Role of psychosocial treatments in management of schizophrenia: a meta-analytic review of controlled outcome studies.

This meta-analytic review sought to answer questions concerning the role of psychosocial treatments in the comprehensive management of patients with schizophrenia. The review focused on the effects of combining psychosocial treatment with somatic treatment. Findings demonstrated the additive and supplementary effects of psychosocial treatments and the durability of these effects. Patients with more chronic illness appeared to be more responsive to psychosocial treatments, as were patients in studies conducted in non-Western countries. Among the Western countries, studies from Scandinavian countries reported the least effectiveness for psychosocial treatments. There was some evidence for differential effect of psychosocial treatments on different dimensions of illness as the measures of disorganized behavior and employment showed little difference in treated and control groups. There was also some evidence for differences between different modalities of treatment as group treatments produced smaller effects. Implications for practice and future research are discussed.

Loneliness and adjustment to old age.

Among two samples of older adults, loneliness (measured by the revised UCLA Loneliness Scale) was related to poor psychological adjustment, generally, and to dissatisfaction with family and social relationships. It was also related, however, to fears, expectations, and personality characteristics likely to inhibit the restoration of personal support networks after a stressful life event such as widowhood. Finally, loneliness was associated with maladaptive behavior patterns such as failure to: a) plan for old age, b) engage in rehearsal for widowhood, c) engage in social comparison, or d) learn about available community health and social services.

Impulsive nonconformity as a trait contributing to the prediction of psychotic-like and schizotypal symptoms.

A 51-item true-false Impulsive Nonconformity Scale was constructed to measure impulsive antisocial behavior of the sort often reported in the premorbid adjustment of some psychotics. Schizophrenics and schizoaffective patients (N = 46) scored higher on the scale than control (N = 76). An experimental group of 120 aberrantly high-scoring (2 SDs above the mean) college students and 176 control subjects were interviewed using modified versions of Weissman and Paykel's Social Adjustment Scale interview and Spitzer and Endicott's Schedule for Affective Disorders and Schizophrenia-Lifetime Version (SADS-L). The experimental subjects reported more antisocial and nonconforming behaviors than control subjects, supporting the construct validity of the scale as a measure of impulsive nonconformity, and reported more psychotic or psychotic-like experiences, more schizotypal experiences, and more depressive and manic or hypomanic symptoms, suggesting that a portion of the experimental subjects may be at elevated risk for psychosis and/or major affective disorder. Subjects who score aberrantly high on both the Impulsive Nonconformity Scale and our earlier Perceptual Aberration-Magical Ideation Scale are more aberrant on several other measures of schizophrenic-like cognitive slippage than are subjects who score high on only one of the two scales.

Relationship of scales of schizophrenia proneness and premorbid adjustment to thinking deficits in schizophrenia.

Scales of premorbid adjustment, which generally rely very heavily upon assessment of premorbid social functioning, long have been known to predict some forms of thinking disorder in schizophrenia. Several scales theorized to detect schizophrenia proneness were compared to the Phillips Scale of Premorbid Adjustment to determine whether the characteristics measured by the proneness scales might underlie the predictive power of premorbid social functioning. In a sample of 48 schizophrenics, only the Phillips Scale predicted performance on the Gorham's Proverb Test. These data give no evidence that anhedonia, ambivalence, or perceptual aberration underlie defective schizophrenic social functioning. Cautions and other uses for the schizophrenia proneness scales are discussed.

Legg-Calvé-Perthes disease.

The incidence, pathology, etiology, clinical characteristics, differential diagnosis, and treatment of Legg-Calvé-Perthes disease are reviewed. Physical therapy and follow-up care are discussed, with emphasis on the relationship between orthopedic and physical therapy services.