Social Behaviour Schedule Research Articles

Comparison of hospital admission rates for psychiatric patients cared for by multidisciplinary outreach teams with and without peer specialist: a retrospective cohort study of Japanese Outreach Model Project 2011–2014

ObjectiveThis study examined whether having peer specialists (PS) in psychiatric multidisciplinary outreach teams was associated with a lower risk of hospitalisation, improved social functioning and decreased problem behaviours.Design and settingThis...

Social Behaviour Schedule (SBS)日本語版の妥当性の検討 : 精神科病院における長期在院者の社会行動を看護師が評価する場合

Social Behaviour Schedule (SBS)日本語版の妥当性の検討 : 精神科病院における長期在院者の社会行動を看護師が評価する場合

Limitations of social behavior among users of the psychosocial care network in the south of Brazil

This cross-sectional study aims to assess through analysis of data suggested by the Social Behavior Schedule (SBS) quantitatively and qualitatively distinguishing between the limitations of social interaction presented by users of substitute services. Analyses were performed of 385 instruments applied to users of Therapeutic Residential Services (SRT) and the Centers for Psychosocial Care (CAPS). Twenty-one items from the Social Behaviour Schedule (SBS, BR). The data indicate that the individuals studied had from zero to 15 social behavior problems, with an average of 2.5 problems per service user with a standard deviation of 2.84. The majority of the sample appeared to have 1-2 problems among those identified by the scale, and the nonspecific behaviors are present in greater proportion in both services, followed by panic attacks among CAPS users and problems with personal appearance and hygiene in SRT users. In this way, the use of tools that make it possible to assess the data on the social aspects of the psychological distress deserves to be encouraged as a way to further research in this area, and rethink ways of effecting social reintegration of these individuals.

Measuring community functioning in schizophrenia with the Social Behaviour Schedule

BackgroundCurrent emphasis on community integration requires reliable and valid measures of social behaviour; existing assessments largely overlap with symptoms or provide little detail on functioning. This study aims to re-assess the Social Behaviour Schedule (SBS) to fulfil this measurement role. MethodsInternal consistency, construct validity and test–retest reliability were investigated in 421 community out-patients with schizophrenia. Concurrent validity was assessed against the Life Skill Profile (LSP), in 143 additional patients. ResultsA 17-item SBS supported the construct validity of four factors: Antisocial Behaviour, Depressed Behaviour, Social Withdrawal and Thought Disturbance. It showed good test–retest reliability and rated significant social behaviour in a community sample. Weak correlations were observed with positive and negative symptoms. With the exception of Depressed Behaviour, the SBS factors showed strong correlations with the LSP. ConclusionSBS-17 is a valid measure assessing relevant community social functioning factors with relatively few items. The SBS could be useful both in research and in clinical settings.

Clusters according to patient need in a long-stay inpatient population with schizophrenia: does executive dysfunction underpin needs-directed care?

To identify the external validators of patient clusters according to need in a long-stay inpatient population with schizophrenia. We recruited without exclusion 112 in-patients with chronic schizophrenia in a long-stay rehabilitation facility of a major psychiatric hospital in Perth, Western Australia. Case managers completed a number of measures for participants, including The Camberwell Assessment of Need-Short Appraisal Schedule, which evaluates health and social needs. Latent class analysis according to patient need was performed to identify clusters within the cohort. One way analysis of variance was used to identify the external validators of these clusters, using variables obtained from the additional study measures (Social Behaviour Schedule, Global Assessment of Function, Basic Everyday Living Skills, Behaviour Rating Inventory of Executive Function-Adult version). Three distinct needs-based clusters with different external profiles were identified. A "low unmet needs" group (n = 50) with relatively intact executive function, with the least problematic behaviour and most independent functioning; a "high unmet need (drug abstinent)" group (n = 43) with greatest executive dysfunction, most problematic behaviour and least independent function; a "high unmet need (drug using)" group (n = 19), with less severe executive dysfunction, and intermediate relative to the other groups on measures of social behaviour and independent functioning. The clinical heterogeneity we have identified, which may well be explained by executive dysfunction, suggests further exploration of appropriate assessment and streams of care for those in the rehabilitation setting is warranted.

The Measurement of Social Disablement and Assessment of Psychometric Properties of the Social Behaviour Schedule (SBS-BR) in 881 Brazilian Long-Stay Psychiatric Patients

Data on the prevalence of social disablement in long-stay psychiatric patients, and the assessment of the psychometric properties of the instruments that evaluate social behaviour in this population are scarce in Brazil. Therefore, this cross-sectional study aimed to estimate the prevalence rates of social disablement in a population of long-stay psychiatric patients from the Rio de Janeiro metropolitan area, and assessed the psychometric properties of the Social Behaviour Schedule (SBS). Data were collected from a population of 881 psychiatric patients housed in the Municipal Mental Health Institute using the 21-item SBS. Most of the patients were women (59%), the mean age was 65.8 years (SD = 11) and the mean length of stay was 37.3 years (SD = 11.5). Of the population, 50.6% were scored as having poor self-care, 46% with little spontaneous communication, 41.1% with poor attention span, and 37.1% with underactivity. Comparing our data with international studies that used the same instrument, we found that our population was more disabled than the others, especially on the social withdrawal factor. Regarding psychometric properties, the inter-rater kappa was 0.709, the inter-informant kappa was 0.500, and the Cronbach's alpha coefficient was 0.766. The groups of patients in the six settings of the institute presented significant statistical differences in the total score (F = 11.447, p < 0.001). This study demonstrates the high rates of social disablement in this population. The precarious conditions of the institution where the patients have been living for decades and unmet individual care may have exacerbated their social disablement. Furthermore, the SBS-BR had satisfactory psychometric properties, particularly reliability, showing it to be an adequate instrument for measuring social disablement in Brazil.

What are the effects of group cognitive behaviour therapy for voices? A randomised control trial

Background Little evidence exists for the effects of psychological treatment on voices even though it is clear that CBT does affect delusions and symptoms overall. This study tested whether a group based on cognitive behavioural principles could produce beneficial effects on hallucinations. Aim To test the effectiveness of group CBT on social functioning and severity of hallucinations. Method Participants were included if they had a diagnosis of schizophrenia and experienced distressing auditory hallucinations (rated on the PANSS). They were randomly allocated to group CBT ( N = 45) or a control group who received treatment as usual ( N = 40). The two main outcomes were social functioning as measured by the Social Behaviour Schedule and the severity of hallucinations as measured by the total score on the Hallucinations Scale of PSYRATS. Assessments were carried out at baseline, 10 weeks (post therapy) and 36 weeks (six months following therapy). Results Mixed random effects models revealed significant improvement in social functioning (effect size 0.63 six months after the end of therapy). There was no general effect of group CBT on the severity of hallucinations. However, there was a large cluster effect of therapy group on the severity of hallucinations such that they were reduced in some but not all of the therapy groups. Improvement in hallucinations was associated with receiving therapy early in the trial and having very experienced therapists (extensive CBT training which included expert supervision for a series of individual cases for at least a year following initial training). Conclusion Group CBT does improve social functioning but unless therapy is provided by experienced CBT therapists hallucinations are not reduced.

Validação transcultural da Escala de Avaliação de Limitações no Comportamento Social - SBS-BR

This article describes the psychometric properties of the Brazilian version of the Social Behaviour Schedule - SBS, developed to provide global assessments of functional living skills of chronically mentally ill individuals. Nucleo de Pesquisa do Instituto Municipal de Assistencia a Saude Juliano Moreira (IMASJM), RJ, has conducted the questionnaires translation and adaptation and the data collection took place in the health care units of IMASJM. Nucleo de Ensino e Saude Coletiva (NESC) da UFRJ has conducted the analysis assessing the scale psychometric properties. The scale was submitted to a backtranslation, an evaluation by an expert committee and a pilot study in other to implement its adaptation to the Brazilian context. The results showed good psychometric properties of reliability and validity, in terms of the internal consistency of the scale, construct validity of the scale and its discriminant validity. Future studies should investigate inter-rater reability and inter-informant reliability. The SBS-BR is an important instrument to evaluate mental health programs for severe mentally ill patients.

Obsessive–compulsive disorder in hospitalized patients with chronic schizophrenia

Obsessive–compulsive (OC) symptoms have been observed in a substantial proportion of schizophrenic patients. In this study, we assessed the rate of occurrence of OC symptoms and the interrelationship between OC and schizophrenic symptoms in 68 hospitalized chronic schizophrenic patients. The patients were interviewed with the Structured Clinical Interview for Axis-I DSM-IV Disorders — Patient Edition (SCID-P) and the appropriate rating scales including the Scale for the Assessment of Positive Symptoms, the Scale for the Assessment of Negative Symptoms, the Yale–Brown Obsessive–Compulsive Scale (Y–BOCS), the Barnes Akathisia Scale, the Abnormal Involuntary Movement Scale, and the Social Behaviour Schedule (SBS). Sixteen patients (23.5%) met the DSM-IV criteria for OCD. A comparison of schizophrenic patients with and without OCD showed that the schizo–obsessive patients were significantly (1.7-fold) more impaired in basic social functioning, as reflected by the SBS score. No significant between-group differences for any of the other clinical variables were found. There was no significant correlation between OC and schizophrenic symptoms within the schizo–obsessive subgroup. The mean Y–BOCS score for the patients with both schizophrenia and OCD was within the typical range (22.8±1.7) observed in OCD without psychosis. The findings provide further evidence for the importance of the OC dimension in schizophrenia and may have important implications for the application of effective treatment approaches in this difficult-to-treat subgroup of schizophrenic patients.

Four behavioural syndromes of schizophrenia: a replication in a second inner-London epidemiological sample

In a previous large epidemiological survey of patients with strictly defined schizophrenia in the London borough of Camden, we extracted four behavioural syndromes (Social withdrawal, Thought disturbance, Anti-social behaviour and Depressed behaviour) by factor analysis of MRC Social Behaviour Schedule (SBS) data. These syndromes had significant differential relationships to symptoms assessed using the Manchester Scale (MS), symptom-derived syndromes, and social functioning variables. A second inner-London epidemiological survey of schizophrenia in South Westminster using identical methodology found the same four behavioural syndromes with identical core component items. The same four behavioural syndromes were extracted, whether applying strict Feighner diagnostic criteria ( n=112) or broader DSM-III-R criteria ( n=198). The four syndromes extracted from the Feighner positive sample showed relationships to symptoms and social functioning variables similar to those found in the original Camden study. However, the symptom-derived factors were not the same and did not conform to the three recognised symptom-based syndromes of schizophrenia. This successful replication suggests that assessment of the four behavioural syndromes of schizophrenia offers a different perspective on disability and a potentially relevant measure in clinical practice, clinical trials and studies of the neuropsychology and pathophysiology of schizophrenia.

A comparison of HoNOS with the Social Behaviour Schedule in three settings

The need for short methods of assessment are often in conflict with the desire for comprehensiveness. This study compared two assessment instruments, the recently developed Health of the Nation Outcome Scale (HoNOS) and the Social Behaviour Schedule (SBS) to investigate their ability to discriminate levels of disability. Three long-stay patient groups in different settings were assessed. Data were compared across groups selected on the basis of likelihood for discharge. The SBS, but not HoNOS, was found to discriminate between the patient group with the least likelihood for discharge from the two patient groups with less severe difficulties. HoNOS, but not the SBS, discriminated between the two less severe groups. Although HoNOS has many advantages with regard to brevity it may lack sufficient discriminatory power for certain patient groups.

Four behavioural syndromes of schizophrenia.

A complementary approach to defining symptomatic subtypes of schizophrenia is to identify characteristic patterns of 'problem behaviours' associated with the capacity of patients to function in the community. In a large epidemiological survey, patients fulfilling Feighner criteria for schizophrenia were identified by key informants and assessed using the MRC Social Behaviour Schedule (SBS) and the Manchester Scale. An exploratory factor analysis was used to extract behavioural syndromes from the SBS data in order to compare the syndrome profiles in community, acute and long-stay subgroups and to examine their associations with symptoms and social functioning. Four behavioural syndromes were identified: 'Thought disturbance', 'Social withdrawal', 'Depressed behaviour' and 'Anti-social behaviour', which distinguished between the patient subgroups and had significant differential relationships to symptoms and social functioning variables. The evaluation of disability in schizophrenia and effectiveness of treatment interventions is incomplete without an assessment of problem behaviours.

The Camden Schizophrenia Surveys

The development of appropriate community care requires knowledge of the characteristics of the severely mentally ill. All patients with a broad diagnosis of schizophrenia (n = 528) were identified via key informants within an inner London health district; Feighner and DSM-III-R criteria for schizophrenia were applied. Clinical and social status, psychopathology (Manchester Scale) and problem behaviours (Social Behaviour Schedule) were assessed in a 4:5 representative sample. Fifty-seven per cent had experienced at least one compulsory admission. Forty-five per cent (excluding long-stay in-patients) had marked positive psychotic symptoms; social isolation and lack of daytime activity was more common than among comparable populations elsewhere. One hundred and eleven (25%) of the non-hospitalised patients were not in contact with specialist services. Difficulties in establishing and maintaining a therapeutic alliance between patients and professionals present a challenge to services in inner London. Many social and occupational needs were not being met by existing community provision.

Four behavioural syndromes of schizophrenia

BACKGROUND A complementary approach to defining symptomatic subtypes of schizophrenia is to identify characteristic patterns of 'problem behaviours' associated with the capacity of patients to function in the community. METHOD In a large epidemiological survey, patients fulfilling Feighner criteria for schizophrenia were identified by key informants and assessed using the MRC Social Behaviour Schedule (SBS) and the Manchester Scale. An exploratory factor analysis was used to extract behavioural syndromes from the SBS data in order to compare the syndrome profiles in community, acute and long-stay subgroups and to examine their associations with symptoms and social functioning. RESULTS Four behavioural syndromes were identified: 'Thought disturbance', 'Social withdrawal', 'Depressed behaviour' and 'Anti-social behaviour', which distinguished between the patient subgroups and had significant differential relationships to symptoms and social functioning variables. CONCLUSIONS The evaluation of disability in schizophrenia and effectiveness of treatment interventions is incomplete without an assessment of problem behaviours.

The social disablement of men in hostels for homeless people. I. Reliability and prevalence.

Studies of mental health problems of homeless people have used diagnosis as the sole measure of these problems. In this study, the feasibility and reliability of measuring social disablement in the psychiatric assessment of homeless people was investigated. A random sample of 101 homeless men living in four long-stay hostels were assessed for their social disablement by the Social Behaviour Schedule (SBS). The prevalence of SBS problems in these men and the interobserver reliability were assessed. The results show that the SBS is a reliable screening instrument which is relatively easy to use. The most frequent SBS problems were 'Other problems', 'Hostility' and 'Depression". Less than 10% of the hostel sample had disablement items similar to those of patients in long-stay wards. The SBS is a useful and reliable tool in the psychiatric assessment of men in hostels for the homeless.

Social Skills Training and Counselling in a Clinical Setting: Evaluation of a Schizophrenic Patient in a Psychiatric Hospital

Ongoing clinical counselling was provided for a schizophrenic patient during a 12-week programme of social skills training. Changes in the patient’s behaviour were evaluated on an Adult Training Instrument, his own reports of his symptoms of anxiety, scores on the Social Behaviour Schedule, and frequency of nocturnal enuresis. Supportive clinical counselling was provided in the ward and outside of the ward. While his functioning continued to deteriorate generally, hospital staff reported that the trend of deteriorating behaviour appeared to have slowed down during the phase when he was exposed to activities outside the ward.

The burden of care of schizophrenia in Malay families

Deinstitutionalization has shifted much of the burden of care of chronic schizophrenia from mental institutions to the family. The aim of this study is to asses the prevalence of mental disorders among 210 primary carers of Malay schizophrenic patients, explored the burden and hardship experienced by them. This is a two-stage psychiatric screening procedure. All the cases suspected from initial screening with WHO Self-Reporting Questionnaires (SRQ-20) were called for clinical interview. Patients' behavioural problems and the burden of relatives were assessed by the Social Behaviour Schedule and the Interview Schedule respectively. It was found that about 23% of the carers developed neurotic disorders resulting from the stress; nearly half of them had neurotic depression. Despite their burden, they do not complaint about it. Neurotic carers compared with non-neurotic carers had significantly more subjective burden and distress related to the product of active psychosis. The carers were generally able to tolerate the negative symptoms of schizophrenia. The number of problem behaviours and previous admissions were significantly correlated with the severity of burden.

The effects of relocation on long-stay psychiatric patients

AbstractObjective: To assess the effects of relocation on the social behaviour and mental state of a group of 43 long stay psychiatric patients transferred from an old institution to a modern hospital. Method: Each patient was assessed using the MRC Social Behaviour Schedule and the Manchester Scale. Assessments were carried out prior to relocation and at six weeks and six months after transfer. Results: Some deterioration was apparent in the patients' social behaviour at six weeks following relocation but this trend was reversed to definite improvement at six months. There was an overall marked reduction in hostility and violence following relocation. Patients who showed most improvement in terms of social behaviour were the lower functioning group where greater emphasis was placed on promoting basic self care and social skills rather than on occupational therapy. Changes in mental state, following relocation, were minimal but a slight deterioration occurred especially in the area of negative symptoms. Conclusions: Relocations caused no serious adverse effects in the majority of these patients. The improvement observed in certain aspects of behaviour are attributable to the improved physical and psychological milieu of the receiving hospital.

Case Study of a Schizophrenic Patient during Social Skills Training in a Forensic Psychiatry Ward

A schizophrenic patient's behaviour was monitored over 12 weeks using the Assessment Schedule and Adult Training Instrument, the patient's self-reports of his symptoms of anxiety, scores on the Social Behaviour Schedule, and the frequency of nocturnal enuresis. Contrary to expectations, the patient's functioning deteriorated generally, with the exception that the trend of deteriorating behaviour, as assessed by hospital staff, appeared to have slowed down during a period involving activities out of the ward.

Assessment schedules for chronic psychiatric patients.

The Social Behaviour Schedule (SBS) was examined as a measure of disability in a series of 66 chronic psychiatric patients, who were also assessed using the Social Role Performance Schedule (SRP) and the ninth edition of the Present State Examination (PSE). All three schedules have been used in previous studies in their present form. SBS and SRP measures were correlated with each other and neither showed any relationship with subjectively described current PSE symptoms. SBS deficit was associated with a clinical diagnosis of schizophrenia and with problems in supervised occupational activity. Long-term hospital residents showed greater SBS deficit than chronic patients in active rehabilitation programmes, although impaired SRP was the major correlate with the type of supervision provided. SRP measures can be compared with population norms, unlike measures derived from the SBS, which cover more severe ranges of disability.