Managment Of Schizophrenia

Question 1

What is operant conditioning?

Answer 1

Behaviour can be shaped by the use of positive and negative reinforcements.

Question 2

What is a token economy?

Answer 2

A form of therapy where desirable behaviours are encouraged by the use of selective reinforcements.

Question 3

Who benefits from token economies?

Answer 3

They are used on those who have developed patterns of maladaptive behaviour through spending long periods of time in psychiatric hospitals.

Question 4

What does token economy NOT do?

Answer 4

Token economies do not cure schizophrenia but improve the quality of life.

Question 5

Who conducted a study using token economy in a schizophrenia ward?

Answer 5

Ayllon and Azrin used a token economy in a schizophrenia ward.

Question 6

What was given for every tidying act in the token economy study?

Answer 6

A gift token was given for every tidying act, later swapped for privileges e.g. films.

Question 7

When were token economies extensively used?

Answer 7

Token economies were used extensively during the 1960s and 70s.

Question 8

Why did the use of token economies decline in the UK?

Answer 8

They declined due to a shift towards care in the community.

Question 9

Are token economies still used today?

Answer 9

Token economies remain a standard approach to managing schizophrenia in many parts of the world.

Question 10

What is institutionalisation?

Answer 10

Institutionalisation occurs in long-term hospital treatment.

Question 11

What categories of institutional behaviour did Matson et al identify?

Answer 11

Personal care, condition-related behaviours (e.g. apathy), and social behaviour.

Question 12

What is the effect of modifying institutional behaviours?

Answer 12

Modifying these behaviours does not cure but does have benefits, such as improved quality of life.

Question 13

What does modifying behaviours do to patients?

Answer 13

It ‘normalises’ behaviour.

Question 14

What are tokens in the context of token economy?

Answer 14

Tokens are coloured discs given immediately after a desirable behaviour to act as an immediate reward.

Question 15

How are target behaviours determined in a token economy?

Answer 15

Target behaviours are decided individually based on the knowledge of the person.

Question 16

Why are tokens given immediately?

Answer 16

Tokens are given immediately because delayed rewards are less effective.

Question 17

What negative symptom of schizophrenia can token economy address?

Answer 17

Token economy can address social withdrawal, which may lead to neglect of self-care.

Question 18

What is a primary reinforcer?

Answer 18

A primary reinforcer is anything that gives pleasure and is directly rewarding, such as food or TV time.

Question 19

What is a secondary reinforcer?

Answer 19

A secondary reinforcer has no intrinsic value but can be exchanged for a range of different primary reinforcers, having a more powerful effect.

Question 20

What evidence supports the effectiveness of token economies?

Answer 20

Glowacki et al identified seven high quality studies showing a reduction in negative symptoms and unwanted behaviours in patients with chronic mental health issues.

Question 21

What time frame did the studies examined by Glowacki et al cover?

Answer 21

The studies examined were published between 1999 and 2013.

Question 22

What was the setting of the studies that supported token economies?

Answer 22

The studies involved patients living in a hospital setting.

Question 23

What is the concern regarding the number of studies supporting token economies?

Answer 23

Seven studies is quite a small evidence base to support the effectiveness of a technique.

This raises questions about the reliability of the findings.

Question 24

What is the file drawer problem?

Answer 24

The file drawer problem leads to a bias towards positive published findings because undesirable results have been ‘filed away’.

This is particularly problematic in reviews with a small number of studies.

Question 25

What ethical issues are raised by the use of token economies?

Answer 25

Token economies give professionals considerable power to control the behavior of patients, imposing one person’s or institution’s norms on others.

This can be problematic if target behaviors are not identified sensitively.

Question 26

How might token economies restrict personal freedoms?

Answer 26

Restricting the availability of pleasures to those who don’t behave as desired can curtail personal freedoms, such as someone who likes to look scruffy or get up late.

This can lead to distress for seriously ill patients.

Question 27

What has been a major factor in the decline of token economies?

Answer 27

Legal action by families who see their relatives in distressing situations has contributed to the decline in the use of token economies.

This highlights the ethical concerns surrounding their implementation.

Question 28

What is a potential negative impact of token economies on patients?

Answer 28

The benefits of token economies may be outweighed by their impact on personal freedom and short-term reduction in quality of life.