard psychiatric treatment. The results show that performance on the Idea Fluency Test, which requests as many responses as possible on the uses of objects, was significantly better after the sessions than before the sessions. However, further qualitative analysis of the responses showed that the improvement of the total score on the Idea Fluency Test was due to the increase of task-dependent form responses connected with the regular uses and shapes of the object. Task modification form responses in the Idea Fluency Test that required conversion of viewpoint did not improve. This may in part explain the difficulty of escaping from stereotyped thinking by patients with schizophrenia.