Management of Schizophrenia Flashcards
Outline the development of token economies with Schizophrenia
-Azrin (1968) trialled TE system in ward of women with schiz
-Every time parties carried out task like making bed they were given plastic token
-Tokens swapped for ward privileges, e.g. watching film
-Numbers of tasks carried out increased significantly
-TE extensively used in 1960s & 70s when norm for treating schiz was long-term hospitalisation
-Use declined in UK due to community-based care, closed psychiatric hospitals & ethical issues
Outline research for token economies for the management of Schizophrenia
-Institutionalisation develops under circumstances of prolonged hospitalisation
-Bad habits often developed, e.g. bad hygiene
-Matson et al. (2016) identified 3 categories of institutional behaviour commonly tackled by TE:
1. Personal care 2. Condition-related 3. Social behaviour
-Modifying behaviour doesn’t cure schiz but two major benefits:
1. Improves quality of life within hospital, e.g. social interaction for socialable person
2. ‘Normalises’ behaviour, easier for people to adapt back to community, e.g. making bed
Outline what’s involved in token economies for management of Schizophrenia
-TE = example of behaviour modification (behavioural therapy based on operant conditioning)
-Tokens = secondary reinforcers - they only have value once person receiving has learned they can get them rewards
-Rewards = primary reinforcers
Evaluate token economies as used in the management of Schizophrenia
STRENGTH - Evidence of effectiveness
E.g. - Glowacki et al. (2016) identified 7 high quality studies published between 1999-2013 examining effectiveness of token economies for hospitalised patients with chronic mental health issues & all studies showed reduction in negative symptoms & decline in freq of unwanted behaviours
Ex. - Supports value of TE
HOWEVER, 7 studies is small evidence base to support effectiveness of technique
This leads to file drawer problem: bias for positive findings as negatives ‘filed away’, particularly in reviews with few studies, leading to serious questions over evidence of effectiveness
LIMITATION - Ethical issue
E.g. - Use of TE raises ethical issues as it gives professionals considerable power to control behaviour of patients
Imposing 1 institution’s norms onto others, problematic if target behaviours aren’t identified sensitively, e.g. someone likes to look scruffy may have freedom curtailed
Ex. -Restricting pleasures to people who don’t behave as desired means seriously ill people already having distressing symptoms, have even worse time
Benefits of TE may be outweighed by impact on personal freedom & short-term reduction in quality of life
LIMITATION - Alternative approach (existence of more pleasant alternatives)
E.g. - Even if TE can be helpful for schiz other approaches with comparable evidence base that dont have ethical issues
Art therapy has been found as good alternative:
Evidence base small & some methodological limitations, but is high-gain low-risk approach
Even if benefits of AT, true for most approaches, unlike alternatives it’s pleasant experience
Means AT may be good alternative to TE
