Clinical observation and retrospective and prospective studies of relapsing psychosis have demonstrated that early symptoms of decompensation are observable in one half to two thirds of patients over a period of 1 to 4 weeks. Whilst the sensitivity of prodromal symptoms is established, their specificity is less certain, particularly at the first episode. The appearance of an “at risk” mental state, if not leading to decompensation, may nevertheless be part of a “transitional” stage to psychosis that is affected by psychological factors concerning the attributions that are made about a change in mental life. The research on prodromal signs is reviewed, with three areas of focus: prodromes as continuous versus discrete phenomena, sensitivity and specificity, and early intervention studies. A psychological model of the transitional process is described with case examples, together with an exploration of its implications for early intervention, again illustrated by case material.

Substance abuse in schizophrenia is a significant management problem for both clients and treatment agencies, impacting on psychotic symptoms, medication adherence, and participation in training and employment. However, there is little published work on the treatment of drug abuse in this population. This paper describes a cognitive-behavioural intervention for alcohol and cannabis abuse which integrates substance abuse treatment with other aspects of psychosis management.

Social skills training (SST) has emerged as one of the most widely practiced methods of psychiatric rehabilitation. The purposes of this article are to review the research about its effects, propose guidelines for its practice, and discuss several related methodological and clinical issues such as promoting generalisation, predicting the degree of benefit, and integrating training with other rehabilitation services. The research suggests that SST, when conducted using appropriate curricula and teaching techniques, helps individuals with schizophrenia acquire relevant interpersonal and instrumental skills. Generalisation of these skills can be promoted by simultaneously linking training to the opportunities, prompts, and consequences needed to perform the skills in the extra-training environments. Long-term SST appears to be necessary in order to produce significant improvements in community functioning. The article concludes with suggestions for future clinical research.

Research reported in the last two issues of Behaviour Change, and elsewhere, shows that cognitive behaviour therapy significantly improves a number of the problems suffered by people with schizophrenia. However, behaviour therapy alone does not constitute adequate care of schizophrenia, and inadequate mental health services undermine the effective implementation of behaviour therapy, in Australia, mental health services for people with severe psychiatric disorders such as schizophrenia are grossly inadequate, but are planned to change substantially in the late 1990s. Changes include a significant shift in resources toward community-based care, expansion of the range of treatment and rehabilitation services available, and increased integration of service provision across government and nongovernment sectors. These planned changes present a challenge to those interested in behaviour therapy to go beyond narrowly focused interventions to develop effective systems of rehabilitation.

This selective review shows that childhood obsessive-compulsive disorder (OCD) is a serious condition that requires early identification and treatment. Initially, we examine the relationship of childhood rituals to OCD, and discuss recent findings on the epidemiology of childhood OCD. The DSM-IV criteria for OCD are presented, along with recent findings on psychopathology. Clinical management of childhood OCD is a challenging and difficult task for mental health professionals. We briefly describe and evaluate advances in behavioural treatment — mainly in vivo exposure and response prevention. The adjunctive use of antidepressant medication is also examined. Whilst these clinical innovations are promising, further controlled evaluations are necessary before the efficacy of behavioural intervention can be confidently asserted.