This is a renewal of a research program that has focused on innovative approaches for combining psychosocial and pharmacological treatments for chronic schizophrenic patients living in the community. During the next phase of this program we plan to compare an atypical neuroleptic drug, risperidone, to haloperidol during a two-year double-blind trial. We hypothesize that risperidone will be more effective in treating negative schizophrenic symptoms and that it will also be associated with fewer side effects and better treatment compliance. The psychosocial strategy will build upon our previous findings by studying the effectiveness of a program which aims to amplify skills training through a community-based extension effort. All study patients will receive fifteen months of Psychoeducational Skills Training (PST), including modules for Medication Management, Symptom Management, and Social Problem Solving, and Successful Living Application, followed by nine months of follow-up, including study medication, case management, and assessment. Concurrent with participation in the skills modules, one-half of the patients will also receive in-vivo amplified skills training (IVAST) focused on generalizing the skills learned in the clinic to naturalistic settings. By specifically incorporating """"""""real-word"""""""" training in the experimental group we intend to offer a more comprehensive, powerful psychosocial program which should result in greater generalization of specific skills, and thus yield more positive overall outcomes. Furthermore, by combining this enhanced skills training with a neuroleptic possessing fewer side-effects and designed to mitigate schizophrenic apathy, isolation, and withdrawal, we intend to maximize the combined benefits of the somatic and psychological treatments.
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