A token economy program for chronic schizophrenic patients

Abstract.— A token economy program was applied on a ward for 12 chronic schizophrenic patients. An ABABC-design, i.e. a group reversal design with a noncontingent reinforcement phase at the end, was used to evaluate the treatment. The patients' activity-level increased from baseline to the treatment phase. During the reversal period the activity-level decreased but it increased again when the token economy was reintroduced. The non-contingent reinforcement resulted in the predicted decrease for two of the six behaviors recorded. Five of the twelve patients were discharged from the ward during the 8-month program period and none of them had been readmitted at the end of the one year follow-up. Individual treatment programs for two of the patients concerning aggressive acts, deficient eye-contact and lip-biting are described.     

Introducing the living with illness group: A specialized treatment for patients with chronic schizophrenic conditions

This paper introduces a specialized psychotherapy/psychoeducational group treatment for patients with chronic psychotic symptoms who receive only partial benefit from psychotropic medications, psychotherapy, and milieu/activities therapy. The goal of the group is to assist patients to accurately identify the feelings, thoughts, and behaviors that are dysfunctional symptoms of their disability and then use the functional aspects of their brain as well as learned coping strategies to compensate for their disability. The group format, philosophy, procedures, and typical topics of discussion are detailed.The authors would like to thank Bruce Levine, Ph.D., and Terry Fujeoko, Ph.D., for their assistance with the initial formation of the group. Mr. Howe and Dr. Fujeoko originated the Living with Illness group and began the first group in 1985 at Waterbury Hospital Health Center, Waterbury, CT.     

A controlled evaluation of token economy procedures with chronic schizophrenic patients

Eighteen chronic schizophrenic patients were allocated to 3 matched groups, one group acting as an own-ward no-treatment control group. The two other groups moved to a token-economy ward, where the token group received contingent tokens, social reinforcement, and informational feedback as a consequence of appropriate behaviour, and where the control group received contingent social reinforcement and feedback with a matched amount of non-contingent tokens. After a 3 month baseline phase, this procedure was followed for a total of 15 months. A continuous assessment system was used with some weekly and monthly assessments, incorporating nursing checklists and ratings, psychiatric ratings, psychological tests, and time-sampling procedures, as well as continuous monitoring of the ward programme. The introduction of contingent tokens had an immediate positive effect in 3 areas of behaviour, but this advantage disappeared over the 15 months owing to the slower but sustained improvement in the control group. Significant improvement was limited to the areas of Social Withdrawal. Appearance and Routine. The patients who improved the most on any measure were those who were initially the most deteriorated. There were paradoxical changes in non-target behaviour, and in symptomatic behaviour. Suggestions and instructions to nurses may play a major part in influencing patient behaviour within and between experimental phases.     

Performance-psychologic cross-sectional study of young schizophrenic patients with a subchronic and chronic disease course

According to ICD-9 and DSM-III-R-criteria 14 subchronic schizophrenic male patients (duration of illness less than 2 years) and 17 chronically ill male schizophrenics (duration of illness between 5 to 12 years) matched for sex, age, education, type of illness, and medication were with the aid of 4 tests investigated with respect to time characteristics of performance parameters. Whereas subchronic patients revealed performance scores within the normal range of reference scores, chronically ill patients showed dissociative variations in performance (high scores in reasoning, low scores in speed factor). This can be interpreted as instability of brain functioning which characterizes schizophrenics suffering from a long duration of illness. Correlations between prolonged reactions to "crossmodal" choices and subjective basic symptoms in subchronic patients are hints at well established introspection ability of self regarded complaints.     

MMPI correlates of performance on a behavior therapy ward.

In a behavioral treatment program for acute psychiatric patients, points were earned for adaptive behavior (e.g. self-care, attending ward activities) and lost for maladaptive behavior (e.g. assaults, verbal abuse). Points earned could be spent for a variety of goods and services (e.g. passes, extra staff time). Statistically significant correlations were found between MMPI scale scores and point-earning behavior. High scores on the F, 5, 6 and 8 scales were associated with low point gain for adaptive behavior, high point loss for maladaptive behavior, a high proportion of points spent to points earned, and a low overall net point earnings. Low score on F scale in combination with high score on 2 scale best predicted point-gain behavior, whereas high score on 8 scale in combination with low score on 1 scale best predicted point-loss behavior. Overall net points were best predicted by low score on F scale in combination with high scores on 0 and 9 scales. When subjects were grouped into common psychiatric profile types, differences were found in point-gain behaviors for items related to personal care and attending ward activities. At least some of these differences could be attributed to two factors: high scores on the 2, 3 and 7 scales were associated with higher than average point earnings, while high scores on the 8 scale were associated with lower than average point earnings.