Social skills performance assessment among older patients with schizophrenia.

OBJECTIVE: Social functioning is an important outcome dimension in schizophrenia. Measures of social skills frequently rely on self-report, and most measures which directly assess social functioning are time consuming. Here we describe a brief performance-based measure, the Social Skills Performance Assessment (SSPA), modified from an instrument published by Bellack et al. (Bellack, A., Morrison, R., Wixted, J., Mueser, K., 1990. An analysis of social competence in schizophrenia. Br. J. Psychiatry 156, 809--818). METHOD: 83 middle-aged and elderly patients with schizophrenia or schizoaffective disorder, and 52 normal comparison subjects (NCs) were rated on two standardized role plays, one requiring introduction to a stranger and another requiring assertive behavior with their landlord. Ratings in eight areas ranging from 'social appropriateness' to 'grooming' were made. RESULTS: SSPA required about 12 min to complete both role play and ratings, and had excellent interrater reliability, and good test-retest reliability. Patients demonstrated significantly greater disability in all areas of social functioning compared with NCs. Social performance was related to severity of negative symptoms and cognitive deficits, but not that of positive or depressive symptoms. SSPA scores were significantly correlated with health-related quality of well-being and observed performance on activities of daily living, but not to a self-reported measure of social functioning. CONCLUSION: The SSPA is a reliable and useful instrument. Direct assessment of social skills may provide a more accurate picture of functioning than self-report measures among patients who frequently lack insight into their own behavior.

Self-perceived interpersonal competence in older schizophrenia patients: the role of patient characteristics and psychosocial factors.

OBJECTIVE: This study compared older schizophrenia patients with normal subjects in terms of their perceived interpersonal competence. METHOD: A total of 95 middle-aged and elderly schizophrenia patients and 85 age-matched normal subjects completed the Interpersonal Competence Questionnaire. RESULTS: Patients scored significantly lower than normal subjects on initiation, provision of emotional support, and conflict management. Severity of psychiatric symptoms and other patient characteristics were examined as predictors of interpersonal competence among patients. Negative symptoms were inversely related to interpersonal competence, whereas emotional support from others and a positive appraisal coping style both yielded positive associations. CONCLUSION: These findings suggest the need for clinical interventions designed to enhance the interpersonal skills of older schizophrenia patients, particularly those with marked negative symptoms.

Health-related quality of life in older patients with schizophrenia and other psychoses: relationships among psychosocial and psychiatric factors.

OBJECTIVE: Few multivariate studies relating psychosocial factors to symptoms of psychosis among older patients exist. We assessed environmental stressors, satisfaction with emotional support, coping responses and psychiatric symptoms, and sought to relate these factors to quality of well-being among older patients with schizophrenia and other psychoses. METHOD: Subjects were 70 psychosis patients with a mean age of 58. Predictors included measures of stressors (number of negative life events), satisfaction with emotional support, coping responses, positive and negative symptoms, depressive symptoms, social adjustment and a general quality of well-being (QWB) score. RESULTS: A conceptual model was tested and modified using path analytic techniques. Preliminary analyses suggested that psychosocial environment (life events, coping and emotional support) was primarily a product of psychiatric symptoms. Therefore, psychiatric symptoms preceded psychosocial environment variables in the proposed model. Further results suggested that depression mediated all of the effects of psychotic symptoms on social maladjustment, but not all of their effects on well-being. CONCLUSIONS: In older patients with schizophrenia and other psychoses, health-related quality of well-being is influenced by symptoms of psychoses, psychosocial factors and social maladjustment.

The social networks of older schizophrenia patients. Clinical Research Center on Late Life Psychosis Research Group.

There is a paucity of research that examines the role of family members and friends in the lives of older schizophrenia patients. This study compared 66 middle-aged and elderly outpatients with 31 normal comparison subjects. Five dimensions of social network were assessed: (a) family composition, geographic proximity, and frequency of contact; (b) instrumental support; (c) emotional support and interpersonal difficulties; (d) role of friends; and (e) use of formal service providers as sources of support and assistance. As compared with normal subjects, the schizophrenia patients were less likely to be married, less likely to have children, more likely to live alone, and had fewer friendships. The patients were, however, similar to comparison subjects on the following family-relationship variables: frequency of contact, instrumental support received, presence of a family confidant, and extent of interpersonal difficulties. These findings do not support the stereotype of older schizophrenia patients as being estranged from family members. The need for developing interventions that use key family members to interface with service providers and to monitor treatment compliance and continuity of care is discussed.

Self-reported social functioning among older patients with schizophrenia.

The purpose of this study was to evaluate the utility of a self-report measure of social functioning as an outcome measure for older schizophrenia patients. Sixty-five schizophrenia patients and 39 healthy controls, ranging in age from 45 to 81 years, were evaluated using a modified Social Adjustment Scale (SAS-M), Scales for Assessment of Positive and Negative Symptoms, Depression Subscale of the Brief Symptom Inventory, Mini-Mental State Examination, Dementia Rating Scale, measures of social support, and measures of background variables. Compared with controls, fewer patients with schizophrenia engaged in social roles, were married, were parents, or held jobs. Moreover, patients were more impaired in overall functioning, specifically in the domains of social/leisure, extended family, and marital roles than controls. Impairments in most roles were correlated with greater severity of symptoms, but not with degree of cognitive impairment, social environment, or background characteristics. The SAS-M is a useful addition to psychosocial batteries; however, the self-report format may not reflect others' perception of functioning.

Quality of well-being in late-life psychosis.

Research in mental health has generally used evaluation and outcome measures different from those applied in other medical specialties. We evaluated the utility of a general health measure, the Quality of Well-Being (QWB) scale, in older patients with psychosis. The QWB and standardized rating scales for assessing psychopathology, cognitive impairment, physical comorbidity, and neuroleptic-induced tardive dyskinesia were administered to 85 patients with functional psychoses (mostly schizophrenia or schizoaffective disorder) and 39 normal comparison subjects over age 45. The patients were more impaired than normal comparison subjects on the QWB and other rating scales. The QWB score was affected more by severity of positive symptoms than by any non-psychopathology-related variables. The patients' QWB scores were similar to those of previously studied ambulatory patients with AIDS. Use of the QWB scale may allow direct comparisons of the impact of different psychiatric and physical disorders on the quality of life.