Mary Sullivan

The relationship of social cognition to ward behavior in chronic schizophrenia.

The relationship between social cognition (i.e., cognition for social stimuli) and ward behavior among individuals with chronic schizophrenia was investigated. Twenty-seven inpatients completed a battery of cognitive and social-cognitive tasks and were rated by staff on various indices of ward behavior. Overall, there was a relationship between the measures of social cognition and behavior on the ward. Social cognition contributed unique variance beyond cognition to maladaptive behavior on the ward (i.e., irritability). Implications for assessment and future research are discussed.

Cognition and social functioning in schizophrenia

This article reviews three studies investigating the relationship between information processing and social functioning in schizophrenia. The most consistent finding is the association between vigilance performance on a hybrid continuous performance/span of apprehension task and various indices of social functioning (e.g., ward behavior). However, the nature of the information processing-social functioning relationships is mutable and appears dependent on a number of factors (e.g., cross-sectional versus longitudinal designs). This article concludes with a discussion of treatment implications and future research directions.

Changing cognitive functioning in rehabilitation of schizophrenia.

A three‐factor model is proposed for clinical assessment of cognitive and neuropsychological impairments in schizophrenia. The first factor is stable, pervasive and vulnerability‐linked. The second and third include executive, memory and conceptual abilities and are episode‐linked. The third factor may be amenable to psychosocial treatment.

State Psychiatric Institutions and the Left‐Behinds of Mental Health Reform

S ome promising developments for people with severe and disabling mental illnesses occurred in the first decade of the 21st century. The keynote was sounded by a special national project, the President’s New Freedom Commission on Mental Health. The Commission issued a scathing indictment of American mental health services, especially those for people with the most severe illnesses, and a corollary call for massive reform. The federal Substance Abuse and Mental Health Services Administration responded with an ambitious reform agenda featuring grants to transform state mental health service systems and projects to identify, package and disseminate proven treatment approaches. Operating one of the world’s largest systems of health care, the Veterans Administration followed suit. In the 1990s, the Institute of Medicine issued a major position paper, arguing that practitioners are not as influenced by current scientific research as they should be. By 2000, this concern had spread to the mental health scientific and professional communities. The idea of evidence-based practice (also variously termed evidence-based medicine, science-based practice, research-validated treatment, etc.) quickly became associated with broader aspects of mental health service reform. the community

Treatment of Cognition in the Schizophrenia Spectrum: The Context of Psychiatric Rehabilitation

Evidence-based approaches and modalities for targeting and treating the cognitive impairments of schizophrenia have proliferated over the past 15 years. The impairments targeted are distributed across the cognitive spectrum, from elemental perception, attention, and memory, to complex executive and social-cognitive functioning. Cognitive treatment is most beneficial when embedded in comprehensive programs of psychiatric rehabilitation. To personalize comprehensive treatment and rehabilitation of schizophrenia spectrum disorders, practitioners and participants must select from a rapidly expanding array of particular modalities and apply them in the broad context of the participants overall recovery. At present, no particular treatment, cognitive or otherwise, can be considered more important or primary than the context in which it is applied. Persistent difficulty in dissemination of new technology for severe and disabling mental illness compounds the significance of the context created by a full treatment array. In this article, a case-study of a mental health service system is described, showing the broad-ranging effects of degrading the rehabilitative context of treatments, obviating the benefits of cognitive treatment and other modalities. To realize the promise of cognitive treatment, the problems that prevent dissemination and maintenance of complete psychiatric rehabilitation programs have to be addressed.

Effects of eliminating psychiatric rehabilitation from the secure levels of a mental-health service system

Psychiatric rehabilitation (PR) is widely recognized as a treatment approach and an array of evidence-based practices effective for promoting the recovery of people with serious mental illness (SMI). However, its use in institutional settings is not widespread for unclear reasons. Policymakers may sometimes believe the superiority of PR in controlled research does not apply in the real world, for various reasons. This study exploits an unusual set of real-world circumstances surrounding the closure of a well-developed PR program in a state hospital. The program was closed after a period of mental-health services reform that significantly augmented the surrounding community-service system. The PR program was converted to conventional medical-institutional model-treatment units with no reduction in beds or funding within the state hospital. A database composed of public documents was used to analyze the consequences of the closing. Within the institution, the consequences included a persistent presence of long-term difficult-to-discharge patients, a slowed discharge rate, a net increase in the hospitals per capita treatment costs, and higher use of restraint/seclusion. Effects were also detectable in the surrounding mental-health service system, including degraded outcome of community-based step-down services and increased pressure on emergency/crisis services. The consequences of closing the program are consistent with expectations based on research, and demonstrate danger in assuming that real world exigencies obviate research findings.

The Idea of Recovery

The idea of recovery has revolutionized our understanding of mental illness and its treatment, yet its meanings are diverse and it is invoked in many different contexts. This chapter systematically analyzes the idea, as it is used in contemporary mental health research, practice, services and policy, the scientific and social issues that fall under its rubric, the evolution of related ideas that results in the current state of affairs, and where that evolution may take us in the foreseeable future. The materials for this analysis include the scientific literature and scholarly discourse on recovery, law, regulation and social policy, discourse in the mental health professions and service industry, and popular media. The conceptual challenge for understanding the meaning of recovery is not one of definition so much as selection, determining which paradigm of recovery is most pertinent to which context or application or person.

Psychosocial Rehabilitation and Psychotherapy Approaches

In this chapter, we reviewed six psychosocial rehabilitation interventions and two psychotherapies commonly used in the treatment of schizophrenia. For psychosocial rehabilitation approaches, we examined skills training, assertive community treatment, supported employment, cognitive remediation, social cognition training, and peer-implemented services. For psychotherapy approaches, we examined family-based therapy, cognitive behavioral therapy. For each approach, we provide background information on its development, a description of the primary methods used in delivering the intervention/therapy, results on efficacy, and a brief summary with future directions. We conclude this chapter by summarizing the current state of psychosocial rehabilitation and psychotherapy treatments covered, and discuss implementation and dissemination issues.