management of schizophrenia

• Who first used token economies in a schizophrenia ward? (2)

  • Allyon and Azrin (1968) used token economies in a schizophrenia ward.
  • Patients were given tokens for tidying up, which could later be exchanged for privileges like watching films.
• What led to the decline of token economies in the UK?

  Token economies declined in the UK due to a shift toward care in the community and ethical concerns about their use in hospitals.
• Where are token economies still widely used?

  Token economies are still a standard approach for managing schizophrenia in many parts of the world.
• What are the three categories of institutional behaviour that token economies can address? (4)

  According to Matson et al. (2016), token economies can address:

  • Personal care (e.g., grooming)
  • Condition-related behaviors (e.g., apathy)
  • Social behavior (e.g., interacting with others)
• What are the two major benefits of token economies in schizophrenia treatment? (2)

  • Quality of life: Token economies improve patients' quality of life by encouraging activities such as putting on makeup or becoming more sociable.
  • Normalizing behaviour: Token economies promote more 'normal' behaviours like getting dressed and making the bed, which aids reintegration into society.
• How do token economies improve the quality of life within the hospital setting?

  Token economies encourage behaviours such as personal grooming and social interaction, which improve the overall quality of life for patients within the hospital.
• what is the process involved in a token economy system?(2)

  • Tokens (e.g., coloured discs) are given immediately after a desired behaviour is exhibited.
  • These tokens can be exchanged for rewards like food, magazines, or privileges such as going for a walk.
• Why is it important that tokens are given immediately following a target behaviour?

  Immediate reinforcement is more effective than delayed rewards in reinforcing and maintaining desired behaviour.
• What kind of reinforcement is used in token economies?(2)

  • Token economies are based on operant conditioning.
  • Tokens are secondary reinforcers exchanged for primary reinforcers (e.g., food, activities).
• What are generalized reinforcers in token economies? (2)

  • Generalized reinforcers are tokens that can be exchanged for a variety of primary reinforcers.
  • This makes them more powerful because they are flexible in the rewards they can provide.
• What are the advantages of token economies for patients with schizophrenia?

  Token economies help improve patients' quality of life, support normalizing behaviour, and provide structure, which helps them reintegrate into society after hospital care.
• What behaviours can be targeted using token economies in long-term treatment? (4)

  Token economies can target:

  • Personal care (e.g. dressing, grooming)
  • Condition-related behaviour (e.g. apathy, lack of motivation)
  • Social behaviours (e.g. communication, interaction with others)
• How did token economies impact patients' social behaviours?

  Token economies encourage more social interaction among patients, helping them build social skills and reduce isolation.
• What is the key idea behind using token economies for people with schizophrenia?

  Token economies are a form of behaviour modification using operant conditioning principles to reinforce positive behaviours and help patients improve their daily functioning and social integration.
• How does token economy contribute to the normalization of behavior for schizophrenia patients?

  Token economies promote engaging in everyday activities like getting dressed or making the bed, which helps patients return to normal, functional behaviors that will ease their transition back into the community.
• What were the ethical concerns around using token economies in the UK?

  Ethical concerns included potential manipulation, lack of patient autonomy, and issues with rewarding behavior that could be seen as basic human rights, such as getting dressed.
• Why did Matson et al. (2016) consider token economies important in the management of institutional behaviours?

  Matson et al. (2016) identified token economies as effective for improving three categories of behavior: personal care, condition-related behaviors, and social behavior, all crucial for patients in long-term care.
• what is the strength of the management of schizophrenia? (3)

  • Glowacki et al. (2016) reviewed 7 high-quality studies (1999-2013).
  • All studies showed reduced negative symptoms and fewer unwanted behaviours.
  • Supports the value of token economies in hospital settings.
• counterpoint/limitation of the management of schizophrenia (3)

  • Glowacki et al. (2016) reviewed only 7 studies, which may be too few to draw strong conclusions.
  • The file drawer problem suggests that studies with negative results are less likely to be published, leading to a bias toward positive findings.
  • This raises concerns about the overall effectiveness of token economies, as there may be unreported studies with less favourable outcomes.
• what is a limitation of the management of schizophrenia (3)

  • Professionals control patients' behaviour, imposing their norms (e.g., forcing them to appear tidy when they may prefer to look scruffy).
  • Restricting pleasures (e.g. privileges or rewards) for non-compliance may worsen the distress of already ill individuals.
  • This suggests that token economies could negatively impact patients' freedom and may reduce quality of life in the short term, outweighing any potential benefits.
• what is another limitation of the management of schizophrenia (3)

  • Art therapy, for example, is a low-risk, high-gain approach with no ethical concerns (Chiang et al., 2019).
  • Even with modest benefits, art therapy offers a pleasant experience, unlike token economies, which may involve ethical issues and restrictions on patients' freedoms.
  • This suggests that art therapy could be a more ethical and enjoyable alternative for managing schizophrenia.
• discussion point - What is a limitation of token economies for schizophrenia, and why might they still be worth implementing in hospital settings?(3)

  • Token economies are difficult to continue outside a hospital due to challenges in monitoring target behaviours and providing immediate tokens.
  • However, improving personal care and social interaction through token economies may be crucial for patients to have a chance at living outside the hospital.
  • This suggests that the benefits of token economies may outweigh the limitations, as they help individuals prepare for life outside the hospital.