SCHIZOPHRENIA - Management of schizophrenia

Question 1

what is a token economy system?

Answer 1

A system to encourage positive behaviour and change patterns of maladaptive behaviour which has developed over a long time in an institution.

Question 2

how widespread are token economies worldwide and the UK?

Answer 2

• used less frequently in the UK due to an increase in community-based care and the closing of psychiatric hospitals = ethical issues in restricting rewards to people with mental disorders.

Question 3

what is institutionalisation? what does Matson (2016) say?

Answer 3

• prolonged hospitalisation
• people develop bad habits = unhygienic, stop socialising w/others

Matson (2016) = these effects are due to a loss of routine.

Question 4

what did Matson et al (2016) identify?

Answer 4

3 categories of institutional behaviour that can be tackled by TES:
- personal care
- Condition-related behaviours
- social behaviour

Question 5

What are the 2 benefits from token economy systems?

Answer 5

• tokens are swapped for tangible awards
  1. improves the quality of life within a hospital setting
  2. ‘Normalises’ behaviour and makes it easier for people to adapt back into the community.

Question 6

How do token economies work?

Answer 6

TES based on operant conditioning = tokens are secondary reinforcers as the person receiving them has learnt they are used to obtain rewards.
rewards = primary reinforcers

Question 7

what did cooper et al (2007) say?

Answer 7

doctor+patients decide on the positive behaviour they want to encourage.
If the patient demonstrates these behaviours = a reward is given

Question 8

give strengths of the token economy system to manage schizophrenia?

Answer 8

+ Glowacki et al (2016) = patients living in a hospital setting with schizophrenia had a reduction in negative symptoms and decline in the frequency of unwanted symptoms = TES = value

+ some people with schizophrenia may get a chance to live outside the hospital = the best way to achieve this is using a TES.

Question 9

give limitations of the token economy system to manage schizophrenia?

Answer 9

• The counterpoint to Glowacki = 7 studies is small evidence. file drawer problem = bias towards positive published findings.
• ethical issues= gives power to professionals to control behaviour of people which involves imposing one person norms onto others = problematic if target behaviour not identified sensitively.
• restricting the availability of pleasure to people who don’t behave in a desired way, they are already distressed so they have it worse.
• Chiang et al (2019) = auto therapy might be a good alternative = it is a high gain, low risk approach.
  Art therapy is a pleasant experience without ethical risks, unlike token economy= better alternative.