Management of schizophrenia Flashcards
How are token economies used for schizophrenics
As reward system to manage behaviour, particularly maladaptive behaviour from long stay in psych ward
Who carried out the classic demonstration of a token economy
Allyon and Azrin (1968)
Outline Allyon and Azrin’s trial
Ward of schizophrenic women given tokens when did tasks (e.g made bed) could swap for privileges (e.g watching film)
-Number of tasks carried out increased significantly
Why has the use of token economies declined in the UK
-Growth of community-based care= less psychiatric hospitals
-Ethical issues with restricting rewards to mental patients
What are Matson et al’s three categories of institutional behaviours
-Personal care
-Condition-related behaviours (e.g apathy)
-Social behaviour
What are the benefits of modifying institutional behaviours
-Improved quality of life in hospital (e.g makeup for someone who took pride in appearance)
-Normalises behaviour and makes easier to adapt to life outside (e.g patient gets dressed in the morning)
How do token economies work
Given tokens for desirable target behaviours can swap for privileges
How are target behaviours decided
On an individual basis so most appropriate
Strength of token economies
Evidence for effectiveness
-e.g Glowacki et al found 7 high-quality studies and all showed - negative symptoms/unwanted behaviours
So supports their value
Counterpoint to token economy’s evidence of effectiveness
7 studies very small evidence base
-Studies with contrary results may have not been published (file-drawer problem)
-So serious question over evidence
Weakness of token economies
Ethical issues if target behaviours not identified sensitively/restricting pleasures (e.g sweets) can be distressing to seriously ill ppl
-Has led to legal action by families
So benefits maybe outweighed by impact on personal freedom/short-term reduction in quality of life)
Example of ethical issues by not sensitively identifying target behaviours
Someone who likes to wake up late/look scruffy has these personal freedoms taken away
2 Weakness of token economy system
More pleasant/ethical alternatives e.g art-therapy
-AT= high-gain low risk approach that is pleasant without side-effects/ethical problems
-NICE recommends for schizophrenia
What are token economies an example of
Behavioural modification-
