Managment Of Schizophrenia

Question 1

Token economy explanation

Answer 1

• a form of therapy where desirable behaviours are encouraged by the use of selective reinforcements
• behaviour can be shaped by the use negative reinforcers (operant conditioning).
• used on institutionalised patients who’ve developed maladaptive behaviour.
  NOT a treatment for schizophrenia but will improve quality of life.

Question 2

Development of token economies for SZ (1968)

Answer 2

Ayllon and Azrin (1968) used a token economy in a Sz ward
- A gift token was given for every tidying act – later swapped for privileges e.g. films
- Token economies were used extensively during the 1960s and 70s but then declined in the UK due to a shift towards care in the community
- Token economies remain a standard approach to managing Sz in many parts of the world.

Question 3

Rationale for token economies

Answer 3

Three categories of behaviour:
- personal care
- condition- related behaviour e.g apathy
- social behaviour.

Token economies can improve quality of life, ‘normalises’ behaviour.

Question 4

How they work

Answer 4

1. Tokens (coloured discs) are given immediately after a desirable behaviour (delayed rewards are less effective).
2. Tokens can be traded for desirable items/privileges.
3. Tokens paired with rewarding stimuli - become secondary reinforcers.
4. Patient becomes more likely to engage in positive target behaviours and cycle repeats.

Token economy used to encourage positive behaviours using operant conditioning e.g making the bed.

Question 5

Definition of a token economy

Answer 5

Token economies a form of therapy where desired behaviours are encouraged by the use of select reinforcements (tokens).

Question 6

Negative AO3

Answer 6

• One weakness of token economies in schizophrenia management is that they are very hard to implement outside of an institution; however, patients who use them may have been unable to function in society without them and would have remained institutionalised so they hold benefit in patient rehabilitation, however they are a management for schizophrenia, not a cure.

• Patients may only be presenting desirable behaviour to get a reward and not understand WHY they are doing the behaviour.

• Another weakness of token economies is that art therapy may be a more effective alternative therapy, there have been several studies that
show art therapy has a low cost high gain outcome, however there are some methodological issues that have been found within these studies.
• ethical issues: Give professionals considerable power to control the behaviour of patients. This inevitably imposes a person’s or institution’s norms on others, which is problematic if target behaviours are not identified sensitively, as well as restriction of pleasures. This means token economies may be outweighed by their impact on personal freedom and short-term reduction in quality of life.

Question 7

AO3 POSITIVE

Answer 7

• One strength of token economies for the treatment of schizophrenia is that there has been 7 high quality studies published that emphasise the effectiveness of token economies for people with mental health issues like schizophrenia, in an institutionalised setting. All of these studies show a decline in negative behaviour and an increase in desirable behaviours, supporting the effectiveness of token economies.

HOWEVER, 7 studies is quite a small evidence base to support the effectiveness of a technique, this could lead to a bias towards positive published findings and negative results could’ve been filed away.