Social skills training, atypical neuroleptics and treatment-refractory psychosis

The advent of novel, powerful antipsychotic medications has had both beneficial and potentially deleterious effects for patients with previously refractory psychoses. Some authors have described medication non-compliance, substance abuse, depression and suicidality in response to rapid clearing of psychosis from these medications. However, others have reported beneficial effects from the combination of effective neuroleptics and various psychosocial rehabilitation interventions, including the Social & Independent Living Skills module series. The Massachusetts Mental Health Center began utilizing the behaviorally oriented modules on a unit for treatment-refractory psychotic individuals before the advent of clozapine. The use of clozapine appeared to facilitate the acquisition of the skills taught in the module series. Because of widespread acceptance by patients and staff, the use of the modules spread and was maintained at the Mental Health Center even after the unit on which they were originally utilized was closed.