Despite neuroleptic medication, many schizophrenic patients continue to experience residual positive psychotic symptoms. These residual symptoms cause distress and disability. We report a controlled trial of two cognitive-behavioural treatments to alleviate residual hallucinations and delusions. Forty-nine patients were recruited into the trial, of whom 27 entered the trial and completed post-treatment assessment, and 23 were reassessed at six-month follow-up. Patients were randomly allocated to either coping strategy enhancement (CSE) or problem solving (PS). Half the patients were allocated to a high-expectancy positive demand condition and half to a counter-demand condition to evaluate expectation of improvement. Patients receiving either cognitive-behavioural treatment showed significant reductions in psychotic symptoms compared with those in the waiting period, who showed no improvement. There was some evidence, although equivocal, that patients receiving CSE improved more than those receiving PS. There was no evidence that improvements generalised to negative symptoms or social functioning, nor was there evidence that expectancy of treatment benefit contributed to the treatment effect.

Changes in coping skills and problem-solving skills were examined in two groups of schizophrenic patients. The groups received either coping skills enhancement or problem-solving treatments to reduce their drug-resistant residual psychotic symptoms. The coping skills group showed significant increases both in the number of positive coping strategies used and in their efficacy, whereas the problem-solving group showed a decrease in these measures during treatment. Both groups showed significant improvements in problem-solving skills. Changes in coping but not problem solving were significantly related to decreases in psychotic symptoms during treatment. It was concluded that treatment involving the teaching of coping skills had a specific treatment effect.

This study compared 58 sexual murderers and 112 rapists who were about to undergo treatment in prison for their sexual offending behavior. The two groups were compared on background, personality, offense, and victim characteristics. The sexual murderer group were less likely to have been involved in a relationship at the time of their index offense, generally attacked older victims, and had higher self-esteem. The rapist sample were found to have more violent previous convictions and scored higher on measures of historical deviance (nonsexual), paranoid suspicion, and resentment. No differences were found on the personality or clinical syndrome scales of the Millon Clinical Multiaxial Inventory-III. However, the rapist sample had significantly higher mean scores on the Paranoid Suspicion, Resentment, and Self-Esteem subscales of the Antisocial Personality Questionnaire. Future research should compare the two groups on dynamic or changeable factors to determine differential treatment needs.

A method of teaching coping skills to patients with schizophrenia who experience unremitting psychotic symptoms is described. This method (Coping Strategy Enhancement CSE) is based on a thorough behaviour analysis of each symptom and the assessment of any coping strategy the subject may already employ. The subject is then systematically trained in the use of appropriate coping strategies i n response to the occurrence of their psychotic symptoms. Two case studies are described in which CSE was used. Both patients showed considerable improvements over treatment. In one patient improvement continued at 6 month follow-up, in the other there was some deterioration at follow-up. Possible reasons for these results were discussed.

Jealousy is a common emotion which can be considered pathological in some circumstances. The term ‘morbid jealousy’ has been used to signify this abnormal or extreme condition. However, the literature on morbid jealousy is sparse and the empirical data fragmentary. The aims of this paper are to briefly review the concept, to define the dimensions of the disorder and to apply a cognitive-behavioural framework to it. Such a summary paper is timely, to draw together the different aspects of the problem and to provide a theoretical base from which to generate further research.