CLINICAL HANDBOOK OF SCHIZOPHRENIA

152 II. ASSESSMENT AND DIAGNOSISof remediation are currently being studied. Some CR interventions provide individualtreatment, whereas others are conducted in small group settings. There is emergingevidence that CR may improve cognitive functioning, and that these improvements maygeneralize to broader outcomes, such as improvements in social functioning and workrelatedperformance.Social Functioning/Family InteractionMany patients complain about difficulty in making friends, initiating conversations, followingcomplex social interactions, and solving interpersonal problems with friends orfamily members. Social skills can be improved by formal social skills training. Trainingfocuses on helping the patient to maintain appropriate nonverbal behavior (e.g., eye contact,voice volume), to learn standard techniques to initiate and maintain conversations,and strategies to solve interpersonal problems. Although social skills may improve withsocial skills training, additional work may need to address the client’s often limited opportunityto use newly developed skills in the home environment.Family InterventionsFamilies may not know where to turn or what to do when a relative is diagnosed withschizophrenia. Family psychoeducation helps family members to learn about the diagnosis,symptoms, warning signs of relapse, and the purpose and side effects of medication.Key information for family members includes understanding the need for continued medicationeven when their relative’s symptoms have been minimized. Psychoeducation canbe helpful in decreasing the risk for relapse or rehospitalization. Other family programs,such as behavioral family management, train family members to communicate better, tosolve problems with their ill relative, and to decrease stresses that may lead to relapse.Finally, many family members become expert at how to help their relative to manageschizophrenia. Their expertise is often shared in self-help groups, such as those run by theNational Alliance on Mental Illness (NAMI). Relatives often have sound advice regardingsymptom control, medication, and providers. Many NAMI organizations provide psychoeducationand host workshops conducted by experts on various topics related to mentalhealth. These resources can help the family to help the patient.Activities of Daily LivingIndividuals with schizophrenia are impaired relative to age-matched control subjects on avariety of independent living skills. Problems with grooming and hygiene, care of livingquarters, and shopping and budgeting are important targets for intervention. When theseimportant aspects of everyday functioning are not attended to, problems can magnify.For example, poor money management may lead to problems paying for needed medication.Improving specific ADLs may be required before work or social function can beimproved. For example, it is very difficult for someone with poor grooming and hygieneto get a job or a girlfriend. Independent living skills can be taught in groups or in oneon-onesessions. Teaching these skills in the consumer’s home environment is preferableto teaching that occurs in a clinic setting, because generalization of skills from clinic tohome environments may not occur without direct training in the home. An in-home interventionsuch as CAT uses environmental supports (signs, alarms, pill containers, hygienesupplies, and organization of belongings) in the patient’s home to improve everyday functioning.These supports cue and sequence appropriate behaviors (e.g., bathing) and discourageinappropriate behavior (e.g., taking extra medication).