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management of schizophrenia - Coggle Diagram
management of schizophrenia
Token economies for schiz
= reward system used to manage behaviour of people with schiz, particularly those who've developed patterns of maladaptive behaviour through spending long periods in psych hospitals.
Developing token economies with schiz
Ayllon & Azrin 1968
trialled token economy system (TOC) on a ward of women
when ppts carried out a task (making bed, cleaning up) they were given a plastic token, marked with "one gift"
tokens could be swapped for privileges, e.g., watch a film
no. of task increased significantly
used in 60s & 70s when long term hospitalisation was norm for treating schiz
their use has declined in UK now due to:
growth of community based care & closure of many psych hospitals
the complex ethical issues (restricting rewards to people with mental disorders)
but is still used to manage schiz in many parts of the worlds
rationale for token economies
prolonged hospitalisation causes
institutionalisation
, they develop bad habits, e.g., poor hygiene, stop socialising (due to living without routine & small pleasures we experience in everyday life)
Matson et al. 2016
identified 3 types of institutional behaviour tackled with TOC.
personal care
condition-related behaviours (e.g., apathy)
social behaviour
modifying these behaviours doesn't cure schiz but has 2 benefits:
improves QoL within the hospital setting (e.g. makeup for someone who usually takes alot of pride in their appearance
normalises behaviour - makes it easier to adapt back into life in the community (e.g. getting dressed in the morning or making the bed)
what is involved in token economy?
tokens are given
immediately
to individuals when they have carried out a desirable behaviour
target behaviours are decided on an individual basis (need to know them to decide on most appropriate target behaviours)
tokens are later swapped for more real rewards
the immediate form of a reward via tokens is important as delayed rewards are less effective
theoretical understanding of behaviour
ToC = behaviour modification (behavioural therapy based on operant conditioning)
tokens =
secondary reinforcers
(only have value once the person has learnt they can be used to get meaningful rewards)
the meaningful reward =
primary reinforcers
tokens which can be exchanged for a range of rewards are most powerful =
generalised reinforcers
at the start of the programme the tokens are administered with the
primary reinforcer
in order for them to become
secondary reinforcers
evaluation
evidence of effectiveness
P: there's evidence of ToC in management of schiz
E: Glowacki et al. 2016 identified seven high quality studies published between 1999 and 2013 which examined effectiveness of ToC for hospitalised patients. all studies showed reduction in
negative symptoms
& decline in frequency of unwanted behaviour
E: strength - supports value of ToC
counterpoint
P: 7 studies is quit small evidence base to support effectiveness of a technique
E: issue with small no. of studies is the
file drawer problem
. this phenomenon leads to bias towards positive published findings because undesirable results have been 'filed away'. this is particularly a problem in reviews which only include small numbers of studies
E: weakness - means there's serious questions over evidence for effectiveness of ToC
ethical issues
P:
E:
E:
alternative approaches
P:
E:
E: