Management of Schizophrenia

Question 1

Management of Schizophrenia

Token Economies

Answer 1

• Token economies are reward systems used in pschiatric hospitals to manage behaviour of people with schizophrenia.
• It was trialed in a ward of women and the participants carried out tasks such as making their bed and were given a plastic token which could be swapped for priveleges.
• The number of tasks patients carried out increased significantly.
• Their use has since declined with the rise of community based care and closure of psychiatric hospitals.

Question 2

Management of Schizophrenia

Rationale for Token Economies

Answer 2

• Institutionalisation develops under circumstances of prolonged hospitalisation.
• People often develop bad habits as a response to living without the pleasures of everyday life.
• The behaviours the token economies enforced was personal care, reducing condition-related behaviours and social behaviour.
• Modifying behaviour does not cure schizophrenia but can improve their quality of life.

Question 3

Management of Schizophrenia

Theoretical Understanding of Token Economies

Answer 3

• Token economies are an example of behaviour modification based on operatant condition.
• Tokens are secondary reinforcers because they only have value onces the person recieving them has learned they can be used to obtain meaning rewards (primary reinforcers).
• Secondary reinforcers that can be exchanged for a range of goods are generalised reinforcers

Question 4

Management of Schizophrenia: Evaluation

Evidence for Effectiveness

Strength

Answer 4

• Token economies are effective in mangaging schizophrenia.
• Glowacki (2016) identified 7 high quality studies that exams token economies for people with chronic mental health conditions.
• It involved patients living in a mental hospital.
• All studies showed a reduction in negative symptoms.

This supports the value of token economies.

Question 5

Management of Schizophrenia: Evaluation

Insufficient Evidence Base

Counterpoint

Answer 5

• 7 studies is not sufficient evidence base to support the effectiveness of a technique.
• This leads to the file drawer problem where research is biased towards positive findings because undesirable results have been “filed away”.

This means there is serious question over the evidence for the effectiveness of token behaviour.

Question 6

Management of Schizophrenia: Evaluation

Alternative Approaches

Limitations

Answer 6

• Even if token economies are helpful in managing schizophrenia, other methods are more reliably accurate and don’t raise any ethic concerns.
• Art therapy could be a good alternative as it is potentially high-gain and is low-risk and a pleasant activity for patients to engage in.

This means that art therapy might be a good alternative to token economies.