Talk:Schizophrenia/Archive 2

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Contents 1 glutamatergic hyptothesis 2 cannabis study 3 should be archived 4 Disputed material 5 Schizophrenia and violence 5.1 Retain/include disputed section 5.2 Exclude/delete disputed section 5.3 Comments 6 viral causes discussion 7 Drugs effect on negative symptoms 8 Eugen Bleuler phrase 9 Cannabis section: Where's NPOV? 10 Schizophrenia and split-personality disorder 11 Need for editorial correction 12 Adding material 13 Mihai_cartoaje is making personal attacks 14 Insufficient Emphasis 15 Contribution by User:Letranova 16 Deficit syndrome, removed 16.1 Deficit Syndrome 17 Violence section 18 Disrupted Prepulse inhibition in schizophrenia 19 FAR ? 20 Lead 20.1 Lack of citations 21 Margaret Singer 22 Streamlining Discussion 23 To Do List - Issues to discuss 23.1 Section break - diagnosis section 24 last para removed 25 2nd last para removed 26 Para on Russian/Chinese political use of diagnostic term 27 Comprehensive 28 Highlighting 29 Causes section 30 Chomped paragraph from prognosis section 31 See Also Section 32 Table for Good/Poor Prognostic indicators 33 Differential Diagnosis Section 34 Contents, are we happy with how it stands? 35 Gamma band paragraph 36 So beginneth the almighty copyedit 37 differential diagnosis 38 FAR update 39 2 heterogeneous problem sections 40 Diagnosis or disorder? 41 Ref to be sorted out 42 Miscellaneous notes 43 Catatonia, ECT 44 Inconsistent hyphens 45 FAR complete and congratulations all round! 46 Strange sentence 47 Alzhiemer's disease only affecting older people? 48 Balance of the article 48.1 How to redress the balance and ad some more emphasis on psychological input 49 Anhedonia is a negative symptom of schizophrenia 50 Life expectancy and antipsychotics 51 violence 52 Organic Bacterial cause 53 Added akathisia Side Effect of Antipsychotics as a Cause for Suicides in People said to be Schizophrenic. 54 Dopamine Stimulation Deficiency As Cause for Dysphoria which can lead to Suicides/. 55 Cultural References 56 Sentence and summaries 57 Interventions 58 =Update on intervetions 59 Chromosome 22 60 OK..here's a goal - Schizophrenia as Featured Topic 61 Weasly 62 Treatment of schizophrenia now done 63 Violence 64 Referencing 65 Latest findings Dr Seeman 66 correction 67 The missing link: 68 Memory loss, lying, difficulty speaking 69 MRI / Grey matter study paragraph 70 Introductory Section 71 Why do we ignore the physcial causes? 72 Schizophrenia, demons, parapsychology ? Researches on border of science and parapsychology 73 Schizophrenia 74 Omega-3s

[edit] glutamatergic hyptothesis

No-one has written anything about the glutamatergic hypothesis of schizophrenia. The dopamine hypothesis has it's own wikipage, thus in the interest of fairness i think a page should be created on the glutamatergic hypothesis, or at least have the role of glutamate be made into a section on the main schizophrenia page —The preceding unsigned comment was added by 160.5.184.175 (talk) 15:29, 29 April 2007 (UTC).

Is there any recent research on this? As I recall, the dopamine hypothesis, nicotinamide, adrenachrome, transmethylated trytamines, and gluten theories are all outdated.66.19.68.181 22:06, 16 June 2007 (UTC)

Dopamine theories aren't outdated and are mentioned briefly, as is the glutamate material. Unfortunately the article is so big everything can't fit in. There is a causes page which this can be expanded upon.cheers, Casliber (talk · contribs) 22:15, 16 June 2007 (UTC)

[edit] cannabis study

The study on cannabis that is referenced (#114 Arseneault, 2004) was specifically a developmental study, and showed that cannabis use by the age of 15 increased the risk of developing psychosis 4.5 times and cannabis use by the age of 18 increased the risk 1.65 times. This is a more interesting and relevant fact than the one actually referenced on the page.

What about the connection between LSD use and schizophrenic symptoms? I think the correlation would be greater than for marijuana. Similarly for methamphetamine. —Preceding unsigned comment added by 12.210.219.192 (talk) 18:09, 4 December 2007 (UTC)

[edit] should be archived

This talk page is already 181 kilobytes long. Shouldn't it be archived? It makes it slow to edit here. —Cesar Tort 22:37, 13 March 2007 (UTC)

That sounds fine to me; how is this done?DPeterson^talk 23:09, 13 March 2007 (UTC)

I can do it. But first I'd like to know if there are no objections. —Cesar Tort 23:15, 13 March 2007 (UTC)

Good idea Cesar. No objections from me. - Vaughan 23:40, 13 March 2007 (UTC)

OK: I’ll do it. —Cesar Tort 00:22, 14 March 2007 (UTC)

NO!!! Don't do it! the government will kill me if you do!!!!—PoidLover

[edit] Disputed material

It seems that it is the following that is disputed:

[edit] Schizophrenia and violence

<snip>

---

However, as pointed out above, this issue has been discussed in the Request for Comment.RalphLender^talk 17:01, 15 November 2006 (UTC)

[edit] Retain/include disputed section

1. RalphLender^talk 17:01, 15 November 2006 (UTC)the material is well referenced with reliable and verifiable sources. In addition, the RFC clearly shows that the vast majority of editors want the material included, based on reliable and valid and verifiable sources.
2. Per above and arguments raised in previous RFC. --Muchness 17:20, 15 November 2006 (UTC)
3. (uncivil comment removed) The section is referenced by the latest review articles in the area, and refutes the myth that people with schizophrenia are necessarily violent. - Vaughan 19:35, 15 November 2006 (UTC)
4. Yes, include and keep...this material is verifiable. If an editor disputes it, better to include/add alternative material with appropriate sources and references which meets the Wikipedia standard of being verifiable. DPeterson^talk 13:28, 16 November 2006 (UTC)
5. YES It is valuable and factual information and should be included. That other articles do or do not include information about violence is not relevant to this discussion. The material meets Wiki standards for inclusionJonesRD_talk 16:58, 14 April 2007 (UTC)

[edit] Exclude/delete disputed section

1. No other article has violence statistics. --Mihai cartoaje 23:04, 30 November 2006 (UTC)

I see violence is back in. If violence is in, then compassionate acts of schizophrenics should be placed with it.--Mark v1.0 19:13, 15 April 2007 (UTC)

ok Vaughan set me staight on this, there is "scientific" literature on schizo. and violence. I would have to find literature on lovemaking and compassionate acts of schizophrenia. —The preceding unsigned comment was added by Mark v1.0 (talk • contribs) 03:36, 16 April 2007 (UTC).

1. Just as as poverty article does not contain a section on violence, this article should not either. None of the information cited supports the claim that "the percentage of people with schizophrenia who commit violent acts is several times higher than the percentage of people without any disorder" except studies done in emergency rooms where violence is, of course, common. This section can be chalked up to "no conclusions have been reached." Please remove.--Jedsen 08:16, 6 November 2007 (UTC)

[edit] Comments

RalphLender and DPeterson have been the object of a suspected sockpuppetry report. A checkuser was not done at the time. More information is here: [1]. --Mihai cartoaje

And the result was the fact that this was not the case...that I am not related to RalphLender and that we are separate individuals. Your accusattion is not only unfounded but is antithetical to wiki policy in that it is irrelvant and and does not assume good faith and is a personal attack DPeterson^talk 01:50, 6 January 2007 (UTC)

JonesRD is one of DPeterson's Company of single-purpose accounts. Here's an explanation from an administrator: [2]. --Mihai cartoaje 20:41, 14 April 2007 (UTC)

This is a Personal attack and violates Wikipedia policy. I am unrelated to Jones this false accusation now requires administrator action as you continue to make personal attacks against me DPeterson^talk 21:18, 14 April 2007 (UTC)

[edit] viral causes discussion

In the recently archived discussion someone made a mention of a problem in the viral etiology discussion, where one writer wrote, "viral infections during the third trimester (4-6 months) of pregnancy." This was clearly an error as the third trimester of pregnancy is from the 6th to the 9th month of pregnancy. In researching the the references listed, as well as a web search, all references to this issue state that, "Patients whose mothers were in their second trimester of pregnancy (between four and six months pregnant) during the epidemic were more likely to be diagnosed schizophrenic than those whose mothers were in their first or third trimester or those born before the virus appeared http://www.findarticles.com/p/articles/mi_m1175/is_n3_v22/ai_6406131 ." Since edits are disabled by non-registered users, can someone make that correction please? It should read, "Some researchers postulate that the correlation is due to viral infections during the second trimester (4-6 months) of pregnancy." Actually, strictly speaking, there is no reference for what "some researchers postulate," so a better edit would remove that phrase and replace it with something like, "Some studies have shown that the correlation is due to viral infections during the second trimester (4-6 months) of pregnancy." and then reference Brown, A.S. (2006) Prenatal infection as a risk factor for schizophrenia. Schizophrenia Bulletin, 32 (2), 200-2, which is reference 35 on the reference list. RAA 65.10.35.73 06:29, 20 March 2007 (UTC)

[edit] Drugs effect on negative symptoms

It says that antipsychotic medication is less usefull against negative symptoms than positive symptoms. These drugs may create negative symptoms. So it should not be hinted that the drugs are somewhat helpfull against negative symptoms.

The newer atypicals claim to help with negative symptoms (Geodon, Abilify?).66.19.68.181 22:02, 16 June 2007 (UTC)

The medication section says that the atypical meds are more likely to cause weight gain. I believe a distinction should be made here (though I only know this anecdotally through a friend who has taken it for six+ years) that the new medication Geodon (ziprasidone) has not caused weight gain the way earlier atypicals have done. 71.237.246.45 02:35, 23 July 2007 (UTC)

Although ziprasidone has been found to have one of the lowest weight gain profiles, it is still linked to weight gain (see PMID 17286524). However, I would argue, as with DrCareBear's contested addition, that this information should go in the antipsychotic or ziprasidone article. The schizophrenia article is not the place for an in-depth discussion of medication effects. - Vaughan 08:09, 23 July 2007 (UTC)

[edit] Eugen Bleuler phrase

why it was deleted ??? He wrote: "The patients that I have observed do not respond to situations as they should; they are frightened by what is not there, yet they remain indifferent to what is. It is as if they have a split mind."  ??? —The preceding unsigned comment was added by 82.137.6.71 (talk) 14:46, 27 March 2007 (UTC).

[edit] Cannabis section: Where's NPOV?

What, is Wikipedia also married to Dupont's daughter? I think it should be stressed not simply that "cannabis may, if assumed causation, increased rates of schizophrenia in populations". That is not NPOV! That is starting with a conclusion and working back to a premise... This needs to be changed. Some amount of criticism is in order. Just because Steven Milloy has (dubious) "studies" to back him up, does not merit those studies being directly quoted from with no critical light cast upon them. With the hysterically over-the-top history of propaganda against this relatively harmless weed I think it is not asking too much to phrase the citation of this "study" with a little mix of what some people would call rationality. Perhaps a link to http://en.wikipedia.org/wiki/Correlation is in need. If this type of POV writing is allowed in Wikipedia, I might as well postulate that the increased rates of schizophrenia in populations from cannabinoids binding to CB1 and CB2 receptors (among, admittedly, others too) occurs merely because those who are already highly genetically schizophrenic practically freak out no matter what drug you give them, caffeine, cannabis, nicotine or any other. I might as will say that assuming a causation between me praying to the Easter Bunny and it raining outside, that it will rain outside. Does anyone else see the absurdity in this? Point is in a clinical condition of schizophrenia the outcome is mostly of brain chemistry which is largely determined by the large set of interacting genes we each possess as individuals. If some is not clinically schizophrenic, but still not "normal" (whatever the hell that means), then they are probably schizotypal or schizoids, etc etc. Point is, that this whole "cannabis causes mental health problems" is an old trick, which has been around for a long time. With organizations such as the UN, and many developed nations still engaging in hysterically over the top rhetoric on the affects of cannabis I am surprised that am "awarded article" such as this can get away with such blatant POV. Look, I love science--but even I know real science (when it comes to *brain chemistry*!) doesn't not entail taking cohorts and doing comparisons, that's how they market drugs like Viagra, not science. Main point: correlation people! If I was a user I would stress this article-- http://en.wikipedia.org/wiki/Correlation_causation I hope this has been helpful and not just annoying....

Amphetamine and cocaine have been proven to cause long-term damage. LSD and DMT can precipitate psychotic breaks, and there are special classifications for drug-induced psychoses. Obviously alchohol, in certain cases, can cause massive damage. It's almost certain that MDMA is triggering major depresive episodes in certain people. If marijuana is safe, it would be the oddball. Recent research is verifying "common sense": hallucinogenic drugs can precipitate mental illness.66.19.68.181 22:16, 16 June 2007 (UTC)

A friend of mine developed schizophrenia after a traumatic incident in his life. He says he uses medical marijuana to treat it. He seemed completely normal, and I was really surprised when he said he had schizophrenia, so it must work. Could it be that there's a correlation, because schizophrenic people use marijuana as medicine?TheRealdeal

Drug addicts who are dependent on marijuana will always try to make it seem as though such drugs are perfectly harmless and even beneficial. It's an old story.Lestrade 16:05, 4 December 2007 (UTC)Lestrade

[edit] Schizophrenia and split-personality disorder

I was very surprised to find no mention of this, since it is a very common misconception that schizophrenia means having multiple personalities, and many people will come to the page thinknig that. I thought maybe a sentence at the end of the first paragraph to clarify this would be useful 212.32.11.115 09:37, 3 April 2007 (UTC)

The only mention is at the beginning of the article where the meaning of the Greek derivation is explained. What would you suggested adding and where? DPeterson^talk 12:22, 3 April 2007 (UTC)

I have added a heading of "Popular misconceptions" just above the Violence heading and done some fleshing out. --CloudSurfer 09:34, 23 July 2007 (UTC)

[edit] Need for editorial correction

The following sentence from the section titled "Alternative Approaches to Schizophrenia," is ambiguous. "A recent literature by scientists at Johns Hopkins University confirms some of these findings.[129]" Does this sentence refer to a literature search, or to a contribution to the literature, or what? Also, the footnote number 129 takes one to a reference to Acta Psychiatr Scand, not to a source related to Johns Hopkins University. Janice Vian, Ph.D. 00:47, 11 April 2007 (UTC)

Looks like it's supposed to say "A recent literature review by...". Although the journal is Acta Psychiatrica Scandinavia, the authors affiliation is given as John Hopkins Uni.

I think that section overall does need some tightening up. For example the first sentence may give the impression that any alternatives, including all those that follow, are part of the "anti-psychiatry" movement. And actually, by what criteria does something belong in the "alternative" section rather than the main sections? EverSince 18:01, 11 April 2007 (UTC)

I agree with EverSince here. RalphLender^talk 18:10, 11 April 2007 (UTC)

[edit] Adding material

I would like to add the following to the Incidence and prevalence (without the http links) http://en.wikipedia.org/wiki/Schizophrenia#Incidence_and_prevalence

--Mark v1.0 17:18, 13 April 2007 (UTC)

1)The Soviet Union had a high prevalence of schizophrenia 5-7 per 1,000 population.

J. K. Wing, 'Psychiatry in the Soviet Union,' British Medical Journal, 9 March 1974, p. 435.

David Cohen, Soviet Psychiatry: Politics and Mental Health in the USSR Today, Paladin, London, 1989, p. 24.

A. L. Halpern, 'Current Dilemmas in the Aftermath of the US Delegation's Inspection of the Soviet Psychiatric Hospitals,' Emerging Issues For The 1990s In Psychiatry, Psychology And Law, Proceedings of the 10th Annual Congress of the Australian and New Zealand Association of Psychiatry, Psychology and Law, Melbourne, 1989, p.11.

C. Shaw, 'The World Psychiatric Association and Soviet Psychiatry' in Robert Van Voren, ed., Soviet Psychiatric Abuse in the Gorbachev Era, International Association on the Political Use of Psychiatry, Amsterdam, 1992, p. 50.

K. W. M. Fulford, A. Y. U. Smirnov, and E. Snow, 'Concepts of Disease and the Abuse of Psychiatry in the USSR,' British Journal of Psychiatry, Vol. 162, 1993, pp. 801-810.

2)In China women have a higher prevalence of schizophrenia. source The British Journal of Psychiatry http://bjp.rcpsych.org/cgi/content/abstract/190/3/237 The Journal of the American Medical Association http://jama.ama-assn.org/cgi/content/full/294/5/557 http://jama.ama-assn.org/cgi/content/full/294/5/621

[edit] Mihai_cartoaje is making personal attacks

This user continues to make Wikipedia:Personal attacks against me despite several warnings. He falsely accuses me of being a sockpuppet or having them, despite there being no evidence and his being warned to stop making such accusations. Any suggestions? I put this warning on his talk page, but he deleted it.

This is your last warning. If you continue to make personal attacks on other people as you did at Schizophrenia, you will be blocked for disruption. Comment on content, not on other contributors or people.

Any suggestions will be much appreciated DPeterson^talk 21:52, 14 April 2007 (UTC)

Calling someone a sockpuppet is a personal attack? I never heard the term sockpuppet before.

Yes, it means that the person is not "real" merely a foil or construct of another user so that it "appears" that there are more than one editor with a POV. DPeterson^talk 20:03, 15 April 2007 (UTC)

RE Violence and schizophrenia. if schizophrenia is a medical disease you can not mention violence as no one mentions it for cancer or any other medical disease. What is the current definition of schizophrenia?--Mark v1.0 18:45, 15 April 2007 (UTC)

Because there is a very large scientific literature on schizophrenia and violence. - Vaughan 19:48, 15 April 2007 (UTC)

Yes, I support that. There is a relationship there that has been studied and there is a literature on the subject, therefore it belongs in an encyclopeida article. In fact, if cancer had a link with violence, based on studies, then it would be mentioned...just like mortality rates are listed. DPeterson^talk 20:03, 15 April 2007 (UTC)

Ok, Thanks for the ncbi reference for a source. Vaughan, and Thanks to DPeterson for the definition of "sock puppet"--Mark v1.0 03:32, 16 April 2007 (UTC)

Doesn't take a rocket scientist to see why the research is correct. Schizophrenics are notorious for paranoia, drug and alcohol abuse, being harassed, etc. Add all those up and you occasionally have a time bomb. There is likely some research out there that concludes that medicated szs in a treatment plan are far less violent and suicidal.172.129.147.238 14:03, 26 April 2007 (UTC)

[edit] Insufficient Emphasis

"In the absence of a confirmed specific pathology underlying the diagnosis, some question the legitimacy of schizophrenia's status as a disease." This sentence should be moved up in the initial text and given more prominence as a first level section or maybe even an article on its own (like the 'Scientific Validity' section of psychoanalysis) . It's my strong sense that these two play the essential role in casting psychology and psychiatry as pseudosciences, with analysis standing on much firmer ground. On the one hand things that aren't really pathologies or disease states are cast as such (e.g.so-called peak experiences) and on the other varying different clearly disease states are lumped together as if they were a single underlying phenomenon without any convincing proof. The bottom line seems to be the real state of affairs is that schizophrenia is what they call madness these days. Unfortunately there's more baggage than just pretension with the use of the term. Lycurgus 10:13, 11 May 2007 (UTC)

How would you factor in the DSM IV R TR criteria? RalphLender^talk 16:49, 11 May 2007 (UTC)

It wouldn't seem to affect the material condition (lack of an underlying scientific hypothesis to explain the phenomenon and therefore give a scientific meaning to the term) at all. Persisting ever more methodically in something fundamentally erroneous is I think what they call perseveration, one of the diagnostic criteria if I'm not mistaken. Lycurgus 12:58, 26 May 2007 (UTC)

The main issue is how many discrete conditions there may be which are currently classified under the banner of schizophrenia. Szasz (and antipsychiatry) raised some good points several decades ago but the idea that schizophrenia as a concept is not legitimate is pretty fringe, especially when there are huge burdens of disease measured in epidemiological studies secondary to schizophrenia. DSM is constantly being fine-tuned with the boundaries between conditions, which is where schizophreniform psychosis arose last time round (III-R to IV I think) cheers, Cas Liber | talk | contribs 13:29, 26 May 2007 (UTC)

It's hardly a fringe issue, as the continuum model of psychosis and as molecular genetic research shows. The issue is not whether experience or phenomena or real or whether people are burdened by them, but whether the diagnostic category signifies a discrete condition than be identified on levels other than its phenomenological description. This is still debated as the literature shows. - Vaughan 13:40, 26 May 2007 (UTC)

I don't think I made myself clear...but nevermind I essentially agree with what you've stated in the previous paragraph.cheers, Cas Liber | talk | contribs 13:49, 26 May 2007 (UTC)

[edit] Contribution by User:Letranova

Letranova has added the following lines:

From yet another angle new discoveries in physics and general systems theory regarding the subject of time, and causality seem to challenge the earlier correlations of causality and schizophrenia. Theories of complex systems, and topics in chaos theory propose the possibility of phenomena like the butterfly effect where a small cause in a system may lead to a complex and large effect on another part of the system. This complex causality challenges narrow assumptions of cause and effect relationships.

I found them too vague, loosely related to such a specific topic as schizophrenia, and unreferenced. I propose to discuss them before including them in the article. Best regards, CopperKettle 06:51, 13 May 2007 (UTC)

I just don't see the relevance to this article. DPeterson^talk 13:59, 13 May 2007 (UTC)

[edit] Deficit syndrome, removed

Removed the following. This section is completely uncited, and appears to be given undue weight. If warranted, perhaps it could have its own article. SandyGeorgia (Talk) 14:31, 17 May 2007 (UTC)

[edit] Deficit Syndrome

Currently, there is debate in the field about a new subtype known as the deficit syndrome.^{[citation needed]} It is not currently included in the DSM-IV-TR, however it has been receiving a great deal of attention in the last 20 years. This subtype is more expansive than the other subtypes as a person can be diagnosed with both paranoid schizophrenia and the deficit syndrome. It is characterized by primary negative symptoms (which means that they cannot be caused by such things as the side-effects of medication or depression). People with the deficit syndrome tend to have extremely flat affect (do not appear to be very emotional), do not have good eye contact, do not enjoy normally pleasurable activities (see dysphoria), and seem to be uninterested in social interaction. (There is, however, conflict in the research on this last point. While people who have been diagnosed with the deficit syndrome report being uninterested in social interaction, in the laboratory, they often report normal reactions to the situations.) Patients who have been diagnosed with the deficit syndrome tend to have a worse prognosis as these symptoms tend to be resistant to medication. This fact has brought much needed attention to negative symptoms (which have traditionally not been viewed as important as the positive symptoms).^{[citation needed]}

Huh? Everyone I know in the field pays alot of attention to negative symptoms as it is a good guide to prognosis...cheers, Cas Liber | talk | contribs 11:39, 20 May 2007 (UTC)

It needs to be cited, and added to the right place (probably to Causes of schizophrenia. SandyGeorgia (Talk) 13:40, 20 May 2007 (UTC)

[edit] Violence section

Hi Sandy,

I think this needs to be in its own section and not in the prognosis section, as it also covers violence to people diagnosed with schizophrenia and is a significant and much debated topic in its own right.

- Vaughan 14:55, 17 May 2007 (UTC)

Yes, I agree with that. I'd like to see it continue in a separate section. BTW, Sandy, nice job of editing...thanks!! RalphLender^talk 15:12, 17 May 2007 (UTC)

But violence against people with Schizophrenia or by people with Schizophrenia are both Prognosis — both have to do with how well people with Schizophrenia fare. I know this section has been the subject of ongoing and debate and mediation here; it seems to have taken on undue weight because of the controversy, but it's still Prognosis. A lot of text will need to be tweaked now that I've altered the structure, but when I rewrote Tourette syndrome, I did find that following MEDMOS helped keep the article focused and streamlined. SandyGeorgia (Talk) 15:51, 17 May 2007 (UTC)

Hi Sandy, prognosis is the course of the disease not the general well-being of the patient after diagnosis. If a person with schizophrenia suffers violence owing to prejudice after they have been diagnosed, this is not part of their prognosis. Articles for medical conditions should reflect the way in which the disorders are handled by the medical speciality which treats them. While generally a good framework, the MEDMOS guidelines have obviously been designed for the sorts of things treated by physicians, rather than psychiatrists. Trying to shoehorn, particularly psychiatric diagnoses, into these headings is likely to obscure some key information. - Vaughan 19:38, 17 May 2007 (UTC)

I don't think it's a big deal if various sections don't fit into MEDMOS, so if it really troubles you, moving it would be fine (although it still seems to be a good fit in prognosis); I was trying to streamline a rambling TOC, but one section isn't a deal breaker. SandyGeorgia (Talk) 20:16, 17 May 2007 (UTC)

I'm done for a bit now and will leave it to you all, having left a long list on the review. I'll add more comments later as work proceeds. It doesn't make sense to get into copyedit needs now, as Causes and Treatment really could benefit from Summary Style. SandyGeorgia (Talk) 15:54, 17 May 2007 (UTC)

Very nice job. I do think that the violence section should remain separate. It is a tricky topic and, given that significance, maybe should have its own section. There are a lot of dimension to the violence issue that do not directly relate to prognosis, which is why I don't think it belongs there...just my opinion. RalphLender^talk 21:26, 17 May 2007 (UTC)

Also just want to say what an excellent job you've done Sandy. - Vaughan 08:07, 18 May 2007 (UTC)

[edit] Disrupted Prepulse inhibition in schizophrenia

Hello. I've improved Prepulse inhibition a little, dug up some references. The section on PPI deficit in schizophrenia is not full, I fear, as I'm an amateur. Improvements are welcomed! I thought that maybe the mention of PPI deficits in schizophrenia and the role of PPI reaction in the search for new antipsychotics (and PPI disruption in rodents as a schizophrenia endophenotype) could be included in this article (or other related articles?). Best regards, CopperKettle 12:03, 18 May 2007 (UTC)

[edit] FAR ?

I was just wondering when the regular editors of this article planned on working on the issues mentioned at FAR? I went ahead and set up Causes of schizophrenia, moving all the content from the main article into it. That can now be summarized back to this article in three or four paragraphs.

I also merged all the content from Overview into the appropriate sections, so now several of those sections are repetitious and need merging.

Then the Lead can be rewritten to the overall summary that was once included in overview, following the guidelines of WP:LEAD. I don't want to get too far ahead of you all, and the article does have a month at FAR, but the copyedit at the end may require a good two weeks, and the citation needs are also going to be time consuming. SandyGeorgia (Talk) 13:18, 19 May 2007 (UTC)

I went ahead and summarized Causes, which brought the prose size down to 45KB of readable prose, and eliminated a TON of uncited text, which is now in the daughter article. I imagine the knowledgeable editors here will want to examine some of my pruning, but that's an example of how it can be done. Regards, SandyGeorgia (Talk) 13:50, 19 May 2007 (UTC)

Wow, that was a ton of pruning (Great work BTW). Are you familiar with the subject matter at all or is your knowledge/interest solely from/within wikipedia? I work in the field but have refrained from much in wikipedia on psychiatry as it can be controversial (and I much prefer doing my hobby thingies) The refs shouldn't be too hard..cheers, Cas Liber | talk | contribs 11:38, 20 May 2007 (UTC)

My interest is really in FAC/FAR; this article has not met current FA standards for a very long time. I was sorry to see it nominated to FAR at a time when I was hoping to focus on another medical article (Lesch-Nyhan syndrome) at FAR; I would have preferred to leave a list here and give editors time to comply before FAR nomination since there is so much to do, but I am really hoping that the regular editors here will kick in and do the work necessary for the article to retain featured status. It has a long ways to go, but there's a month in which to do the work. I'm dismayed that little progress has been made, and I've probably done all I can do for now, by putting a structure in place and listing the work still needed. The copyedit needs after the article is trimmed, merged, and cited will take several weeks, so I hope work gets underway soon. SandyGeorgia (Talk) 13:54, 20 May 2007 (UTC)

Get stuck into the other then and I'll see what I can do....one of the reasons I didn't like to edit psych things is there were generally loads of people involved but it's pretty quiet 'round here otherwise.............cheers, Cas Liber | talk | contribs 21:01, 20 May 2007 (UTC)

[edit] Lead

FWIW I think para 4 can come out of the lead, given its length. cheers, Cas Liber | talk | contribs 13:27, 20 May 2007 (UTC)

I find it hard to focus on the WP:LEAD when so much work is needed throughout. The lead should be a stand-alone, compellling summary of the entire article, which is why I usually leave work on it for the very end, when everything else is done. The summary of Causes of schizophrenia needs work, and Treatment of shizophrenia should probably be written and summarized back to the main article before the lead is finally written. SandyGeorgia (Talk) 13:56, 20 May 2007 (UTC)

Yeah, good point. I'll find some time to work on it a bit later. can do bits but Common Raven is first priority at present. cheers, Cas Liber | talk | contribs 20:59, 20 May 2007 (UTC)

I'd agree that the para 4 Prevelance, cold be removed...or heavily edited along with the para 2. Is this what you are referring to here? DPeterson^talk 00:42, 22 May 2007 (UTC)

Heck, I think they've moved. Anyway I'll take SandyGeorgia's advice and wait up a bit until the rest is reorganized. cheers, Cas Liber | talk | contribs 04:42, 22 May 2007 (UTC)

I've been reorganizing alot today - I think Epidemiology should probably slot in before Causes as it is a nice segue between diagnosis and cause (given the epidemiological focus of alot of the stuff in causation) cheers, Cas Liber | talk | contribs 04:42, 22 May 2007 (UTC)

MEDMOS isn't strict on order of Section headings; do whatever makes sense. Glad you're going to wait on the lead; all too often, editors get all tangled up in spending too much time on the lead, which really can be left 'til last. A new problem: a whole crop of new choppy sections just appeared in Causes, Prognosis and Epidemiology; two sentence sections aren't really warranted, and clutter up the TOC with the choppy sections. Those could be merged into a whole. Unless there are several substantial paragraphs to be written on a topic, it really doesn't warrant a separate heading. Also, to keep in mind; the article is still largely uncited, which is still the most urgent need; if the regular editors can't thoroughly cite the article, the rest of the work will be for nought. SandyGeorgia (Talk) 11:41, 22 May 2007 (UTC)

I agree epid should go before causes. DPeterson^talk 22:08, 22 May 2007 (UTC)

OK, I removed Urban Drift' subheading, but I am wary of others - I felt many points within the article were lost in a mass of text previously, so much so that there was much reduplification which I am sure was unintentional.I figure Factors (within prognosis) can be a table, which is what it is in texts I have. Causes I am not so sure about. I can move Stress-diathesis into main bit though. The Others at the end of that section is tricky and probably should go on the subsidiary page. cheers, Cas Liber | talk | contribs 23:48, 22 May 2007 (UTC)

[edit] Lack of citations

Sandy I've tagged a few that I can see. Can you (or others) please tag other sentneces thoughout which you feel need citing? This needs to be the first step towards achieving adequate citation (BTW what is the recrod number of cites on a wikipeida article?)cheers, Cas Liber | talk | contribs 23:57, 22 May 2007 (UTC)

I've gone through and added all the missing citations. I notice a few recent ones have been added by citing a general psychiatry text book which will really need replacing with primary sources in the future - Vaughan 15:03, 25 May 2007 (UTC)

Kaplan and Sadock (now Sadock & Sadock) is one of the benchmark psychiatric texts used by psychiatrists in training. However you're right, they are all secondary sources...cheers, Cas Liber | talk | contribs 11:16, 26 May 2007 (UTC)

[edit] Margaret Singer

Psychologist Margaret Singer was reported to have been nominated twice for a Nobel Prize, for her work in schizophrenia.^[1]

• Can someone please add this information, backed up by a secondary sourced reputable citation, into the article someplace? It is most certainly notable information. FYI, there are, I think, about 5 more citations from reputable sources that back up this information. Smee 20:38, 23 May 2007 (UTC).

What work did she do? RalphLender^talk 20:45, 23 May 2007 (UTC)

I am not aware of her and the article is really long as is. Its seems as though most of her status is with other aspects of psychology/psychiatry but as we edit we can see where it may be useful, such as family therapy in schizophrenia.

Sanger or Singer?

The Sanger Paradox- the Myth of Choice

The founder of Planned Parenthood in her own words

"The demand that defective people be prevented from propagating equally defective offspring... represents the most humane act of mankind."

Adolf Hitler, Mein Kampf, Vol. 1, Chapter 10

"We prefer the policy of immediate sterilization, of making sure that parenthood is absolutely prohibited to the feeble-minded."

The Pivot of Civilization  Margaret Sanger, Brentano's Press, NY, 1922, p. 263

"Authorities tell us that 75% of the school-children are defective. This means that no less than fifteen million schoolchildren, out of 22,000,000 in the United States, are physically or mentally below par.

Planned Parenthood was known as the American Birth Control League until 1942. (Backlash against the eugenics movement which the ABCL espoused, and its ties to Nazis here and abroad compelled the name change.) That said, now for some little known facts regarding Margaret Sanger, the founder of Planned Parenthood, and her stated aims from its conception...

The eugenics movement was a pseudo-science which advocated the forced sterilization of "feeble-minded" U.S. citizens in hopes of insuring racial purity; it was a doomed and tragic attempt to create what Sanger believed would be "a race of thoroughbreds." Eugenics as a "science" fell apart with the discovery of DNA and new insights on chromosomes and genetic mutation. But thought the sterilization program which Sanger and supporters advocated most adversely affected poor whites and minorities, it was also aimed at all Americans of every color and creed who didn't fit into an insanely narrow and scientifically invalid notion of who was fit to conceive. This was only 1 in 4 Americans, in Sanger's most generous estimates.

Confronted with these shocking truths about the menace of feeble-mindedness to the race, a menace acute because of the unceasing and unrestrained fertility of such defectives, we are apt to become the victims of a 'wild panic for instant action.' There is no occasion for hysterical, ill-considered action, specialists tell us. They direct our attention to another phase of the problem, that of the so-called 'good feeble-minded.' We are informed that imbecility, in itself, is not synonymous with badness. If it is fostered in a 'suitable environment,' it may express itself in terms of good citizenship and useful occupation. It may thus be transmuted into a docile, tractable, and peaceable element of the community. The moron and the feeble-minded, thus protected, so we are assured, may even marry some brighter member of the community, and thus lessen the chances of procreating another generation of imbeciles. We read further that some of our doctors believe that in our social scale, there is a place for the good feeble-minded.

"In such a reckless and thoughtless differentiation between the 'bad' and the 'good' feeble-minded, we find new evidence of the conventional middle-class bias that also finds ___expression among some of the eugenists. We do not object to feeble-mindedness simply because it leads to immorality and criminality; nor can we approve of it when it expresses itself in docility, submissiveness and obedience. We object because both are burdens and dangers to the intelligence of the community"

[edit] Streamlining Discussion

Right, I guess we should come to a decision on where we'll discuss stuff as it can be done here or on the FAR page. I guess it is better to do it here and await presentation as it were when we're pretty happy and asking for a discussion on keeping/removing etc. Thoughts? If we're all ok then I would place a quick note on the FAR discussion page to indicate this. cheers, Cas Liber | talk | contribs 11:19, 26 May 2007 (UTC)

[edit] To Do List - Issues to discuss

• Medication - either expand here or summarise and cleanup/expand antipsychotic page. Tricky to do here. Need to mention clozapine, depots (2 weekly injections for noncompliant clients), the fact that the atypical group is an artifical arbitrary grouping - what they have in common is expense and some varying affinity with serotonin receptors. All the side effects WRT typicals vs atypicals is too generalised and wrong and can only be fixed by itemising. eg. risperidone and amisulpride cause more extrapyramidal-side effects than chlorpromazine (a typical) and weight gain is restricted to olanzapine, clozapine and to a lesser extent risperidone. This section could get very big.....

• Regarding this study, On being sane in insane places, it isn't really cited much these days. I have a problem with how big the controversies section is and the overlap with the alternative approaches and am windering how it can be streamlined. cheers, Cas Liber | talk | contribs 11:36, 26 May 2007 (UTC)

I really think the controversies section should stay, as diagnostic validity is one of the big issues in schizophrenia research. As the Rosenhan study has been hugely influential, and only takes up one paragraph, I don't see any reason to omit it specifically. - Vaughan 13:22, 26 May 2007 (UTC)

I'm not saying delete it, just wondering how many bits we need in it. I guess what would be really helpful is some consensus on the ceiling size this article can be. If it can remian featured at this size then I don't think there's a real problem. The more I think about it the more I think all the antipsychotic stuff should be on the drug page......Sandy?cheers, Cas Liber | talk | contribs 13:35, 26 May 2007 (UTC)

I still say a separate Treatment of schizophrenia page would be good, because then treatment could be dealt with more comprehensively, without growing the article. Some sections in the article now (including Controversy and the On being sane in insane places) have the problem of undue weight; controversy and marginal info is given more weight in the article than well-established info. I'm going to be traveling this week and will read several summaries of schizophrenia on the plane, to get a sense of whether this article is comprehensive in the fundamental information. As to size, see WP:LENGTH on prose size. The prose size is currently at 43KB, so there is a bit of room to grow. At 50KB, I start to get nervous about summary style. So glad to see work is progressing; I'll run through now and see if I need to add any cite tags. SandyGeorgia (Talk) 21:30, 26 May 2007 (UTC)

The controversy over diagnostic validity is well-established and part of mainstream research. Please see my reply to an earlier and have a look at the literature. The Rosenhan study has a single short paragraph. This seems hardly to be undue weight for such an influential study. - Vaughan 21:50, 26 May 2007 (UTC)

Is the Rosenham study the "Being Sane in Insane places"? By undue weight, I mean that it is mentioned without also mentioning the other articles criticizing it; it's not presented in an NPOV and balanced fashion. I saw 14 other articles in PubMed. Maybe I should say that section is POV rather than undue weight? SandyGeorgia (Talk) 22:26, 26 May 2007 (UTC)

Agreed. A counter point is best added. Spitzer's reply is the most pertinent and well-known and can be grabbed from the Rosenhan experiment page. - Vaughan 22:34, 26 May 2007 (UTC)

This paragraph in Diagnosis needs copyedit attention; I'm not sure how to fix it, but it's vague and wishy-washy. SandyGeorgia (Talk) 21:39, 26 May 2007 (UTC)

The diagnosis of schizophrenia is based upon the behavior of the person being assessed. There is a list of criteria that must be met for someone to be so diagnosed. These depend on both the presence and duration of certain signs and symptoms.

The Subtypes section in Diagnosis is unclear; it's never clearly stated what the ICD10 criteria are, or how the subtypes differ between DSM and ICD. Also, "the ICD-10 identifies 7:", but then five are listed. And the last paragraph refers to brackets, but there are no brackets.

This section mixes prevalence and incidence (the incidence sentence refers back to the prevalence sentence, not connected). Whatis received mention? As the article progresses through FAR, Tony1 will eventually look at the prose, and he'll be a Remove if it isn't tight. The whole paragraph mixes discussion of prevalence with factors of prognosis.

The same study found that prevalence may vary greatly among countries, despite the received wisdom that schizophrenia occurs at similar rates throughout the world. Due to this high, although variable incidence, schizophrenia is a major cause of disability.

Is it OK to end a sentence with controlled for ?

even after factors such as drug use, ethnic group and size of social group have been controlled for. (yes - I'd say so and have seen in peer-reviewed journals)cheers, Cas Liber | talk | contribs 22:57, 26 May 2007 (UTC)

Would it work to change it to "even after controlling for factors such as ... ", just in case that sentence doesn't make it past the "prose experts"? SandyGeorgia (Talk) 13:41, 27 May 2007 (UTC)

Significant used twice in same sentence, and is this usage of significant used in the statistical sense or does it just mean "greatly"? If so, make clear and link to statistical significance. See WP:MEDMOS

Evidence suggests that the diagnosis of schizophrenia has a significant heritable component, although this may be significantly influenced by subsequent environmental factors or stressors which trigger or cause illness onset.

I found it linked in a later occurrence - others aren't clear:

A recent study of over 50,000 Swedish conscripts found that there was a small but significant protective effect of smoking ...

SandyGeorgia (Talk) 22:02, 26 May 2007 (UTC)

This text is redundant and can be tightened up and clarified; I'm not sure how to fix it, but I suspect both sentences can become one, with a semi-colon:

Particular focus has been placed upon the function of dopamine in the mesolimbic pathway of the brain. This focus largely resulted from the accidental finding that a drug group which blocks dopamine function, known as the phenothiazines, could reduce psychotic symptoms.

Seems fine to me. Not sure where the redundancy is. - Vaughan 22:34, 26 May 2007 (UTC)

Definition and defined three times in one sentence:

However, the exact definition of what constitutes recovery has not been widely defined, although criteria have recently been suggested to define a remission in symptoms.

Choppy sections are re-appearing, for example, Factors section has two sentences, as does High EE and Life expectancy and suicide — suggest combining them all to one section and generally streamlining the TOC, or the article will be criticized for choppy prose when/if it goes to FARC. Two sentences don't warrant separate sections. High EE as a section heading uses an abbreviation not known to everyone, in fact, never defined in the text, although expressed emotion can be deduced. SandyGeorgia (Talk) 22:21, 26 May 2007 (UTC)

Agreed. - Vaughan 22:34, 26 May 2007 (UTC)

Generally, the article is going to need an independent copyedit as soon as content is nailed down and referenced, and that will take a while. Is Outriggr (talk · contribs) still working on this, or do you all have someone else who might run through the article and tighten up the prose? It's coming up on two weeks at FAR soon. SandyGeorgia (Talk) 22:29, 26 May 2007 (UTC)

Umm..agree, but there is still some addition/omission/issue with content, so starting in the next 4-5 ddays may be a bit premature. cheers, Cas Liber | talk | contribs 22:55, 26 May 2007 (UTC)

WP:LEAD should be a compelling stand-alone summary of the entire article, summarizing rather than presenting anything not already covered in the text. I think there may be some text in the lead which is not covered in detail in the text, but probably should be. SandyGeorgia (Talk) 22:38, 26 May 2007 (UTC)

Agreed. I'd left it alone as the text still has some additions/omissions to go. Also some factual issues I have. In Australia (and the UK), only a doctor would officially confirm a diagnosis of schizophrenia though other health professionals would certainly suggest a diagnosis. I am not sure over how this works in the US.cheers, Cas Liber | talk | contribs 22:55, 26 May 2007 (UTC)

Clinical psychologists can make diagnoses in the UK and regularly do, but your general point about fact checking is well made. - Vaughan 23:00, 26 May 2007 (UTC)

[edit] Section break - diagnosis section

OK - i've organized section into diagnosis' (process/criteria) then controversies. The first two paras of controversies overlap quite a bit.

Looks good Cas. - Vaughan 23:17, 26 May 2007 (UTC)

thankyou. Can I leave the frist two paras to you?cheers, Cas Liber | talk | contribs 23:19, 26 May 2007 (UTC)

In principle, this would stop people being forcibly detained or treated simply for what they believe. - this sentence is untrue. There is such pressure on inpatietn beds that the opposite is true these days, i.e. numerous people at risk are released early or not admitted not the other way around.

Detention under a mental health act requires someone be dangerous to self or others secondary to symptoms, not just symptoms alone.cheers, Cas Liber | talk | contribs 23:19, 26 May 2007 (UTC)

In terms of Controversies, given it is a heterogeneous section, should it be instead divided into validity, and politics sections? or would these be too small? thoughts?cheers, Cas Liber | talk | contribs 23:23, 26 May 2007 (UTC)

It splits rather nicely into 2 4-5 para sections, and the neurocog stuff can go under thge diagnosis bit.cheers, Cas Liber | talk | contribs 23:24, 26 May 2007 (UTC)

Actually, the last para is probably redundant and largely incorrect and emotive in writing (apart from the first sentence which is good and could slot in nicely into the first paraas way of part of an intro in controversies section. thoughts? cheers, Cas Liber | talk | contribs 23:30, 26 May 2007 (UTC)

[edit] last para removed

The more I read this the less sense it actually makes to me and is just plain incorrect:

Western psychiatric medicine tends to favor a definition of symptoms that depends on form rather than content (an innovation first argued for by psychiatrists Karl Jaspers and Kurt Schneider).^[1] Therefore, a subject should be able to believe anything, however unusual or socially unacceptable, without being diagnosed delusional, unless their belief is held in a particular way. In principle, this would stop people being forcibly detained or treated simply for what they believe. However, the distinction between form and content is not easy, or always possible, to make in practice (see delusion).

Issue:

context of beliefs is critical and the criteria allow for a belief in a cultural context which may otherwise be deemed delusional; this may include cults or peer groups as well as various religions. Furthermore part of the DSM criteria is about bizarre delusions (i.e. taking note of the content) - also, one must have the criteria as well as Social/occupational dysfunction not due to substance misuse/mood disorder/medical illness, so a nondistressing delusion in a normally functioning person doesn't count anyway.

Please add thoughts here before reinstating. cheers, Cas Liber | talk | contribs 13:35, 27 May 2007 (UTC)

Concur with removal. SandyGeorgia (Talk) 13:44, 27 May 2007 (UTC)

[edit] 2nd last para removed

The diagnostic approach to schizophrenia has also been opposed by the proponents of the anti-psychiatry movement, who argue that classifying specific thoughts and behaviors as an illness allows social control of people that society finds undesirable but who have committed no crime. They argue that this is a way of unjustly classifying a social problem as a medical one to allow the forcible detention and treatment of people displaying these behaviors, which is something which can be done under mental health legislation in most Western countries.^[2]

Issue:

This is now outdated as since the early 1980s the massive deinstitutionalisation means no-one gets admitted to hospital for very long if at all, and the case is far more that potentially dangerous or suicidal people are not admitted than non-dangerous people locked up for long periods. This is worldwide. What is more an issue is that many people currently in jail have an undiagnosed mental illness.cheers, Cas Liber | talk | contribs 13:41, 27 May 2007 (UTC)

Agree. SandyGeorgia (Talk) 13:45, 27 May 2007 (UTC)

PS: I should add that I feel Szasz's criticisms were interesting and very important for the time, but this particular section is 25 years out of kilter with current practice as the opposite now occurs.cheers, Cas Liber | talk | contribs 13:46, 27 May 2007 (UTC)

[edit] Para on Russian/Chinese political use of diagnostic term

I'm really conflicted on this one. It is clearly a political rather than medical diagnosis and there is a ton of good material about it, but part of me feels the link with the medical condition of schizophrenia per se is only tenuous, so is sort of tangential to the material of the rest of the article (like some sort of imposter). Anyway, musing here...Maybe better in political abuse of/by/with psychiatry page? cheers, Cas Liber | talk | contribs 13:50, 27 May 2007 (UTC)

[edit] Comprehensive

WP:WIAFA criterion (b) is "Comprehensive" means that the article does not neglect major facts and details. I'm listing items from both of the eMedicine articles on Schizophrenia (Gerstein and Frankenburg), and the NIH that may not be addressed comprehensively (please pardon me if they are covered and I missed them - I'm scanning fast here):

Paul S. Gerstein at eMedicine: (An ED physician, not a psychiatrist - some helpful bits but focussed on ED stuff)

• Diagnosis - requirement that syndrome must continue for at least six months (now in)
• Differential diagnosis is not covered, including confusion with bipolar, autism and other conditions. Diagnosis by exclusion. (Differential Dx is covered way down the bottom - not a bad list really)
• Spectrum concept and conceptualized as a broad syndrome rather than a single entity.
• Strong statements on prognosis that aren't reflected in the article: "a devastating disorder and has a profound impact on family, social, and occupational life".
• Insidious onset in half of patients; discussion of prodomal phase
• Lab studies necessary to rule out other conditions in Diagnosis section (positive lab results are pretty rare, but now in)
• Medication, lots of info can be taken from this article (not a bad list, some doses and things I'd disagree with but overall OK)
• There is no Prevention/Screening section (see WP:MEDMOS); some info here on deterrence/prevention
• This article has some info on Prognosis that discusses a "plateau" afer 5 years. (that's debatable and the course is so heterogeneous as to make the generalization pointless)

Frances R. Frankenburg at emedicine:

• Consists of "several separate illnesses" (spectrum is better)
• Are all of Lower rates of marriage, employment, and independent living mentioned?
• Are no known racial differences mentioned in Epidemiology? Cultural bias in black vs. white diagnoses.
• Symptoms remit in older patients, Most deterioration in first 5 to 10 years. (again, not necessarily true and so heterogeneous as to make the generalization pointless)
• Good description of basic signs and symptoms, under a section labeled History.
• Good section that can be used to write Differential diagnosis, in section called Other Problems to be Considered. (see below)
• Lab studies for ruling out other conditions for Diagnosis.
• Adverse effects to expect from medications (oho...there's a big one...)

NIMH, Schizophrenia, at www.nimh.nih.gov/publicat/nimhschizophrenia.pdf It is public domain, and can be used verbatim: suggest review of entire document for comprehensive needs, as you can lift any text you want from this article without permission. The sections are also easily organized to agree with our sections, so you can see if wer'e missing anything important.

• Definitions of positive and negative symptoms
• Three broad categories for signs and symptoms (we only have two, and we don't mention Cognitive symptoms) (Cognitive symptoms are very general and not diagnostic though there are some specific patterns they are not used clinically for diagnosis)

• Adherence to treatment - do we cover ? (yes, partly)
• Good section on psychosocial treatment, this article could almost be used to take entire Treatment article.

SandyGeorgia (Talk) 23:06, 26 May 2007 (UTC)

There is certainly some good information in these documents but I don't think we should get too enthusiastic about using them as sources to match our article against. I could put you towards any number of psychiatry textbooks or books on schizophrenia itself which would cover different areas from these documents. Please also note that both of these texts are specifically based on US critieria and have some of their own assumptions and interpretations of the literature. - Vaughan 23:14, 26 May 2007 (UTC)

Agreed, but it gives some areas you can examine for comprehensiveness (like treatment). My sense is that there are areas of this article that still need expansion. SandyGeorgia (Talk) 23:16, 26 May 2007 (UTC)

Most of us in psychiatry were taught the Amercians were more inclusive in what hey called schizophrenia than the british or Australians, but I don't know if that is referenced as such.cheers, Cas Liber | talk | contribs 23:21, 26 May 2007 (UTC)

This certainly was the case, but was addressed by the tightening of criteria after the US-UK diagnostic study. See PMID 4926366 - Vaughan 07:59, 27 May 2007 (UTC)

Vaughan, for those of us not that well versed in schizophrenia, can you explain what changed/when/why, maybe with a sentence or two in the History or Diagnosis section? (Probably History, since you seem to indicate it was 1971, based on the PMID?) In general, differences and similarities between DSM/ICD need to be understood, if there are any. A summary of ICD criterion for schizophrenia would be good, as well as sorting out the subtype paragarph. In the territory I know best (Tourette syndrome), ICD and DSM are essentially identical, so I'm never sure how they may differ in other conditions, and we have to be sure to give them equal play. SandyGeorgia (Talk) 13:49, 27 May 2007 (UTC)

I can add that DSM IV TR is used much more widely than ICD10..cheers, Cas Liber | talk | contribs 23:21, 26 May 2007 (UTC)

Even outside the US? Why? Is there an issue with the ICD definition (my bias show: I don't like the ICD :-)  ? (I haven't yet read the article changes, so ignore this if you already said :-) SandyGeorgia (Talk) 13:51, 27 May 2007 (UTC)

Dunno, DSM is easier to tick boxes of symptoms in whereas ICD can be more vague. This is a big issue in medicolegal cases, and prescription of expensive drugs where Authority is required. Have to look into this sometime (we all use DSM in Oz, never ICD)cheers, Cas Liber | talk | contribs 13:55, 27 May 2007 (UTC)

Ah, I see. I took out a statement yesterday about expensive drugs; maybe you want to add something back in, but as I recall, it wasn't cited or related to the text ? SandyGeorgia (Talk) 14:38, 27 May 2007 (UTC)

The US-UK diagnostic study was one of the major motivations for the creation of the DSM-III, which brought in the 'algorithmic' diagnostic mechanism, rejected a lot of the psychoanalytic terminology which formed the basis of many of the diagnoses, and made the criteria more closely match the ICD criteria. Actually, there's little substantial difference between the diagnostic descriptions between the DSM and ICD, perhaps except that the ICD puts more emphasis on the significance of 'first rank' symptoms, and includes some additional subtypes (e.g. F20.6 'simple schizophrenia') that were not included in the DSM. As demonstrated by a recent study that compared the DSM and ICD diagnoses, in practice, they're virtually identical and show high diagnostic agreement (Kappa = 0.87; PMID 16195122).

The ICD is use extensively in Europe, although it is not uncommon for research studies to use DSM criteria to fall in line with US research - Vaughan 14:36, 27 May 2007 (UTC)

Thanks, Vaughan; can some of this context be added to the article? SandyGeorgia (Talk) 14:38, 27 May 2007 (UTC)

[edit] Highlighting

I notice some key words are higlighted with italics, others with boldface. Is there a guideline for this, or should we just decide on one for consistency? - Vaughan 09:27, 28 May 2007 (UTC)

Yes, there is a guideline, and it is currently being tightened up to address the messy bolding going on throughout Wikipedia. See WP:MOS and WP:MOSBOLD. SandyGeorgia (Talk) 12:52, 28 May 2007 (UTC)

Related note; you might want to run through WP:MEDMOS at some point to pick up anything that might apply and/or need to be addressed (particularly in terms of comprehensive, which is becoming my main concern about the article as the citations are being addressed. Has anyone added info on differential diagnosis yet?) SandyGeorgia (Talk) 12:55, 28 May 2007 (UTC)

Yep, Cas added some great info on medical tests to discount other possible causes. I'll add some stuff on the different diagnostic systems - Vaughan 12:58, 28 May 2007 (UTC)

Great ! SandyGeorgia (Talk) 13:01, 28 May 2007 (UTC)

[edit] Causes section

I've removed the 'tobacco' paragraph from the causes section as this seemed mostly to be about prevalence and interactions, rather than causes. Also it's repeated in the main 'causes' article. Furthermore, I've added an 'environmental' section which needs expanding a little. - Vaughan 10:11, 28 May 2007 (UTC)

I'm glad you did that with the tobacco - will have a look at environmental.cheers, Cas Liber | talk | contribs 11:04, 28 May 2007 (UTC)

That was one of my questions when I did the summarizing. I left it there because there was one small portion of it that did mention causes. If the whole thing is deleted from Causes (and doesn't all pertain to causes), where can tobacco be mentioned in the article? If it's not Causes, then it doesn't actually belong in Causes of schizophrenia either, no ? SandyGeorgia (Talk) 12:54, 28 May 2007 (UTC)

It's one of those things which is an interesting observation and probably has some relevance to various hypotheses of receptor abnormalities proposed in schizohprenia. The real problem is that the coverage of subpages is pretty patchy currently. I'd leave it at causes at the moment and it can be hived off or noted elsewhere. Maybe a note in hte editspace..cheers, Cas Liber | talk | contribs 13:03, 28 May 2007 (UTC)

[edit] Chomped paragraph from prognosis section

I've removed the following from the 'prognosis' section for discussion:

Just as the clarity of the diagnosis itself attacts controversy and criticism, it is difficult to establish a clear picture of recovery and rehabilitation. Both long ago and in the recent past, patients in developed countries were told that chances of recovery were limited, with statistics being quoted to support this negative prognosis. Today, with the advent of a vocal "Recovery Movement" in mental health, and longitudinal studies indicating better rates of recovery than previously assumed, attention is drawn to cultural and local factors in impeding or accelerating recovery and different models of rehabilitation and recovery.^[3][4]

It seems to talk about recovery models, but not about prognosis. Like the 'tobacco' information, this was originally in a more generally titled section, where it live quite happily. Personally, I'm ambivalent about keeping it, but I think we need to keep an eye on this sort of 'orphaned' information to make sure we don't lose any good stuff - Vaughan 14:26, 28 May 2007 (UTC)

Agree, I was musing on removing it as this information is touched on elsewhere.cheers, Cas Liber | talk | contribs 14:42, 28 May 2007 (UTC)

Great work happening here; glad to see it picking up steam! Since I won't be around a lot of this week, I just wanted to give you all a heads up on how FAR works. Don't be alarmed if the article gets moved to FARC just to keep it on track as work progresses (articles are moved down at two weeks, unless they are very close to finished). The FARC period can be extended longer than two weeks, and always is if work is ongoing, but Marskell likes to keep articles on track timewise by moving them down from review to FARC. If he does that, it does NOT mean the article will automatically be FARC'd, so don't worry. Just post a note that work is ongoing, and if more time is needed, post a note later to that effect, and reviewers will hold off on opining whether to Keep or Remove. SandyGeorgia (Talk) 14:54, 28 May 2007 (UTC)

[edit] See Also Section

I thought these were generally frowned upon in FAs these days. I am reviewing these to see how they can be incorporated into the text. Already I have incorporated thought disorder into the lead. All input appreciated. cheers, Cas Liber | talk | contribs 04:50, 31 May 2007 (UTC)

• Tardive dysphrenia - currently an isolated link. I've never heard the term though I am familiar with the idea. It is not a DSM diagnosis, what do we want to do with it? cheers, Cas Liber | talk | contribs 05:09, 31 May 2007 (UTC)

• Schizoid personality disorder - it is schizotypal personality which is linked to schizophrenia not this one. I can't see why this should be here. removed. cheers, Cas Liber | talk | contribs 05:09, 31 May 2007 (UTC)

• Biopsychiatry controversy - can't this be linked somewhere in the critique? linked near top of diagnostic controversies section now.

The last three maybe need a note on each as to why they are significant or they should not be in the article. Given how big the article is I am in two minds, maybe some section on personal experiences (?)cheers, Cas Liber | talk | contribs 05:09, 31 May 2007 (UTC)

• Interpretation of Schizophrenia (book)
• The Eden Express
• Soteria

I think the Eden Express and books belong in the other reading section under Personal Accounts JonesRD_talk 15:39, 31 May 2007 (UTC)

Yep. All incorporated into text. cheers, Cas Liber | talk | contribs 12:05, 2 June 2007 (UTC)

[edit] Table for Good/Poor Prognostic indicators

There is a list of factors which portend a good or poor outcome. At the moment this section is stubby. We can either expand it as a listy paragraph or have a table. thoughts? cheers, Cas Liber | talk | contribs 05:00, 31 May 2007 (UTC)

[edit] Differential Diagnosis Section

I can whip up a few sentences on differential diangoses - do we want one somewhere in the diagnosis section? cheers, Cas Liber | talk | contribs 05:10, 31 May 2007 (UTC)

Yes, that would be a good place for it. JonesRD_talk 15:37, 31 May 2007 (UTC)

Done, but I need to get some refs methinkscheers, Cas Liber | talk | contribs 21:34, 2 June 2007 (UTC)

[edit] Contents, are we happy with how it stands?

OK, I've added and subtracted what I feel is the necessary, apart from discussion on a table for prognostic issues above. Now are we happy with the content and time to start copyedit and lead?cheers, Cas Liber | talk | contribs 21:36, 2 June 2007 (UTC)

It seems more or less there to me. Actually, I want to add a little in the epidemiology section but I think a copyedit and read through will also do much good in picking up on gaps as well. There's still some minor checking of references to be done as well. - Vaughan 22:45, 3 June 2007 (UTC)

[edit] Gamma band paragraph

I've removed the following paragraph as it's a very specific finding and seems a lot of text for a single study:

Electroencephalograph (EEG) recordings of persons with schizophrenia performing perception oriented tasks showed an absence of gamma band activity in the brain, indicating weak integration of critical neural networks in the brain.^[5] Those who experienced intense hallucinations, delusions and disorganized thinking showed the lowest frequency synchronization. None of the drugs taken by the persons scanned had moved neural synchrony back into the gamma frequency range. Gamma band and working memory alterations may be related to alterations in interneurons that produced the neurotransmitter GABA.

- Vaughan 22:39, 3 June 2007 (UTC)

Agree. cheers, Cas Liber | talk | contribs 03:09, 4 June 2007 (UTC)

That is fine with me too. DPeterson^talk 13:11, 4 June 2007 (UTC)

[edit] So beginneth the almighty copyedit

This sentence: ..characterized by impairments in the perception or expression of reality, most commonly manifest as auditory hallucinations, paranoid or bizarre delusions or disorganized speech and thinking in the context of significant social or occupational dysfunction... strikes me as ungainly. We need to figure out how to rewrite. Maybe just the descriptive bit as this is the lead - i.e. just the symptoms?

I also think the lead can be reorganised into 3 paras as this then leaves the first one looking slim. Or we can add some stuff. eg. mention 3 subtypes.cheers, Cas Liber | talk | contribs 21:00, 5 June 2007 (UTC)

And the whole lead is without sources.--Svetovid 22:55, 5 June 2007 (UTC)

Lead doesn't need sources as it summarises points in the rest of the article (where refs are)cheers, Cas Liber | talk | contribs 23:39, 5 June 2007 (UTC)

Although the old intro was a bit clumsy, it was accurate. Take the new lead:

"The mental disorder Schizophrenia (from the Greek word σχιζοφρένεια, or schizophreneia, meaning "split mind") is a psychiatric syndrome..."

As the article notes, there is no agreement that schizophrenia is a syndrome, and some disagree that it is a mental disorder. Describing schizophrenia as a 'psychiatric diagnosis that describes a mental illness characterized by...' is acceptable to everyone, regardless of your views on the diagnostic validity. - Vaughan 06:17, 6 June 2007 (UTC)

I would say illness implies a discrete entity and syndrome a collection of symptoms, which it essentially is. How do you feel about the third clause and reality testing?cheers, Cas Liber | talk | contribs 07:49, 6 June 2007 (UTC)

You could say that all illnesses are a collection of symptoms as that's how they are defined. The question is over whether there is a core pathological process that gives rise to the various symptoms (discrete disorder) or a number of pathological processes that tend to occur together (syndrome). This is currently a matter of debate (e.g. see PMID 15995899), although I would agree with you in that I consider it a syndrome. However, I think the article should reflect the neutral position, i.e. provide a descriptive rather than an explanatory definition, and leave the explanation for further down. Third clause seems OK to me, but could possibly do with a bit of stylistic tweaking if needed - Vaughan 08:27, 6 June 2007 (UTC)

Yeah, when I thought of what it is in DSM IV I realised that diagnosis is the most accurate term currently...cheers, Cas Liber | talk | contribs 08:38, 6 June 2007 (UTC)

[edit] differential diagnosis

"Rarely, medical illnesses may manifest with psychiatric symptoms and so investigations are undertaken to rule out a large number of conditions.[citation needed] Once a delirium or other organic condition is ruled out, there are several psychiatric conditions which may present with psychotic symptoms. Regardless of cause, antipsychotics are the acute treatment of choice for psychotic symptoms although ones with minimal anticholinergic activity, such as haloperidol or risperidone are preferable if a delirium is suspected."

ummm... what? this doesn't make any sense. would there be objections if i deleted this (and replaced it with different content) or does this actually mean something to someone? ~[[kinda]] 01:41, 6 June 2007 (UTC)

Yes it does. I will lsit the points and am happy to see if you think it can be rephrased better:

• Most of the time someone presents with psychotic symptoms it is schizophrenia or some psychosis of a shorter duration (eg drug induced etc.). Rarely a medical condition such as thyroid dysfunction, vitamin B12 deficiency, neurosyphilis, cerebral manifdestation of an AIDS related illness or some other condition may mimic psychotic symptoms. This is why baseline investigations are done when someone presents for the first time with psychioatric symptoms.

• With psychosis or delirium - the treatment involves antopsychotics (the one exception is alcohol withdrawal which is treated with valium)

• Though in delrium it is beter to use haldol or risperidone (actualy I could leave this out)

How's that? (yeah is a bit muddled isn't it) cheers, Cas Liber | talk | contribs 02:47, 6 June 2007 (UTC)

Casliber, that's ok...what about this:

In rare instances, medical illnesses may manifest with psychiatric symptoms. These conditions may include delirium or organic conditinos. Once an organic condition is ruled out, there are several psychiatric conditions which may present with psychotic symptoms, such as Schizophrenia (maybe list others?. Regardless of cause, antipsychotics are the acute treatment of choice for psychotic symptoms although ones with minimal anticholinergic activity, such as haloperidol or risperidone are preferable if a delirium is suspected.

JonesRD_talk 14:00, 6 June 2007 (UTC)

Great. We'll take one para please :) cheers, Cas Liber | talk | contribs 14:05, 6 June 2007 (UTC)

is "psychiatric" in the first sentence supposed to be "psychotic?" also, the treatment information seems misplaced... ~[[kinda]] 18:22, 6 June 2007 (UTC)

[edit] FAR update

Is anyone planning to address the last comments I made on the FAR four days ago? Also, how much more time is needed to finish up after those items are reviewed? SandyGeorgia (Talk) 14:10, 9 June 2007 (UTC)

I have no idea where the others are. If it is just me it'll be about a week I think (honestly not optimistically)cheers, Cas Liber | talk | contribs 21:21, 9 June 2007 (UTC)

I've been away for a week, but am now back. I can happily add a little on screening and prevention, although this is a relatively new field and still somewhat embryonic (see 'prodrome / at-risk / ultra-high-risk mental state' work) so it probably doesn't warrant a great deal, but worth adding. Will have a look through the FAR and see what still needs addressing. Great work by the way Cas - Vaughan 11:15, 11 June 2007 (UTC)

OK - to update - we need a Prevention/Early Psychosis/Prodrome etc. section, and a section on neurocognitive/frontal lobe' subsection in pathopyshiology. Anything else? cheers, Cas Liber | talk | contribs 23:26, 11 June 2007 (UTC)

[edit] 2 heterogeneous problem sections

Actually in terms of content I am thinking of alternate ways of organizing Diagnostic issues and controversies which cotains 3 distinct ideas - 1st is casting doubt on diagnosis with some political overtones, 2nd is neurocognitive stuff (which I wonder may be better elsewhere as it isn't a controversy as such but a development of recent work into the coginitive deficits in scz which psychiatry is well aware of, and 3rd is the political abuse stuff (Russia/China). Neurocoginitive stuff could be moved from here into either diagnosis or pathophysiology where they could come after discussion of frontal lobe underactivity. Sound good?

I'd be concerned if this section was removed or dissolved into other sections, as it is a significant area of debate in both the academic and non-academic literature. I've no problem with the political overtones, as psychiatric diagnoses has a social as well as a medical function and has been the subject of much discussion. The neurocognitive stuff is indeed an extension of the work into neurocognitive deficits but is also being used as a basis for arguing against the current diagnostic criteria (e.g. see the work on latent inhibition, PPI, non-affected family members, schizotypy and the continuum model of psychosis). Also, from experience, if this section ceases to exist you'll just get lots of people adding an 'arguments against schizophrenia' section without bothering to track down the relevant information in the other sections. - Vaughan 09:23, 12 June 2007 (UTC)

Actually on second thoughts if the neurocog stuff goes to pathophysiology then the rest makes for a more cohesive section.cheers, Cas Liber | talk | contribs 10:06, 12 June 2007 (UTC)

The 2nd section is the Alternative approaches section. This starts with alot of social theory and antipsychiatry stuff, then Soteria (which could feasibly go in treatment), shaman, diet stuff, and cognitive remediation. I'm at a bit of al loss with this. cheers, Cas Liber | talk | contribs 23:25, 11 June 2007 (UTC)

I think this section desperately needs a cleanup, but I think it's a good focus for the theories that might not be mainstream, but still have a significant following. - Vaughan 09:23, 12 June 2007 (UTC)

[edit] Diagnosis or disorder?

Hello. The lead section defines schizophrenia as a "psychiatric diagnosis". Wouldn't the term "mental illness" be more accurate? After all, one is hopefully suffering from schizophrenia before one is diagnosed with it. I would change it myself, but the article appears to be protected. Regards. 195.137.96.79 00:08, 13 June 2007 (UTC)

The reasons it describes schizophrenia as a diagnosis is that it is not agreed that the diagnosis represents a discrete or unitary mental illness. In fact, it is possible for two people who share no symptoms in common to be diagnosed with schizophrenia. Some disagree that the diagnosis necessarilly represents a mental illness at all. Actually, I think it should note that the diagnsis is intended to represent a mental illness - will edit this in a sec. - Vaughan 08:09, 13 June 2007 (UTC)

I like that, it is a diagnosis for a mental illness or disorder. Very nice work so far. RalphLender^talk 16:54, 13 June 2007 (UTC)

Yes, this article is really progressing nicely; Vaughan and Cas liber have done a very nice job. Almost there; don't forget to give feedback on the FAR as to when you consider it all finished. SandyGeorgia (Talk) 17:56, 13 June 2007 (UTC)

Indeed. This is an excellent article, and thanks for responding to my point so well. Regards to all 195.137.96.79 21:28, 13 June 2007 (UTC)

Sandy, as you're a bit more familiar with the criteria, could you perhaps note which areas are still in need of attention? Many thanks - Vaughan 10:52, 14 June 2007 (UTC)

I haven't followed closely this week, because the article is in such competent hands that my input isn't needed that much. If all of the citation tags are gone, and you all consider the article mostly ready, I like to do my final review on a printable version, as I see things in hard print I don't see on the screen. Are we to that stage now? Is everything cited? If so, I'll print and review, but I suspect it's just about there. (What a nice job you all have done.) SandyGeorgia (Talk) 14:45, 14 June 2007 (UTC)

There's a few more citations to sort. Notably the paragraph in treatment starting "Treatment-resistant schizophrenia is a term used for the failure of symptoms to respond satisfactorily to at least two different antipsychotics..." needs referencing, plus the citation tag on ECT treatment section. I've had a look and I've found plenty on the use of ECT to treat catatonia, but no controlled trials to support the statement that it is 'most effective where symptoms of catatonia are present'. However, I haven't looked in enough depth yet, but if anyone has any relevant citations to hand, do include them. After that, I think your review would be ideal Sandy. - Vaughan 15:03, 14 June 2007 (UTC)

Got one for Treatment-resistant schizophrenia.cheers, Cas Liber | talk | contribs 20:41, 14 June 2007 (UTC)

....where does the PMID: 9524789 go in the citation template??cheers, Cas Liber | talk | contribs 20:47, 14 June 2007 (UTC)

You use the pmid paramater.--Rmky87 21:03, 14 June 2007 (UTC)

Yup, got it now :)cheers, Cas Liber | talk | contribs 21:05, 14 June 2007 (UTC)

[Here] is something about ECT and catatonia. Catatonia is pretty rare these days so I doubt there's much in the way of controlled trials on it. I couldn't get anything to come up on Cochrane.cheers, Cas Liber | talk | contribs 21:05, 14 June 2007 (UTC)

I began sifting through the Further reading text to see how various ones could be incorporated into the main article. e.g. the personal book by Anne Deveson into book bit. Thought of other things like French Film Betty Blue but it isn't clear to me whether the character has BPD or schizophrenia....

[edit] Ref to be sorted out

I tagged a ref which is goofed up; the source given is ^ Luc Ciompi, MD, Switzerland: The Soteria-concept. Theoretical bases and practical 13-year experience with a milieu-therapeutic approach of acute schizophrenia, but I find PMID 9396381 Can anyone verify the text and figure out what the correct ref is (or remove the text)? SandyGeorgia (Talk) 16:11, 13 June 2007 (UTC)

Hi Sandy, I've removed the text as it's a Japanese journal that doesn't seem accessible online. If anyone can verify it, it's probably worth re-including it, but I don't think the articles misses much without it. - Vaughan 16:43, 13 June 2007 (UTC)

[edit] Miscellaneous notes

• (I don't know what "received wisdom" is. Perceived wisdom? "they have been shown"? how about, just ... it varies across the world ...) Despite the received wisdom that schizophrenia occurs at similar rates throughout the world, they have been shown to vary across the world,[46] within countries,[47] and at the local and neighbourhood level.[48] SandyGeorgia (Talk) 21:37, 14 June 2007 (UTC)

Received wisdom is a common term like "common knowledge" though in this instance could be considered pretty fluffy.cheers, Cas Liber | talk | contribs 00:48, 15 June 2007 (UTC)

Who knew :-)  ? SandyGeorgia (Talk) 01:02, 15 June 2007 (UTC)

I started reading, and the first two sections have been very rough going. I hope editors will print out the article and read it through with a big red pen, to pick up inconsistencies or copyedit needs. I'll leave notes and questions here as I go; please check all of my ce changes to the article, and revert any that are incorrect.

• First, I deleted the statement from the lead about five subtypes, because it introduces partial detail, but then leaves us hanging as to what the subtypes are about. Best not to get into that detail in the lead, unless it can be succinctly summarized and the thought completed.
• "One of the more consistent findings is the overactivity of the receptor dopamine in mesolimbic pathway of the brain." Does this mean to be "the mesolimbic pathway" or "mesolimbic pathways"? I changed it to "the".

Correct cheers, Cas Liber | talk | contribs 00:48, 15 June 2007 (UTC)

• There is a very confusing mixture throughout of single quotes, double quotes, and italics, and it's not clear why the three different methods are employed. The entire text should be reviewed per WP:MOS#Italics and WP:MOS#Quotation_marks. It looks like words should be italicized, and I'm not clear why single and double-quoting of some words are used (see in particular the lead and History; I haven't gotten any further yet).

• I think the definition of the word schizophrenia is mentioned three different times, two different ways. Why not get it all up front in the lead and be done with it?

• Too many sentences start with although; I've changed a few, but based on the high number in the lead and History, this should be reviewed throughout. (At one point, I found two consecutive sentences starting with although.) SandyGeorgia (Talk) 22:52, 14 June 2007 (UTC)

• I don't know what to do with this at all:
  • The diagnostic description of schizophrenia has changed over time. It became clear after the 1971 'US-UK diagnostic study' that schizophrenia was diagnosed to a far greater extent in America than in Europe. This was partly due to the difference in diagnostic systems with respect to their criteria for schizophrenia, with the US using the DSM-II manual and Europe the ICD-9. This was one of the factors in leading to the revision not only of the diagnosis of schizophrenia, but the revision of the whole DSM manual, resulting in the publication of the DSM-III.
• First, there's again the strange issue throughout of single and double quotes versus italics, which I can't figure out how to sort out per WP:MOS. The 'US-UK diagnostic study' is mentioned, but the reference is to a paper with another title; perhaps this is an informal name it has come to be known by, but the unitiated don't know that. Otherwise, the reader has no idea what that study is. Next we are told about differences in diagnostic systems, but are given no idea (at least a brief overview) of what those differences may be which led to less diagnoses in the Europe. Then we're told this was one factor (with no mention of other issues, so we don't know if it was the main factor, well, we just don't know what the issue was at all) that led to a DSM revision, but we're given no idea what the revision involved. In other words, this entire passage may make sense to those steeped in and familiar with the schizophrenia literature, but it gives no clue to the unitiated. A few more words, phrases, or explanations will help out the novice, first-time, or lay reader.

Essentially it evolved - Americans had looser criteria than other countries and hence diagnosed schizophrenia more often. Criteria were later tightened and streamlined in 70-71. Since then there has been some shifting of goalposts with the creation of schizophreniform psychosis to describe a more episodic psychotic illness with a better outcome. I have wondered about this passage myself

But what specifically was looser in the US? What exactly were they doing differently on each side of the pond? SandyGeorgia (Talk) 01:02, 15 June 2007 (UTC)

Essentially folk were diagnosed with schizophrenia in the US who would not have qualified for teh diagnosis in the UK. I can't remember exactly which criteria differed though.cheers, Cas Liber | talk | contribs 01:04, 15 June 2007 (UTC)

That's as far as I got for now; it gives an example of the kind of attention needed throughout. Taking a merciless red pen to a printout may be helpful, keeping the novice as well as the expert reader in mind. SandyGeorgia (Talk) 23:06, 14 June 2007 (UTC)

• I can't decipher this:
  • Some symptoms, such as social isolation, may be caused by a number of factors. One possible factor is impairment in social cognition, which is associated with schizophrenia, but isolation may also result from an individual reacting to psychotic symptoms (such as paranoia) or avoiding potentially stressful social situations which may exacerbate mental distress in some people.
• Is social isolation a symptom or a consequence/reaction? Is one diagnosed with schizophrenia based on social isolation? Social cognition is associated with schizophrenia, or a deficit in social cognition is associated with schizophrenia? This is the first mention of paranoia, but it's not wikilinked or defined in the context of schizophrenia. The whole thing is just confusing, partly because terms are presented before they're defined, and partly because concepts aren't made clear to the novice reader. It may be easier if I add inline comments from here on in; do you all know how to read, then correct and delete inline comments if I leave them that way? SandyGeorgia (Talk) 23:20, 14 June 2007 (UTC)

It is not a symptom as such but a common feature I guess - with several factors potentially contributing to it as listed. this could be reworded a bit.cheers, Casliber (talk · contribs) 13:40, 15 June 2007 (UTC)

• Prodromal was not wikilinked; a complete runthough to make sure terms are defined or wikilinked on first occurrence is needed. SandyGeorgia (Talk) 23:22, 14 June 2007 (UTC)

• Hello, especially to Sandy, who knows I never really leave...a couple of comments:
  • What can we do to make the experience of schizophrenia clearer? "Signs and symptoms" touches the usual bases - there must be respected sources that describe a sufferer's account. For a mental illness with so much confusion surrounding it, this seems vital to a full treatment of the subject.
  • Copyediting... I can assist if you are at that stage. I have difficulty not calling patients "patients" and schizophrenics "schizophrenics" (we'd say "sufferers" for athlete's foot but better not say it here?)—to avoid this "directness", the usual approach is to slip into passive voice, leave the subject hanging from a previous sentence ("Many avoid potentially stressful social situations which may exacerbate mental distress in some people"—except the last subject was symptoms!), all of which get clumsy. –Outriggr § 05:49, 17 June 2007 (UTC)

It's important to be careful with language for the sake of accuracy and good style. Primarily, the term 'schizophrenic' as applied to a person is becoming increasingly depreciated as it defines a person by their condition. Notably, this is a trend across the board according to international guidelines on writing about disability, so it's worth avoiding talking about 'diabetics', 'schizophrenics' and so on. Also, 'sufferer' implies the person is suffering, which may not be the case in schizophrenia. In fact, they may positively delight in their psychosis, even if they are disabled by it. Furthermore, some people diagnosed with schizophrenia may lead a full, unimpaired, distress-free and / or symptom-free life. Describing all people with schizophrenia as suffers is inaccurate and possibly stigmatising. 'Patient' should only be used where the person being described is under medical care. Notably, this may not be the case in many studies relevant to schizophrenia as they might deal with never-treated or prodromal participants, or psychosis-like experiences in healthy participants. - Vaughan 17:03, 17 June 2007 (UTC)

Thank you for clarifying all this. I hope you don't think I was being glib, as my first bullet point was asking about including accounts of the experience of schizophrenia, not something I'd likely inquire on if I had some simplistic concept about "schizophrenics".[3] I was suggesting that "sufferer" is a word commonly used to refer to anyone with a disease state (in certain contexts), whether or not they're "suffering". The implicit question was, I wonder what one does write instead of "schizophrenic", "patient", and so on? Are we reduced to writing "a person who has been diagnosed with schizophrenia" over and over?... –Outriggr § 03:05, 18 June 2007 (UTC)

Well, I can see now that maybe I did sound glib. I didn't mean for this phrase to come out like it did: "I have difficulty not calling... schizophrenics 'schizophrenics'". It was a rhetorical device, I guess, a roundabout way of asking what is a reasonable way of referring to "a person diagnosed with schizophrenia" while still writing well. I'm sorry. If somebody quoted me on the above phrase—I didn't intend it to come out that way—I'd be aghast! –Outriggr § 03:26, 18 June 2007 (UTC)

Yeah tricky - "people with schizophrenia" mixed with liberal pronouns is about the best way to go..cheers, Casliber (talk · contribs) 05:22, 18 June 2007 (UTC)

Hi Outiggr, I don't think you sounded glib, but were just highlighting an important and tricky point about prose style which is one of the challenges about writing about complex medical and social phenomena. - Vaughan 07:59, 18 June 2007 (UTC)

[edit] Catatonia, ECT

Per PMID 15774232 I'm removing this passage to here until it can be sourced:

• reffed now and moved back

So, the article is now fully sourced. SandyGeorgia (Talk) 04:47, 17 June 2007 (UTC)

[edit] Inconsistent hyphens

Is it hyphenated or not? Schneider's first-rank symptoms is hyphenenated in the article, but not in Schneider's article. SandyGeorgia (Talk) 17:03, 17 June 2007 (UTC)

Both are used freely in the medical literature. - Vaughan 17:09, 17 June 2007 (UTC)

But within Wiki articles, we should be consistent. We can't have a hypenated version linking to a non-hypenated version. Tony1 just extensively reworked WP:MOS to cover hyphens; someone who understands grammar better than I might review that and consult with Tony1 (talk · contribs) if needed. In fact, I'll leave him a note. SandyGeorgia (Talk) 18:04, 17 June 2007 (UTC)

When I changed that one, I consulted external usage and found the same as Vaughan. Since that leaves us free to choose either, we should choose the hyphenated version, which is syntactically correct. –Outriggr § 03:10, 18 June 2007 (UTC)

I agree with both of these points. Internal consistency is the way to go. - Vaughan 08:01, 18 June 2007 (UTC)

I have no strong opinion. Happy to go with the flow.cheers, Casliber (talk · contribs) 08:10, 18 June 2007 (UTC)

I'd hyphenate it; it's much easier to read that way, especially for those unfamiliar with the term/topic; and maybe there's such a thing as "rank symptoms". Tony 07:33, 19 June 2007 (UTC)

[edit] FAR complete and congratulations all round!

I just noticed the article passed the Featured Article Review. Just a note of thanks to everyone for the great teamwork and especially to Sandy for her watchful eye and skilfull co-ordination, and Cas for his informed and erudite prose. - Vaughan 13:38, 24 June 2007 (UTC)

OK, now to make Bipolar Disorder like this one then....cheers, Casliber (talk · contribs) 14:34, 24 June 2007 (UTC)

Good. DPeterson^talk 15:50, 24 June 2007 (UTC)

[edit] Strange sentence

"No one sign is diagnostic of schizophrenia, and all can occur in other medical and psychiatric conditions.[16]"

The whole thing before the comma is just horrible... :) Seigneur101 16:07, 26 June 2007 (UTC)

How about "No single sign" then....cheers, Casliber (talk · contribs) 21:19, 26 June 2007 (UTC)

[edit] Alzhiemer's disease only affecting older people?

The statement grabbed from the schizophrenia article should be changed from:

"Kraepelin believed that dementia praecox was primarily a disease of the brain,[6] and particularly a form of dementia, distinguished from other forms of dementia, such as Alzheimer's disease, which occur late in life.[7]"

To this:

"Kraeplin believed that dementia praecox was primarily a disease of the brain,[6] and particularly a form of dementia, distinguished from other forms of dementia, such as Alzheimer's, which is a degenerative brain disorder.[7]"

I dispute the fact presented that Alzheimer's affect only older people and thus can be discriminated with regards to age see reference below:

http://www.alzheimers.org.uk/Younger_people_with_dementia/Information/info_ypwd.htm

There are many more references that state Alzheimer's affects both older and younger people.

So instead state something like Alzheimer's the degenerative brain disorder that eventually causes death compared to schizophrenia the idea of a certain type of dementia that is not as degenerative as alzhiemer's. Or as above. Use data that is more up to date with current findings please!

Drugged monkey 11:39, 30 June 2007 (UTC)

In this case "younger" means younger than 65 which is somewhat different to what most would understand by the term (which in this case is late teens to mid twenties)- and, yes, Alzheimers is a degenerative disease.cheers, Casliber (talk · contribs) 11:43, 30 June 2007 (UTC)

It is rare but people in their 30's and I would still think that people think that a fairly young age.

http://www.mentalhealth.com/mag1/p5m-alz1.html

"Onset in the most severe form associated with the new gene can appear as early as age 30." In regards to getting Alzheimer's disease.

http://findarticles.com/p/articles/mi_m0BJI/is_17_30/ai_66168799 states that "Alzheimer's Disease Can Strike by Age 20".

Hence Alzheimer's can strike at a young age. From the second article research suggested that those with Alzheimer's at this younger age did poorly with regards to education. So Alzheimer's has the potential to strike early and would thus be hard to differentiate between schizophrenia if age were the only deciding factor. Because Alzheimer's is degenerative and its effects have been studied it can be differentiated from schizophrenia.

Thus changing the original quote..."Alzheimer's disease, a fast brain degenerative disease" or comparing it to dementia instead perhaps.

This is not to say that you didn't do a good job on the page. Just wanted to make it more accurate and up to date with current research.

Cheers,

Drugged monkey 11:51, 30 June 2007 (UTC)

Hi there,

Your revised sentence is certainly accurate based on what we know today, however it's important to include information about the late / early distinction as it describes why the original name ('dementia praecox') stuck, and why it was later changed. I've now changed the sentence (added the world 'typically' as a qualifier) to make it more accurate based on your point above and also include the late / early distinction:

Kraepelin believed that dementia praecox was primarily a disease of the brain, and particularly a form of dementia, distinguished from other forms of dementia, such as Alzheimer's disease, which typically occur later in life.

- Vaughan 11:56, 1 July 2007 (UTC)

Point taken - this is still extremely rare though, but "typically" fits nicely. cheers, Casliber (talk · contribs) 18:10, 1 July 2007 (UTC)

[edit] Balance of the article

The balance of the content of this article has changed quite a lot recently, in addition to the changes necessary for featured article format. The first thing I'd like to address is that the sourced material on cognition, emotion, relationships and society has been moved off to a subarticle (except for two sentences on two particular issues) while the lengthy detailed paragraphs on neural function and neurotransmitters have been retained both here and in the subarticle. I'd like to redress the balance, within the article length restrictions, and I'm seeing if there's any comments here first. EverSince 15:42, 5 July 2007 (UTC)

I'm not sure which particular bits you're referring to but it is a pretty long article and we had to prioritize. Although interesting, much material in this area is still in the reasearch field without having alot to do with clinical diagnosis. Similarly causation. Given all the drugs (which are a pretty core feature of treatment) work on neurotransmitters it is important to mention them. As it is the medication stuff is also summarised pretty succinctly. Why not cut-and-paste bits you want to add here and we can discuss them. cheers, Casliber (talk · contribs) 21:37, 5 July 2007 (UTC)

I do appreciate how long the article had become. It is important to cover the neurotransmitter issues purely because they are thought to be, and found to be, important aspects of Schizophrenia. And yes they're also related to medications and indirectly to other interventions (the coverage of which is a separate issue I'd like to address in due course). But it is also important to cover issues other than neurotransmitters because they are also thought and found to be important aspects of schizophrenia. They are also related to therapeutic interventions, as sourced in the article e.g. cognitive, behavioral, systemic (e.g. based on Expressed Emotion) or social rehab methods (and, indeed, to medication). And in terms of causal (and maintenance and recovery) models and findings, this range of issues is widely implicated as well as neurotransmitters.

I don't think pasting here first is necessary because I'm just talking about re-adding a summary of issues already detailed and sourced in the subarticle (whose removal from here I didn't see discussed). You didn't specify what material you think isn't related or applied to clinically-diagnosed schizophrenia, but of course any summary edits can be re-edited or raised here in the usual Wikipedia way. So unless anyone disagrees in principle with having any coverage of these issues at all, I will try to summarise them. EverSince 13:21, 6 July 2007 (UTC)

Hi EverSince, I'd welcome so more detail on cognitive / psychological influences, but I think the key is to summarise them as the previous version had included too much detail for a main article (most of which is now in the 'Causes' subarticle). - Vaughan 15:09, 6 July 2007 (UTC)

Hi Vaughan, I do appreciate and agree about the length as I've mentioned. It is also key that summation be applied in a balanced NPOV way, e.g. across the biopsychosocial board. EverSince 09:43, 9 July 2007 (UTC)

Ummm Eversince...so you feel the article is unbalanced? I'm having trouble figuring out what it is you want to specifically add. You mention EE (which has been shown to increase the rate of relapse) - we've got a note on family therapy being beneficial (which I agree with - funnily enough Cochrane which only looks at metaanalysis says there's no evidence as yet it is effective in reducing relapse (don't worry, I am a fan of family therapy)) Do you want something else on EE increasing relapse? I mentioned it in Prognosis. If you don't want to discuss it here just add away and we can all have a play with it then. cheers, Casliber (talk · contribs) 10:15, 9 July 2007 (UTC)

I'm just talking about the causes/pathology sections at the moment, and purely saying that the bio and psycho and social aspects all merit inclusion there, and summation to the same degree. Which I think it would be most productive just to have a go at. EverSince 11:26, 9 July 2007 (UTC) p.s. shouldn't that Cochrane review point be added to the section on family interventions?

Well I had a go, and ended up merging the causes and pathology sections (which are anyway both in the Causes subarticle) - if splitting, please could discuss on what basis? As you can see, the neuro stuff is still over 3 times the length of the psych stuff, along with 2 images, and goes into detail of evidence from the effects of therapeutic interventions which the psych subsection doesn't even go in to at all. So still needs more balancing imho. EverSince 12:47, 9 July 2007 (UTC) p.s. skagedal suggested ages ago using

(see Louis Wain) perhaps that could illustrate the cognitive aspect somewhere. EverSince 13:07, 9 July 2007 (UTC)

The toxoplasma hypothesis is esoteric and that it is why it is on the 'causes' page. There have been other infective causes and all sorts of theories postulated at one time or another. It makes no impact on clinical practice. The Louis Wain stuff is interesting maybe something from somewhere like here would be more apt (provided permission for fair use is gotten).Also the EE stuff is more about prognosis so goes there. The other psych stuff is more about cognitive features, not causes at all so should go under 'symptoms' the stuf about delusions is self-explanatory to the point where I don't see the relevance of mentioning it reallycheers, Casliber (talk · contribs) 20:31, 9 July 2007 (UTC)

The article was under review for over a month; it would be helpful now if significant changes to the text were proposed on the talk page before being introduced into the article, as suggested above. From reading the talk page (above), it doesn't appear that there was consensus for these changes; that's not conducive to the article's stability. SandyGeorgia (Talk) 17:10, 10 July 2007 (UTC)

hmmm. Just had a closer look. Only a few weeks since the close of FAR, and an important section (pathophysiology) is gone, while new sections were created, giving undue weight and heading back towards the rambling, unorganized TOC that existed pre-FAR. Can pathophysiology be easily restored, or do we need to revert? Please propose major changes on the talk page so that consensus can be developed. SandyGeorgia (Talk) 17:21, 10 July 2007 (UTC)

Hmm SandyGeorgia there was a clear suggestion above that, if separate pathophysiology was wanted again, to discuss on what basis (i.e. what goes in there and what in causes)? Removing it reduced the TOC, so not sure how that was going in the direction you describe at all. Or what undue weight you refer to - perhaps you refer to the addition of a "psychological" subsection three times shorter than the neuro section? There is incidentally an issue of balance re the term "psychopathology" as well as the term "pathophysiology", I think.

About the issues raised by Casliber. I'm trying to keep this clear so I'll comment on the incidental infection and imagery issues below separately. The summary of psych processes involved in the causation and pathology of schizophrenia has all been removed from that section once again, for various different reasons now, and again without any reference to sources. I don't know what I'm supposed to do because it seems like the onus should be on the person removing long-standing sourced content to justify it properly, via more than a few dismissive comments (or nothing at all originally).

What counts as pathophysiology or psychopathology, symptom, feature, cause or maintenance factor, can be a grey area and depend partly on the model used. The article needs to reflect the range of sources and views on this, not just assume a biomedical (rather than biopsychosocial) model, and just shape everything to fit that. Currently the causes/pathology section is being allowed to contain mention of "functional differences in brain activity" related to deficits in "memory, attention, problem solving, executive function, and social cognition." - presumably because it's framed in the context of brain imaging and neural activity - but not allowed to contain the same kind of processes revealed through psychological or psychosocial studies. This is neither NPOV or logical (or at least betrays a particular dualistic philosophy of mind). I don't know how else to support this other than take a load of quotes from a range of sources, some already within the article and others - see below. I believe these demonstrate valid notable verifiable views going against your presumptions and assertions that the psych stuff is just symptoms or prognosis or irrelevant (incidentally the "self-evident" point to which I think you refer, was that the content and themes of delusions can be meaningful and causally-related, which is very much non-obvious and oft contested).

"A plausible model of the onset of psychosis needs to draw not only on neuroscience, but also on the insights of social psychiatry and cognitive psychology." (Broome et al. 2005)." "Asarnow presents a view that is increasingly held by experts in the field, namely, that cognitive impairments antedate, and are developmental precursors of, psychotic symptoms." (Lewis 04). "Although schizophrenia is not typically conceptualized as an “emotional” disorder, several lines of evidence indicate that many individuals with schizophrenia are highly emotionally responsive to affectively laden stimuli or events"..."heightened emotional reactivity to stress may be a vulnerability marker for psychotic illness" (Horan & Blanchard, 03). ""Recent studies into the relationship of emotion recognition abilities with social functioning have indicated that this aspect of social cognition is highly predictive in explaining the functional status of patients with schizophrenia...If these findings are already verifiable in first-episode patients, it may be essential to include mental state attribution in psychoeducational programs (e.g., Moritz et al., 2005)...as well as in preventative measures for prodromal stages...The positive effects of such trainings have recently been shown by..." (Brune et al. 07). "Neuropsychological views of the role of dopamine in the CNS have evolved from that of a simple reward signal to a more complex situation in which dopamine encodes the importance or 'salience' of events in the external world." (Iverson & Iverson 07). "A jumping to conclusions ( JTC) bias has been assumed...this account may elegantly explain both the genesis and maintenance of a number of non-elaborated delusional beliefs" (Moritz & Woodward (05) and similar by Brunelin et al. 07. "The formation model is based on a ‘stress-vulnerability’ approach and argues that persecutory delusions arise from an anomalous experience (potentially precipitated by a biological or psychological stressor), especially when interpreted by someone with extreme cognitive biases or maladaptive pre-existing beliefs" (Moritz & Woodward (05). "In contrast to the Bentall et al. [9] model, where delusions are thought to arise as a ‘defence’ or attempt to keep negative affect from consciousness, Freeman and Garety argue for a ‘direct’ role of emotion, where the delusion shares much of its content and structure with the proposed form of emotional disturbance. This is based on evidence for thematic similarities between common delusions and emotions [48], and..." (Bell et al. 06 PMID 16600666) "The profoundly difficult and inescapable experience of ongoing discrimination and stigma may present a threat to social identity of individuals, which is a severe cognitive and emotional challenge. Individuals with a genetic vulnerability to schizophrenia often have impaired executive function, and when subjected to such a severe challenge, they may be more likely to develop the disorder. This may apply in particular to those who have a greater tendency for making external attributions, as these attributions may lead to paranoid ideations and in extreme form to persecutory delusions" (Veling et al. 2007). ""Studies have reported that certain measures of intrafamilial transactions are associated with an increased risk both for the initial onset of schizophrenia and for its recurrence following the initial episode of disorder. Two of the most studied of these are communication deviance (CD), a measure of subclinical thought disorder expressed in speech, and expressed emotion (EE), defined as notable attitudes of criticism and/or emotional overinvolvement manifested in a semistructured interview." (Subotnik et al, 02). "In the context of a model of cognitive, emotional, and social processes in psychosis, the latest evidence for the putative psychological mechanisms that elicit and maintain symptoms is reviewed." (Kuipers et al. 06 PMID 16885206) Following quotes all from Bentall et al. 07 review (PMID 17524210): "There is, in contrast, considerable evidence that positive symptoms are associated with emotion or emotion-related psychological processes beyond those usually considered within neurocognitive frameworks....Although some neurodevelopmental risk factors appear more frequently in people who are later diagnosed as suffering from schizophrenia than in people who later receive other diagnoses...many indicators of neurodevelopmental impairment are found in a wide range of patients" "Many...abnormalities concern social information processing and reasoning processes which are content-specific and which therefore cannot be attributed to global neurocognitive impairment." "In summary, recent research which has adopted a psychological approach to positive symptoms has made progress in identifying specific cognitive and sociocogitive abnormalities which might underlie these experiences." "The influence of family relationships is revealed by the association between positive symptoms and abnormal adult attachment representations, which has been demonstrated in...prospective studies which have shown that parental expressed emotion (Goldstein, 1998), parental communication deviance (Wahlberg et al., 1997) and being unwanted at birth (Myhrman, Rantakallio, Isohanni, & Jones, 1996) confer an increased risk of psychosis" "A number of studies have shown that hallucinations are associated with dissociation, a common response to traumatic experiences". "The only existing high-risk study of schizophrenia to include a measure of cognitive bias found that an external locus of control (a tendency, similar to attributional style, to attribute all events to external factors) was a predictor of future psychosis in high-risk adolescents (Frenkel, Kugelmass, Nathan, & Ingraham, 1995)." (Bentall et al. 07)

(deindent to avoid long text above). Happy to explain. If you look at this version which had consensus, there are no third level headings, and no short, choppy sections. This version has third level headings with a convoluted Causes and pathology TOC, and a one-sentence, choppy section giving undue weight to Infective. I see Casliber put some effort into restoring a cleaner organization and due weight, but I'm not sure a revert to the consensual version wouldn't be more effective, followed by proposing and discussing your changes on the talk page. More than a month of consensual work went into building the content you changed. SandyGeorgia (Talk) 18:55, 10 July 2007 (UTC)

Yeah so basically I removed a heading (because I didn't know where to put back content originally removed without discussion) - a heading which I then suggested discussing re-adding. And you and Casliber think the infective issue shouldn't be mentioned - well I'm really not bothered but that's obviously a matter of debate (debate I didn't see when it was originally removed) but please can we address that separately below. Incidentally much of the "choppiness" obviously comes from each neurotransmitter having its own subheading, unlike anything else there. I'm very glad you've raised the point that major changes should be discussed beforehand, I hope we can focus fairly on all sides in that regard and on the major issue of the psych content. EverSince 19:37, 10 July 2007 (UTC)

Well the Pathophysiology header is back in, fine. Could stuff on abnormal psychological processes go in there, or under causes if sourced as a possible cause, or elsewhere? What about under a Psychopathology header, which would perhaps be the equivalent to the neuro stuff (with which it merges in reality of course) and could be a neutral but tidy sort of solution? EverSince 20:23, 10 July 2007 (UTC)

Right - Eversince, in May and June when were overhauled the article for FAR, one of the things I did was try to write detailed edit summaries explaining what I did as I went along. I have just trawled through and you're right I can't find an exact summary indicating why I moved the toxo cause of the page. I can tell you now though. The fact is that 3 of us (Sandy, Vaughan and me) were having major input at the time and there was open discourse. You have been editing at the time and I'm not sure why you decided not to pop in at that stage. You chose not to and now you're coming in and attempting wholesale changes and complaining no-one told you about others (?!).

Look, I can see you've put alot of work into articles in this are and that is commendable as they often end up laden with considerable difference of opinion which is why I have stayed away from the area until now. One of the issues (I hope you can take this constructively and I'm sorry if it offends but I am not sure how else to bring it up) is you don't write succinctly. I have my faults too which is why I've never done an FA wholly by myself and I get copyedited to bits. In the material you mention it doesn't need the detail you provide. I am trying to accommodate what you want to put in but ultimately don't want this ending up in an edit war and right now I think there's been about as much accommodation as the article needs. This is what I am talking about placing ideas here first. I and others are happy to explain if you feel a past explanation has been unsatisfactory. cheers, Casliber (talk · contribs) 21:27, 10 July 2007 (UTC)

Respectfully, ditto. There's a long passage posted above that I can't make heads or tails of (it might be more productive to place something like that in a sandbox somewhere?) It would be helpful if you would specifically and succinctly outline what text you want to add, where, and how you will incorporate it into the existing flow and organization of the article; this will help avoid reverting and rewriting. I'm not sure how to answer your queries about "stuff on abnormal psychological processes" when I don't know what that "stuff" is, where you want to put it, or how it may or may not relate to that long chunk of text above. Also, concerned that you didn't participate during five weeks of serious review and collaborative work, and now make substantive changes that don't uphold current FA standards. SandyGeorgia (Talk) 21:54, 10 July 2007 (UTC)

EverSince, you make some valuable points and I think there needs to be more on psychological mechanisms. I don't think that these to equal the amount of biological description to balance the article though, because, as much as we may disagree with the degree of focus, there is much more research on neurobiology than psychology. However, I agree that the psychology content is lacking and needs expanding. The information you added was excellent in my view, but I'm not sure we know both a 'Cognitive features' and a 'Psychological' as much information is repeated (i.e. cognitive deficits, biases). I think one section should be enough and some of the other information can be added into other sections where necessary (e.g. prognosis as Cas suggests).

I don't think editors need to discuss before making major changes, as long as they're happy for the changes to be pulled from the main article and onto the talk page if others disagree. Most of the major changes that have been made over the review period were discussed as they happened, and this is usually a good plan for major revisions.

In terms of the pathophysiology / causes distinction, pathophysiology describes the physiological mechanism of the disorder. In other words, it can only be about biology. It's also important to note that pathophysiology may not be a biological cause, it might be the disorder itself, albeit only described on the biological level (e.g. broken bones are not caused by fractures, they are fractures; abnormal psychology is not caused by disturbed neurobiology, it is disturbed neurobiology - because all psychology is a reflection of brain function). Most of the information in the dopamine and glutamate sections does not describe causes as such, only correlates - i.e. the neurobiological differences found in schizophrenia.

Anyway, just my 2ps worth - Vaughan 12:05, 11 July 2007 (UTC)

Casliber, I'm obviously not complaining no one told me about removing the psych stuff - I just pointed out that it didn't appear to have been discussed at all. I regret if I've done that in an accusatory way but I didn't even mention you personally. I wasn't involved at the time becuase it was during a period when I wasn't editing much because I'd had enough, and I couldn't face it. The list of quotes I provided (yes at length) was purely to refute your claims that psychological processes related to Schizophrenia are merely symptoms or irrelevant. As I said, I felt you gave me no other option but to actually quote from sources. I never said the material itself should be added to the article, so I dont know why you suggest that and SandyGeorgia joins in even worse. Your comment about writing style is getting personal, against Wikipedia policy - but I guess I called your style dismissive so whatever. Sometimes I maybe do over-explain or over-source due to anxiety to avert possible objections or removals of stuff.

Let's be clear that serious collaborative work was ongoing before the FA review period, and should continue according to Wikipedia guidelines. The TOC heading change that seems to have been so notably damaging to FA standards was made incidentally to an edit focused elsewhere, was raised on the talk page, and has already been addressed and reverted to allay concerns. Regarding the psych content, all suggestions and demands can be targeted at me in a clearly one-sided way, but since it seems accepted that it was originally removed without discussion (even though during that period), I think it's fair to say that the onus is also on others. This section has become a bit of a mess and keeps distracting from this issue, so I'm going to raise the issue more specifically below separately. EverSince 13:14, 11 July 2007 (UTC)

You beat me to it Vaughan. I agree about the need for one psych section - I was just offering alternatives before. I also agree with the point about the meaning of pathophysiology and the neural evidence - that's why Psychopathology might be a suitable equivalent title for the psych stuff. EverSince 13:14, 11 July 2007 (UTC)

(Sigh) Um..I actually do think psychological causes are important. I have seen some stuff on trauma histories of people with schizophrenia running contra to the idea that its predominantly biological. The issue I have is using succinct wording and summarise evidence rather than piecemeal adding of research fidnings and hypotheses. OK let's move forward from here:

PS: Sorry about commenting on your editing style - let's try to look forward :)

[edit] How to redress the balance and ad some more emphasis on psychological input

Right. What I'd do under causes:

Environmental - this section could include psychological input and be called Psychosocial (includes trauma line anyway)

Childhood experiences of abuse or trauma have also been implicated as risk factors for a diagnosis of schizophrenia later in life -after this line could go some other material.

OK to move on and I agree that the need is for a summary, as agreed earlier. Sometimes easier said than done when trying to cover less coherent views and evidence from NPOV, but then obviously anyone's free to edit or discuss the style of particular content. I might not personally look to place issues exactly how you say btw, e.g. psych mechanisms related to genetics as well as environment, so I trust we can see how it goes collaboratively. EverSince 13:20, 12 July 2007 (UTC) p.s. I realised the pathophysiology header hasn't been reverted - was an edit history link made me think so.

I'll stop there before further edits or additions, in case anyone wants to alter or revert or critique that structure I've just tried, which is hopefully along the lines of "mechanisms" mentioned by Vaughan. EverSince 14:18, 12 July 2007 (UTC)

[edit] Anhedonia is a negative symptom of schizophrenia

Anhedonia is a negative symptom of schizophrenia. This needs to be added to the list of negative symptoms. Someone please unlock this page and add it to the list of negative symptoms.

This is very important because it is a feature of schizophrenia that often goes untreated, and people with the illness suffer. People need to know about it.

I know about anhedonia because I have been diagnosed with schizophrenia and diagnosed with anhedonia as one of my negative symptoms.

Anhedonia is a loss or diminishment of the experience of pleasure/enjoyment/goodfeeling. It is a chemical problem not an emotional problem. People with anhedonia will not experience pleasure for things that they would otherwise normally enjoy. Hobbies, aesthetics, conversation, sex, eating, physical sensations, reading, watching movies... all these things and others are affected. People with anhedonia are literally unable to have fun or to have a good time or to feel good. Anhedonia can be in degrees of seriousness and is treated somewhat by antidepressants.

Anhedonia is different from emotional blunting, as it is specific to the emotions and sensations of pleasure.

Anhedonia is also a symptom of depression, but schizophrenics may have anhedonia without having depression.

The schizophrenia entry is incomplete until Anhedonia is added as a negative symptom.

HopeMr 20:26, 5 July 2007 (UTC)

Anhedonia is a symptom of depression. Post-psychotic depression is common in schizophrenia. This is coded separately. It is also important to distinguish symptoms from common side effects from medication. You're right it is important to treat and that is why coding separately to allow treamtent for depression or side effects of meds is a priority. cheers, Casliber (talk · contribs) 21:28, 5 July 2007 (UTC)

Actually this has reminded me that we have't reall covered post-psychotic depression in the article (on a brief look-over). I'll try and find some refs and slot it in somewhere later.cheers, Casliber (talk · contribs) 21:31, 5 July 2007 (UTC)

After a quick PubMed search, it seems anhedonia is often reported in schizophrenia itself. See also PMID 16879797 - Vaughan 15:15, 6 July 2007 (UTC)

[edit] Life expectancy and antipsychotics

Thanks for your addition Dr CareBear, you made a good point. It was actually addressed in the citation for that paragraph but wasn't in the text as this summary section

However, I've moved your point to the mortality section and added some other info from the study (other causes of early mortality), as the summary section is largely descriptive. I've also replaced your reference as the article needs to be cited with peer-reviewed published research, rather than personal accounts, however, articulate they may be. Thanks for your input! - Vaughan 11:20, 11 July 2007 (UTC)

You may want to look at the mortality section because there is a bug in it now. "Prevention and Screening" is being run together with "Mortality". I do not understand what the problem is. Also the references at the bottom of the article are not being displayed properly starting with the "Mortality" section.

I disagree however that the reference I added should not be added. It is rather arbitrary to say that only professionals who write material should be allowed inclusion. The work I posted has been on the internet since 1997 and is the most likely reason the FDA, Clinicians and consumers are taking a close look at metabolic issues concerning antipsychotic drugs. For instance the FDA requires a warning on all the newer atypical antipsychotics that they can cause diabetes. Dr CareBear 08:32, 12 July 2007 (UTC)

CareBear, I don't think it has to be a professional source but the guidelines around reliability and fact-checking etc might apply here e.g. WP:RS EverSince 13:33, 12 July 2007 (UTC)

[edit] violence

If only 0.4-0.6% of people are schizophrenic, but some source in the article found 3% of violence is commited by schizophrenics, does it not follow that schizophrenics are roughly "6 times more likely" to be violent? (not a fan of logical fallacies or pseudoscience) --Kvuo 04:47, 12 July 2007 (UTC)

Interesting point, tricky because studies try to take covariates into account so that they're comparing like with like, e.g. people living in neighbourhoods with the same levels of crime, deprivation, substance use etc, since individuals diagnosed with schizophrenia tend to be disadvantaged in those ways. Findings have varied but would be good to have a clearer sourced statistic of that sort I think. EverSince 12:54, 16 July 2007 (UTC)

I checked and that figure is cited as 2.7% by Walsh & Buchanan (2002, sourced in article) and is actually for the percentage of people who had schizophrenia out of all those who committed violence, in the ECA study. The ECA article actually focuses on a different type of figure - 8% of those with schizophrenia/schizophreniform disorder (and no other comorbid disorder) committed violence, compared to 2% of those with no diagnosed disorder. They conclude "It would seem that public fear of persons with schizophrenia living in the community is largely unwarranted, though not totally groundless...Even so, citizens stand a much greater chance of being assaulted by an alcoholic: 25 percent of those with alcoholism were violent by their own report"

Walsh & Buchanan report a 1998 study finding that men with schizophrenia were "up to five times more likely" to be convicted of serious violence than the general population. However, Stuart (03) (sourced in article) says "The MacArthur Violence Risk Assessment Study recently completed in the United States...stands out as the most sophisticated attempt to date to disentangle these complex interrelationships...the prevalence of violence among those with a major mental disorder who did not abuse substances was indistinguishable from their non-substance abusing neighbourhood controls...Those with schizophrenia had the lowest occurrence of violence over the course of the year (14.8%), compared to those with a bipolar disorder (22.0%) or major depression (28.5%)."

So still not very clear but maybe the article can say something like: the percentage of people diagnosed with schizophrenia who commit violent acts has been found to be several times higher than the percentage of those with no disorder, but this difference has not generally been found in same-neighbourhood comparisons and when related factors such as substance abuse are taken into account... EverSince 15:50, 18 July 2007 (UTC)

[edit] Organic Bacterial cause

Lead on original research.

There may be an organic cause, created by some 'parasites', and the inability to correctly test for them. The actual cause is the bodies reaction to the toxins created by such common bacteria as giardia. Once the test falsely suggests no infection the bacterial growth expands causing a wave like result in symptoms.

The bridge between the label "schizophrenia" and its cause may be found in the term fugue state, casued by bacterial toxins.

I will try to follow-up, may I suggest this as a lead to others.

--Caesar J. B. Squitti : Son of Maryann Rosso and Arthur Natale Squitti 16:32, 12 July 2007 (UTC)

Original research lead:

As the researcher who discovered the half-truth3, please note that many reference to chemical imbalances, while possibly technically true, a half-truth often fail to acknowledge a possible bridge caused by a malabsorption problem, through let us say a bacterial infection that can cause the chemcial imbalances.

--Caesar J. B. Squitti : Son of Maryann Rosso and Arthur Natale Squitti 02:44, 13 July 2007 (UTC)

[edit] Added akathisia Side Effect of Antipsychotics as a Cause for Suicides in People said to be Schizophrenic.

Added two per reviewed published references with the new sentence added. Discuss here before making any changes. Dr CareBear 03:15, 13 July 2007 (UTC)

Hi Dr CareBear, I looked up the studies you added on akathisia and suicide and also did a search of the rest of the literature. Firstly, I think this information would be better placed in the antipsychotic article, not schizophrenia, as it relates to the affects of a drug group, not schizophrenia specifically.

Secondly, the references you added were both case studies. A 2004 group study (PMID 15358982)found no relationship between akathisia and suicide, although the authors note in a 2006 letter (PMID 16449715) to the British Journal of Psychiatry that they "identified agitation (motor restlessness), impulsivity and depression as risk factors but not akathisia. However, akathisia could contribute to or be confused with any of these three identified risk factors."

In other words, no conclusive link has yet been shown, and the presence of akathisia is not restricted to schizophrenia. Removed text below.

Reports also show that the agonizing side effect of antipsychotics called akathisia is associated with feeling suicidal in people said to be schizophrenic and attempted suicides by them. ^{[6] [7]}

- Vaughan 09:20, 13 July 2007 (UTC)

I added the sentence back. This article makes a lot of assertions implying that schizophrenia itself is the reason for suicides when the suicides themselves may very well be the cause of the drugs being given to these people. I think that this needs to be made clear in the article. Also that study you provided is about "treatment-resistant Schizophrenia" not schizophrenia in general. "treatment-resistant Schizophrenia" is schizophrenia that resists treatment to drugs. In other words the antipsychotics have little or no effect on this subclass of schizphrenics so therefore they would not be affected by akathisia because the drugs are not having an affect on them so they do not attempt suicide because they are not suffering. Added line back. Dr CareBear 02:30, 17 July 2007 (UTC)

That doesn't make sense. Many people who have treatment resistant schizophrenia have side effects (?). cheers, Casliber (talk · contribs) 02:43, 17 July 2007 (UTC)

Agree. SandyGeorgia (Talk) 03:47, 17 July 2007 (UTC)

Hi DrCareBear, nowhere does the article say that schizophrenia causes suicide, it simply talks about the increased suicide rate in people diagnosed with the condition, and this could be caused by any number of factors. The information you provide is an interesting theory, but if it is genuinely a result of the drug, and not schizophrenia, then this information shouldn't be in the schizophrenia article, it should be in the antipsychotic article, as these drugs can be used to treat any number of conditions. Furthermore, while your theory is interesting, to back up an assertion that akathisia increases suicide you need to cite studies which test this hypothesis. Case studies do not do this and they rank low on the hierarchy of evidence. My advice would be to search for the relevant studies on PubMed or other medical research databases. The results of my search are above, but if you find any other relevant studies, please highlight them. - Vaughan 08:17, 17 July 2007 (UTC)

Also to clarify Casliber's point, treatment resistant schizophrenia is where the drugs do not affect the psychotic symptoms. Sadly, side effects such as akathisia can still be present. For example, the study I mentioned above (PMID 15358982) reports that 38 of the 86 'treatment resistant schizophrenia' patients had akathisia. - Vaughan 08:30, 17 July 2007 (UTC)

The article may not say that disease is the cause of the suicides but it certainly is strongly implied. That is why I added the statement for a convincing cause of the suicides. See the REWARD DEFIENCY SYNDROME article below. There is a link for it there that I left. Dr CareBear 08:10, 23 July 2007 (UTC)

Hi Dr CareBear, firstly, the information you're adding is not well-suited to this article unless you can show it is a particular effect in people diagnosed with schizophrenia. If it is a general effect of the drugs, it needs to go in the antipsychotic article, because they can be prescribed for a number of conditions. Secondly, the the reward deficieny syndrome you mention is a theory. To back up a point that akathisia or antipsychotics increase the risk of suicide, you need to cite good quality group studies or a review paper than support this point. Simply citing a case study is not good enough for an encyclopaedia article. The only study I know of (I would be glad to hear of more though, as my search wasn't exhaustive) which has looked at the effect of antipsychotics in untreated schizophrenia showed that they significantly reduced suicidal thinking and attempts (PMID 16648319). If you can find evidence to the contary, please cite the studies here. - Vaughan 08:45, 23 July 2007 (UTC)

Actually it is not the motor restlessness of akathisia that cause increased suicides in people said to be schizophrenic. It is the dysphoria that these drugs cause. Motor restlessness can come with or without dysphoria and some patients have motor restlessness even before they take the drugs. The studies should be conducted as dysphoria as being a cause for increased suicides in people said to be schizophrenic because the name akathisia only obfuscates the real cause of increased suicides which is dysphoria. See the Reward Defiency Syndrome article below in the heading below this. Low patient compliance with antipsychotics is because of the dysphoria that the drugs cause not the motor restlessness. Most patients can only simply express themselves by saying that the drugs make them "feel bad". It is actually dysphoria that is the cause of increased suicides not motor restlessness by itself. Dr CareBear 08:06, 28 July 2007 (UTC)

[edit] Dopamine Stimulation Deficiency As Cause for Dysphoria which can lead to Suicides/.

Reward Deficiency Syndrome

Studying the article above will reveal why Dopamine antagonists such as the antipsychotics will cause suicides in those who recieve them because of how they take away a person's sense of well being. People who already have Dysphoria will suffer even more from be given antipsychotics and push them over the edge an perhaps actually commit suicide. No mention is made of Dopamine antagonists in the article above but if you understand this subject the implications become very clear. The article explains that inadequate dopamine stimulation is the cause of conditions such as attention deficit hyperactive disorder, conduct disorder (iritability) and autism. In autism people except fantacies because nonreality in more stimulating then reality and it helps relieve the suffering of inadequate dopamine stimulation. In ADHD people are compelled to be over active because it causes dopamine release which relieves the suffering of inadequate dopamine stimulation. I see a similar thing happening in people said to be schizophrenic who are given antipsychotics. The akathisia caused by these drugs is the symptom of inadequate dopamine stimulation and this as the article listed above states can lead to suicide. Ritilin works in ADHD and ADD because it is a dopamine reuptake inhibitor. Since the article points out that autism and ADHD and ADD have the same underlying root cause of inadequate dopamine stimulation then I see that antipsychotics are actually making people worse rather then helping them and also leading them to commit suicide. I feel sorry for people with autism because the FDA has approved Risperidone for treating irritability in people with autism including children. Risperidone causes extream dysphoria. It seems to me that Risperidone is contrandicated in use with autism when autism is caused by inadequate dopamine stimulation as the article above pointed out. The article points out that autistic people accept fantasy over reality as a means to relieve their inadequate dopamine stimulation but Risperidone actually antagonises dopamine and it appears that this drug would just make their condition worse but the FDA has approved it for treating their "irritability". Sometimes I wonder if these professionals even know what they are doing and don't understand these things or if they simply do not care and like to see people suffer. Autism sounds very much like the scizoid behavior of schizophrenia because they also accept fanciful ideas they may not be rooted in reality. Read the article above called Reward Deficency Syndrom and you may be on your way to understanding why dopamine antagonists like antipsychotics are causing great suffering and causing people to be violent and suididal and addicted to substances. Dr CareBear 03:56, 13 July 2007 (UTC)

Comings? Not a high quality source, not well-accepted. SandyGeorgia (Talk) 03:45, 17 July 2007 (UTC)

Galileo was not well accepted either. He was imprisoned in his own home for saying that the Sun did not orbit around the Earth but rather that the Earth orbited around the Sun. Mental illness is caused by lack of dopamine stimulation NOT too much. That is why schizophrenics try to cure themselves with street drugs. Dr CareBear 08:04, 23 July 2007 (UTC)

Furthermore the article I left was published in American Scientist Magazine which is not strictly a medical magazine but covers all aspects of science. This magazine publishes cutting edge scientific articles. Dr CareBear 08:09, 28 July 2007 (UTC)

[edit] Cultural References

Minor really, but I just thought that it would be interesting to add Jibreel Farishta from the quite famous Salman Rushdi novel "The Satanic Verses," as a sufferer of schizophrenia into the Cultural References section of the article.

great idea - better for someone who has read the book to add it which excludes me cheers, Casliber (talk · contribs) 05:05, 16 July 2007 (UTC)

[edit] Sentence and summaries

To me this:

Some evidence suggests that the content of delusional beliefs and psychotic experiences can reflect emotional causes of the disorder, and that how a person interprets such experiences can influence symptomology

- seems to be explaining the obvious, which if we're trying to summarise, isn't particularly necessary. What do others feel? cheers, Casliber (talk · contribs) 01:21, 17 July 2007 (UTC)

Personally I'm unsure and need some clarification of the sense in which it might be too obvious, or not enough of a summation. These are two major elements of modern psychological understandings of Schizophrenia, which are often contrasted with traditional psychiatric models where the form is thought to be significant but not the meaning of the content or a person's reactions to their experiences. EverSince 12:10, 17 July 2007 (UTC) p.s. I tried to remove the "of the disorder" bit because these are generally seen as intermediary causes or mechanisms.

[edit] Interventions

I'm planning to add mention of a few other aspects to this section, and just mentioning some of the rationale in advance - specific edits can be addressed anyway of course.

Regarding social skills training, there's a sourced mention of advances but there's also significant negative findings in this area, e.g. 2003 NICE guidelines and the 2004 APA guidelines (www.psych.org/psych_pract/treatg/pg/SchizPG-Complete-Feb04.pdf). Regarding family therapy, there's a mildly positive but equivocal Cochrane review (as mentioned by Casliber), as well as the NICE and APA guidelines reporting strong/consistent evidence at least if it's longer-term. Also the two sentences on music could perhaps be turned into one sentence on other possibilities (e.g. the Schizophrenia-related Cochrane reviews also address art and drama therapy, doesn't sound like much to go on judging by the abstracts).

Re. the mention of antipsychotics as mainstay, the cited NICE guidelines say "Although pharmacological interventions have been the mainstay of treatment since their introduction in the 1950s, the limited response of some people to antipsychotic treatments, the high incidence of side-effects and the poor adherence to treatment have necessitated a more broadly based approach combining different treatment options..." Some mention needed of the limits to their efficacy and utility (and both guidelines seem to report lower doses generally more effective), and not just in the context of "treatment-resistance" and finding better medication options - e.g. mainstream psychiatric article PMID 17502806 reports repeat findings that many seem to do better over the years not taking antipsychotics compared to those who do (although others suggest otherwise, e.g. Eli-Lilly-authored PMID 16649833).

There's also the major related issue of "compliance" and forced treatment, and e.g. PMID 16461575 "It is well known that many, if not most, consumers do not take antipsychotic medication as prescribed." (e.g. 3/4 discontinued in the CATIE trial) and the different views on that from psychiatric services ("generally assumed that failure to take medication as prescribed represents poor judgment by the patient and is something that needs to be fixed, whether through education, persuasion, or use of a medication with a different side-effect profile...") versus consumers ("Discontinuation...rarely assumed to be a reasoned decision by the consumer that should be respected"). EverSince 13:29, 17 July 2007 (UTC)

This is where it gets chicken-and-egg like as it is a heterogeneous illness with a huge amount of difference between mild and severe forms - many who have stopped taking meds and have done better may have had an episodic illness anyway. Very tricky - regardless of conflicitng views on overprescription currently they are the mainstay as anyone working in most areas mental health will confirm (notwithstanding communties etc.). Compliance is a big issue - these drugs are laden with side effects, some very serious and many do give serious consideration on whether to intervene -however many public sector health services are so busy that treatment is often only restricted to those where there is a clear risk to self or others. cheers, Casliber (talk · contribs) 02:53, 18 July 2007 (UTC)

I don't disagree with the term "mainstay", for the reasons you mention, just think that it needs some qualification - maybe something like "within psychiatric services". I guess edits could be tried out on that, as well as to include mention of some of these limits and compliance/consent issues, bearing in mind that there are different chicken-egg possibilities in both directions (withdrawal may itself provoke psychosis, PMID 16774655 & mentioned in guidelines) and the risk management issue as you mention. In the particular source I cited I don't think they state any group differences in symptom severity in the initial diagnostic assessments, only on prognostic indicators such as perceived locus of control or self-esteem - but even then "the off-medication patients showed better global outcomes than the on-antipsychotic patients, even when subgroups with similar prognostic status were compared." In fact the majority of those who stayed on antipsychotics for 15 years still showed "psychotic activity" in assessments. EverSince 10:17, 18 July 2007 (UTC)

[edit] =Update on intervetions

The treatment of schizophrenia is begging for significant expansions here. This article could appraoch the size of the main one. cheers, Casliber (talk · contribs) 12:12, 14 August 2007 (UTC)

[edit] Chromosome 22

I have reverted a change by The Geneticist which added a sentence in the introduction saying, "Schizophrenia disorder is located on chromosome 22." While there is some substance to this claim, it was placed in the main introduction rather than in the section on genetics. One interesting article that refers to this claim is at this site[4]. The section on genetics alludes to this connection without actually naming chromosome 22. Not being up on the literature, I have started this thread to invite further input.

--CloudSurfer 05:37, 20 July 2007 (UTC)

Schizophrenia isn't located on chromosome 22, although 22q11.2 deletion syndromes typically increase the risk of developing schizophrenia and some individual genes (e.g. COMT) linked to psychosis in general are located in this loci. In fact, recent evidence suggests that genetically, schizophrenia isn't a discrete disorder. See PMID 17599182, PMID 17551090. - Vaughan 09:05, 20 July 2007 (UTC)

Vaughn, you beat me to it. I had the same, and a few other, references discounting c-22, and noting 1q as being an unlikely culprit, while 21-22 might be considered (given their consistent relationship to bi-polar), but only under the auspices of a gigundo (that is a technical term) sample set. Blessings... --DashaKat 18:03, 20 July 2007 (UTC)

Thanks for that guys and Vaughan thanks particularly for the reference. Discrete disorder or a cluster of different disorders, I think I will wait for better indications before changing my treatment regimes.

Having been away from Wikipedia for the last three years, congrats on all your good work. I am currently planning to spend a bit of time watching articles and doing some edits but not at the level from the past.

--CloudSurfer 18:26, 20 July 2007 (UTC)

Welcome back CloudSurfer! - Vaughan 11:29, 22 July 2007 (UTC)

[edit] OK..here's a goal - Schizophrenia as Featured Topic

Alright - these Featured Topics look interesting....if schizophrenia were one..what else would go in...

Definite:

• Causes of schizophrenia
• Disorganized schizophrenia
• Dopamine hypothesis of schizophrenia
• Dementia praecox
• PANSS - if really short can be exempt from FA/GA (see topic page)
• a treatment of schizophrenia page
• Paraphrenia

Possibles (all these overlap with some other category - I'd think about not doing them due to the size of the undertaking....

• psychosis?
• catatonia?
• Interpretation of Schizophrenia?
• Schizophreniform disorder?
• Sluggishly progressing schizophrenia?

thoughts? cheers, Casliber (talk · contribs) 02:30, 23 July 2007 (UTC)

[edit] Weasly

A lot of weasly text has crept in over the last few weeks; I left some tags of areas that need cleanup or clarification. SandyGeorgia (Talk) 20:02, 8 August 2007 (UTC)

The sources for the two treatment statements have been discussed just above on this talk page, with quotes, so re-edits can be made. EverSince 14:32, 9 August 2007 (UTC)

[edit] Treatment of schizophrenia now done

OK all - I've made a page for this with Prognosis and Treatment sections from this article and tried to rearrange it to make a cohesive essay focussing (not surprisingly) on prognosis and treatment. This can be massively expanded and possibly be another FA candidate. The idea is that, along with causes of schizophrenia the 3 can form a featured topic...cheers, Casliber (talk · contribs) 11:34, 9 August 2007 (UTC)

[edit] Violence

If Schizophrenics are roughly 5 times more likely to commit a violent crime than people without it, why did the section violence end up under the subheader of common misperceptions? Apparently (and from my own experience) schizophrenics are more likely to commit violence. (217.169.236.12 14:06, 13 August 2007 (UTC))

I didn't add that subheader, but the way you choose to phrase it as if every single person with schizophrenia is more likely to commit violent crime (i.e. applying a statistical total to every individual in a group) is potentially misleading and unsupported. Just as in the general population, the vast majority do not commit violence, while a small minority do. That small minority is a few times larger, in the ballpark of 10%, but no more than various other disorders, including alcoholism. And numerous individual and social variables have been linked to the occurence of violence in that minority - not "schizophrenia" in general. It may be, I believe, that those violent acts includes a higher proportion of the most serious acts such as murder - not sure on the exact findings on that. EverSince 11:40, 14 August 2007 (UTC)

[edit] Referencing

Several parts of the article now have single points referencing by multiple citations. In some cases this seems to be multiple points in the sentence referenced at the end, or multiple studies referenced where a recent review article would do. As this isn't an academic article, I don't think each individual study needs referencing unless they each support separate points. - Vaughan 18:59, 13 August 2007 (UTC)

Sounds reasonable. EverSince 11:47, 14 August 2007 (UTC)

[edit] Latest findings Dr Seeman

Dr Philip Seeman of the University of Toronto published an article in collaboration with a number of authors who have worked on schizophrenia over the past decade. The article was first published in the journal 'Synapse' but is now available in PNAS (Proceedings of the National Academy of Sciences of the United States of America) on internet as of 2005. This journal has a very high impact factor.

The title of the article is: "Dopamine supersensitivity correlates with D2High states, implying many paths to psychosis" and more discussion of it is mentioned in the Wikipedia section on the dopamine hypothesis.

Briefly the article proves that many causes of schizophrenia (such as gene knockouts and traumatic births); as researched by other authors over the last decade, all result in an increase in the sensitivity of dopamine D2 receptors sometimes to 400% and this is a reason for psychosis and schizophrenia.

As a patient with schizophrenia one of my desires is that there be an answer to the question: "What causes schizophrenia?"; and I have heard this said of other schizophrenics as well - it is an issue of validity and Dr Seeman's article needs to become word of mouth as a respected possibility on the main page.

131.181.23.34 14:00, 18 August 2007 (UTC)

Schizophrenia has been on the main page, so won't be again, however if causes of schizophrenia or treatment of schizophrenia are enlarged and improved to Featured Status, then they might be; this would be ideal information to get on the causes of schizophrenia page. cheers, Casliber (talk · contribs) 14:17, 18 August 2007 (UTC)

[edit] correction

Sorry about this - when I referred to the main page, I meant the page called 'Schizophrenia' - where most hits for schizophrenia would strike. (I am new to Wikipedia and didn't realise there was a main page). 131.181.23.34 14:30, 18 August 2007 (UTC)

[edit] The missing link:

Lead on original research...

The lack of focus on 'organic causes' ie undetected bacterial infections of the intestinal system, ie giardia, or lymes disease can cause symptoms that may be taken as being some type of labelled mental illness.

The illness is impacting the mind, it is a mental illness but caused by toxins created by the infection, and/or the infection that corrupts the needed biochemical reactions.

There should be a cross link to the reality that such labels while true, ignore a most likely cause. half-truths

Hopefully someone can google this lead to find other researchers who can provide the necessary links...

Former Chief of Psychiatric Assocation and views on bacterial infections

--Caesar J. B. Squitti : Son of Maryann Rosso and Arthur Natale Squitti 02:54, 22 August 2007 (UTC)

According to Mr Squitti, every illness or symptoms is caused by giardia or lyme (what are the digestive symptoms of Lyme, Caesar?), see his contributions to talkpages. The recurrent mention of "half-truths" is also telling. JFW | T@lk 03:09, 24 August 2007 (UTC)

By Dr. James Howenstine, MD. September 13, 2004 NewsWithViews.com

Dr. Paul Fink, past president of the American Psychiatric Association, has acknowledged that every psychiatric disorder in the Psychiatric Diagnostic Symptoms Manual IV (DSM-!V) can be caused by Lyme Disease.

That was Dr. James Howenstine MD commenting on a Dr. Paul Fink's observation. That is not my observation, although my research suggests that they may be correct.

--Caesar J. B. Squitti : Son of Maryann Rosso and Arthur Natale Squitti 22:38, 31 August 2007 (UTC)

If we overlook the obvious, ie the tests are unreliable, ie Dr. Lower, giardia takes 4-6 negative tests, then we falsely eliminate the most likely cause.

--Caesar J. B. Squitti : Son of Maryann Rosso and Arthur Natale Squitti 22:40, 31 August 2007 (UTC)

Many Lyme patients were firstly diagnosed with other illnesses such as Juvenile Arthritis, Rheumatoid Arthritis, Reactive Arthritis, Infectious Arthritis, Osteoarthritis, Fibromyalgia, Raynaud's Syndrome, Chronic Fatigue Syndrome, Interstitial Cystis, Gastroesophageal Reflux Disease, Fifth Disease, Multiple Sclerosis, scleroderma, lupus, early ALS, early Alzheimers Disease, crohn's disease, ménières syndrome, reynaud's syndrome, sjogren's syndrome, irritable bowel syndrome, colitis, prostatitis, psychiatric disorders (bipolar, depression, etc.), encephalitis, sleep disorders, thyroid disease and various other illnesses. see

Source: Canadian Lymes Association

This material may apply to a variety of illnesses. Like my research has suggested the testing for this one possible cause is difficult, and if overlooked then the patient has very little chance of cure.

--Caesar J. B. Squitti : Son of Maryann Rosso and Arthur Natale Squitti 03:26, 1 September 2007 (UTC)

[edit] Memory loss, lying, difficulty speaking

My mother who is a therapist, deals with schizos who have these symptoms, but I'm not sure if it's rare. Can someone find a source that it is true? Thanks! —Preceding unsigned comment added by Colagal (talk • contribs) 17:48, 3 September 2007 (UTC)

They are included in multiple sections. Depending on your exact context you are refering to disorganised speach (difficulty speaking), delusions and embarressment (lying), poor memory. Are you refering to more specific things?

202.58.54.177 02:53, 26 September 2007 (UTC)

[edit] MRI / Grey matter study paragraph

This paragraph was recently added, which describes interesting research, but doesn't merit a full paragraph and only includes a link to a copy of a Yahoo! News story. - Vaughan 16:46, 5 September 2007 (UTC)

A recent study by UCLA researchers [5] involved MRI scanning in recently diagnosed schizophrenic patients over a period of 5 years. Researchers found a dramatic destruction of gray matter in a short period of time in those diagnosed, the destruction spreading from the back of the brain to the front over time. Interestingly, when the destruction had reached the frontal lobe, the most acute symptoms arose, and severe delusions began. Those with the most severe symptoms were shown to have lost the most brain matter per year. This study is important in shedding light on schizophrenia as a physical disorder of the brain and less likely "a disease invented by society".

Be good to put on the causes of schizophrenia page. I have a dodgy connection.cheers, Casliber (talk · contribs) 00:01, 6 September 2007 (UTC)

Better now, so I'll move it posthaste. cheers, Casliber (talk · contribs) 02:34, 6 September 2007 (UTC)

[edit] Introductory Section

I'm just a lay person, and I was confused by what seems like a sudden shift in tone and topic in the last two paragraphs of the introductory section, starting with the sentence "Increased dopaminergic activity in the mesolimbic pathway of the brain is a consistent finding." Those are some big words, and I'm not sure they belong in the opening section. Could somebody who knows more about the topic take a look at those paragraphs, and see if they can be cleaned up/clarified, so that they're not so confusing? Thanks. Kevinq2000 03:08, 8 September 2007 (UTC)

Thanks for your input Kevin - it is tricky sometimes balancing readability with accuracy. I tend to rely a bit on bluelinks so that folk can read on things they don't know but will have a look. cheers, Casliber (talk · contribs) 03:25, 8 September 2007 (UTC)

The intro is not only confusing, but it's an awfully long introduction. I think that a lot of that section should be cut and pasted evenly through the whole article. 4.225.80.60

The intro is effectively cut and pasted throughout the whole article because it is a summary of what is discussed in more detail below. The topic requires a lot of discussion and I'm not sure a four paragraph summary is entirely unwarranted. - Vaughan 07:09, 16 September 2007 (UTC)

[edit] Why do we ignore the physcial causes?

Modern medicine sees all mental illness deriving only from the brain - primarily from neurotransmitter imbalance and nothing else - the truth is that in many cases there is often an underlining physical cause (eg: infection, celiac disease, etc) and this is often never investigated, and so its no wonder today we are faced with the current tragedy that the Mentally ill die 25 years earlier, on average. Psychiatrist Dr Reading Chris reading knew this and treated hundreds of patients with schizophrenia and found a common link - infection, celiac disease, auto-immune tendencies and malabsorbtion, after treating patients with dietry modification, antibiotics and nutritional supplementation many patients recovered, yet current day medicine does not accept this. 'An autopsy of 82 patients who had been diagnosed with schizophrenia. Gastritis was found in 50%, enteritis in 85% and colitis in 92%.' read more... '99% certain of a genetic association between schizophrenia and coeliac disease' see [6][ Gut and mental illness] —Preceding unsigned comment added by 211.30.235.237 (talk) 05:57, 19 September 2007 (UTC)

[edit] Schizophrenia, demons, parapsychology ? Researches on border of science and parapsychology

I am seriously questioning the relevance and importance of this link. It is not written well, and who is the person who wrote this?Bronayur 02:55, 12 October 2007 (UTC)

[edit] Schizophrenia

An ambiguous topic, an undiagnosable disease is not a disease. Modern science due due mind invasice technology from "Nazi" doctors has meant that they breach the Human Rights Act. Thus, implants injectable and other rubbish made in a lab, are used to harm or hurt against the ethics of medicine, but not to Nazi doctors. These Nazi "scientists" are at work in the NE of England in Newcastle University, and also in St Georges Mental Hospital NE England Morpeth. So then, it is up to you to act or evil will prevail. This article is crap written by crap. —Preceding unsigned comment added by 78.86.130.236 (talk) 20:16, 25 October 2007 (UTC)

[edit] Omega-3s

Paul, the meta-review you used as a reference explores whether there is sufficient evidence for clinical use of omega-3s. As you can read on my talk page, proving that something works in medicine is a long and arduous process. It would have suprised me if there was enough evidence for clinical use. But even if there is not enough evidence yet for clinical use, it doesn't mean that they don't work for anyone. There have been documented cases of them improving schizophrenia symptoms: [7] [8] [9]. Also, the abstract only says that there is less evidence than for depression.

That meta-review was written by the APA which has a conflict of interest: the APA is asking for more forced-drugging laws. According to this, "the American Psychiatric Association, which receives large financial contributions from Pfizer." Pfizer is a pharmaceutical company makers of the antipsychotic Geodon.

There is a newer meta-review which reports that "Several investigations have also reported that EPA could effectively treat schizophrenia."[10] --Mihai cartoaje (talk) 02:31, 20 November 2007 (UTC)

The meta-analysis I quoted combined the data of four studies with ~200 patients, nevertheless the improvement obtained with omega-3 did not reach even marginal statistical significance as compared to placebo. For any experimental drug, this kind of data is usually enough to bury it. On the other hand, the same meta-analysis confirmed that the addition of omega-3 to existing medication helps for depression, so you may consider adding that piece of information to the Clinical depression article.

Although this meta-analysis was supported by APA, it is a consensus study, and it included the principal author of many positive studies of omega-3 for psychiatric indications (including schizophrenia) Malcolm Peet. Since he agreed with the results, you cannot claim that the study was biased—it is as definitive and impartial as it gets. Paul gene (talk) 11:30, 20 November 2007 (UTC)

That's not true: vagus nerve stimulation did not have good results.

Omega-3s and experimental drugs have different strengths. Experimental drugs have a temporary effect on symptoms, but they risk causing tardive dyskinesia and according to the three World Health Organization studies, they make patients worse in the long term. Omega-3s might not have an immediate effect on everyone, but they are risk-free.

It is a matter of comparing risks and benefits. Take the case of this pregnant woman for example: [11]. If she was given neuroleptics, there would have been a risk of congenital malformation for her baby. So it was worth trying omega-3s. --Mihai cartoaje (talk) 01:13, 22 November 2007 (UTC)

Some time ago, I created a subarticle - Treatment of schizophrenia - where alternative treatments and other treatment-related issues can be gone into in more depth. This article is reaching maximum size and we had to really prioritize what was kept and what was moved into subarticles at FARC. Stubby 1 sentence sections don't really sit well either. Mihai if you want to go into more detail that page is ideal. Would be good to get that page into a shape for GA or FA too. As far as I was aware the evidence was fairly equivocal for omega-3's. Agree no meds are absolutely safe in pregnancy but then again untreated psychosis can be a risk too. cheers, Casliber (talk · contribs) 02:05, 26 November 2007 (UTC)

I found 4 trials in addition to neuroleptics, and a fifth where "EPA was used as a sole treatment, though the use of antipsychotic drugs was still permitted if this was clinically imperative." [12] [13] [14] [15] . Is there any I missed? --Mihai cartoaje (talk) 04:17, 26 November 2007 (UTC)

Hmmm..interesting, though the first study is pretty small and it can be tricky from the abstact as to what they count as significant (i.e. how much on the PANSS). Nothing else overly exciting though it is nice to have things with safer adverse to trial than antipsychotics. These things aren't rountinely used in hospital and the size of the article means trying to stick to routine treatments etc. As I said, though, the subarticle has plenty of space for summarising and expanding on new research etc. Based on this I don't think there is any expansion warranted in the main article cheers, Casliber (talk · contribs) 04:58, 26 November 2007 (UTC)