Management of schizophrenia

• Token economy is a form of behaviour modification where desirable behaviours are encouraged by the use of selective reinforcement

  the tokens are secondary reinforcers and can be exchanged for primary reinforcers like privileges
• taken economy was child in award of woman with a diagnosis of schizophrenia

  Every time the participant carried out the tasks, such as making my bed, they were given a plastic token, with the words one gift written

  These tokens could then be swapped for ward privileges, like watching a film

  The number of tasks carried out significantly increased
• Take a economies were extensively used when the norm for treating schizophrenia was long-term hospitalisation

  the use has declined in the UK because of the growth of community based care and the closure of psychiatric hospital

  also because of complex Erica issues raised by restricting privileges to people with mental disorders
• modifing behaviours like personal care and social behaviours doesn’t cure SZ, but has 2 main benefits

  improves quality of life in hospital settings

  normalises behaviour to make it easier to adapt to life when returned to community
• A limitation of token economies is ethical issues

  it gives professionals considerable power to control the behaviour of people in the role of the patient

  restricting the availability of pleasures to people who don’t behave as desired means that seriously ill people who are already experiencing distressing symptoms have an even worse time

  The benefits of token economy may be outweighed by their impact on personal freedom and short-term reduction in quality of life
• A limitation is the existence of more ethical alternatives

  token economies can be helpful for managing SZ, but there are other approaches with comparable evidence base that do not raise the same ethical issues

  for example, art therapy is a high Gagne and Lo rest approach, it’s a pleasant experience, without major risks of side effects or ethical issues
• a strength is the evidence of effectiveness

  Identified seven high quality studies that examined the effectiveness of token economies for people with chronic mental health issues and involved patients living in a hospital setting.

  All studies showed a reduction in negative symptoms and a decline in the frequency of behaviour

  However, seven studies is quite a small evidence base, there could be a bias towards positive published findings as there is only a small number of studies reviewed