Management of schizo:

• Developing token economies with schizophrenia

  The classic demonstration of a token economy was carried out by Ayllon and Azrin

  • They trialled a token economy system in a ward of women with a diagnosis of schizo
  • Every time the pp carried out a task such as making their bed they were given a plastic token embossed with the words 'one gift'
  • These tokens could then be swapped for ward privileges ie being able to watch a film
  • The number of tasks carried out increased significantly.
• Developing token economies:

  Token economies were extensively used in the 1960s and 70s when the norm for treating schizophrenia was long-term hospitalisation

  • Their use has now declined in the UK, partly because of the growth of community-based care and the closure of many psychiatric hospitals, but also because of the complex ethical issues raised by restricting rewards to people with mental disorders
  • However token economies still remain a standard approach to managing schizophrenia in many parts of the world.
• Rationale for token economies

  Institutionalisation develops under circumstances of prolonged hospitalisation

  • One outcome is that people often develop bad habits, for example they might cease to maintain good hygiene
  • This is an understandable response to living without the kind of routine and small pleasures we experience in everyday life.
• Rationale for token economies

  Matson et al identify 3 categories of institutional behaviour commonly tackled by means of token economies: personal care, condition-related behaviours and social behaviour

  Modifying behaviours doesn't cure schizo but it has 2 major benefits

  1. Improves the person's quality of life within the hospital setting for example make-up for someone who usually takes a lot of pride in their appearance
  2. 'Normalises' behaviour and this makes it easier for people who have spent a time in hospital to adapt back into life in the community ie getting dressed in the morning