management of schizophrenia Flashcards
what is developing token economies with schizophrenia
ayllon and azrin- trialled token economy system in ward of women with schizophrenia, everytime pps carried out task such as making bed or cleaning up they were given plastic token embossed with words one gift, tokens could be swapped for ward privileges, number of tasks increased signf
use has now declined in uk because growth of community based care and closure of psychiatric hospitals and complex ethical issues raised by restricting rewards to epople with mental disorders
remain standard approach to managing schizophrenia in parts of world
what is rationale for token economies
institutionalisation develops under circumstances prolonged hospitalisation
people develop bad habits
matson-identify three categories institutional behaviour commonly tackled by means of token economies- personal care, condition related behaviours and social behaviour
modifying behaviours does not cure schizophrenia but 2 benefits- improves persons quality of life within hospital setting and normalises behvaiour makes it easier for people who have spent time in hospital to adapt back into life in community
what is involved in token economy
tokens given to individuals when carried out desirable behaviour
target behaviours decided on individual basis and important to know person in order to identify most appropriate target behaviours for them
tokens have no value themselves, swapped later for more tangible rewards
immediate reward for target behaviour important because delayed rewards less effective
administered as soon as possible after target behaviour
what is theoretical understanding of token economies
behaviour modification- operant conditioning
secondary reinforcers- only have value once person has learned they can be used to obtain meaningful rewards- primary reinforcers
tokens can be exchanged for range of different primary reinforcers are powerful secondary reinforers- generalised reinforcers
secondary reinforcers have to be paired with primary reinforcers
tokens and primary reinforcers are administered together
what is evidence for effectiveness (evaluation)
evidence for effectiveness
glowacki- identified 7 high quality studies published between 1999 and 2013 examined effectiveness of token economies for people with chronic mental health issues and involved patients living in hospital setting, ll studies showed reduction in negative symptoms and decline in frequency of unwanted behaviours
supports value of token economies
7studies small evidence base to support effectiveness of technique
file drawer problem- leads to bias towards positive published findings because undesirable results filed away
serious question over evidence for effectiveness of token economies
what is ethical issues (evaluation)
ethical issues raised
gives professionals considerable power to control behaviour of people in role of patient
involves imposing one persons norms on to others
problematic if target behaviours not identified sensitively
restricting availability of pleasures to people who dont behave as desired means seriously ill people already experiencing distressing symptoms have a worse time
legal action by families who see relative in position have been major factor in decline of us of token economy
benefits of token economies may be outweighed by their impact on personal freedom and short reduction in quality of life
what is alternative approahes (evaluation)
existance of more pleasant and ethical alternatives
other approaches with more comparable evidence base that do not raise same ethical issues
chiang- concluded art therapy might be good alternative
evidence base small and has methodological limitations but appears to show that art therapy is high gain low risk approach
generally true for all approaches to treatment and management
art therapy pleasant experience without major risks of side effects or ethical abuses
NICE guidelines recommend art therapy
art therapy might be good alternative to token economies
