A03: Management of SZ

• Evaluate Management (Token Economy) A03 


  + Effectiveness (Glowacki et al 2016)

  -Ethical Issues

  -Small sample size (McMonagle & Sultana 2009)

  - Existence of more pleasant & ethical alternatives (Chiang et al 2019)
• RS of effectiveness - M of Sz A03

  Glowacki et al (2016) identified 7 high quality studies published between 1999-2013 on the effectiveness of token economies in a hospital setting.

  • All of the studies showed a reduction in negative symtoms and a decline in frequency of unwanted behaviours.
  • This supports & adds validity to the value of token economies
• Ethical Issues - M of Sz A03

  Prof have power to control people's behaviour & this mean imposing one person norms on to others (e.g patient may like to look scruffy)

  • Rewards more available to those with milder symptoms as they are more able to engage in + behaviours. Lead to discrimination of those who severely affected.
  • Restricting availability of pleasures to people who dont behave as desired means very ill people, already experiencing distressing symptoms, have even worse time
  • So the benefits of TE that may be outweighed by impact on freedom & short time reduction in quality of life
• Small sample size - M of Sz A03

  7 studies in Glowacki et al (2016) and 3 in M&S is a small evidence base.

  One issue with such a small number of studies is the file drawer problem - a bias towards publishing positive findings.

  • This means that there is a serious question over the effectiveness of token economies

  E: McMonagle & Sultana (2009) reviewed evidence for token economy & found 3 studies which used random allocation to assign patients to condition. Of these, 1 found improvement in symptoms & none found evidence of behaviour change
• Existence of more pleasant & ethical alternatives - M of Sz A03

  Other approaches do not raise ethical issues e.g art therapy is a high-gain low-risk approach to managing sz (Chiang et al 2019).

  • Even if the benefits of art therapy are modest this is true for all approaches to treatment and management of sz and art therapy is a pleasant experience.

  This means that art therapy might be a good alternative to token economies - no side effects or ethical abuses