Talk:Schizophrenia/Archive 10

Archive 5

←

Archive 8

Archive 9

Archive 10

Archive 11

Archive 12

Updates from new manual.

DSM5 manual has been out for several months now, and this article needs to be updated and redrafted in numerous sections to be current and maintain quality.

1)Article as a whole appears to completely overlook the comparison and relationship of this diagnosis with "Personality Disorders" as presented in ICD10 and DSM5, the discussion is completely missing.

2)Lede does not mention relevance of associated personality disorders to Schiz. diagnosis and treatment.

3)"Schneiderian" classification should be discussed under "History" section. It is secondary to both the ICD10 and the DSM5 classification categories and the section should reflect this. They (DSM5 and ICD10) presently do not appear in discussion until section 4 here as "Diagnosis".

4)"Causes" subsection completely ignored personality disorders; possible correction may be with a new subsection, or as a subsection to present "Genetics" subsection; Or, possibly under "Developmental."

5) Very scant "Psychological" subsection under "Mechanisms" compared to more fully developed "Neurological" subsection; Personality Disorders completely ignored in this subsection.

6) "Diagnosis" opening paragraph in subsection mentions only DSM4 and needs to be updated; no mention is made of disagreements and contrasts between DSM5 and ICD10 regarding "Schiz." diagnosis and assessment.

7)"Diagnosis" subsection on "Criteria" is outdated and does not mention DSM5 updates for schizophrenia.

8)"Diagnosis" subsection on "Subtypes" is outdated to DSM5 standards and needs to be re-drafted. ICD-10 classifies the DSM-5 schizotypal personality disorder as a form of schizophrenia rather than as a personality disorder. BillMoyers (talk) 18:47, 10 December 2013 (UTC)

Have to read up on DSM5 when I get to work...might take a few days. Cas Liber (talk · contribs) 19:17, 10 December 2013 (UTC)

BillMoyers, when you add text, you should cite it. Your addition appears to contain some original research. SandyGeorgia (Talk) 19:19, 10 December 2013 (UTC)

For the reason Sandy just mentioned, I've reverted it for now, but I'm fine with adding something like it back. --Tryptofish (talk) 20:04, 10 December 2013 (UTC)

Are you arguing that personality disorders cause schizophrenia.[1] Text does not fit in the section. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:17, 10 December 2013 (UTC)

ICD-10 classifies schizotypal personality disorder as a form of "Schizophrenia." This is one of 8 edit questions raised above, the others are also useful from DSM5. Can you suggest a better section or subsection for this one. BillMoyers (talk) 23:15, 10 December 2013 (UTC)

Were Trypto put it is fine. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:19, 10 December 2013 (UTC)

It appears as though DSM5 is recognising what clinicians had suspected and reclassifying schizotypal personality disorder as a form of psychosis rather than as a personality disorder. Now what I don't know right now is whether it has been included within schizophrenia proper or just within the overall group of psychoses (in which case it'd be better on the psychosis page). In any case, neeed to get my hands on a DSM5....Cas Liber (talk · contribs) 23:34, 10 December 2013 (UTC)

Not sure what you are getting at here

Both the differential diagnosis and direct diagnosis of schizophrenia has been influenced by the DSM-5 re-organization of personality disorders into "Clusters." In contrast to DSM-4, the updated DSM-5 published in 2013 now lists personality disorders in exactly the same way as other mental disorders such as schizophrenia, rather than on a separate 'axis' as previously. DSM-5 lists ten personality disorders, grouped into three clusters. Of the three clusters, "Cluster A" is directly relevant to the diagnosis and treatment of schizophrenia as ICD-10 indicates the schizotypal personality disorder is a form of schizophrenia. "Cluster A" includes the three personality disorders:Paranoid personality disorder, Schizoid personality disorder, and Schizotypal personality disorder, the latter described as a pattern of extreme discomfort interacting socially, distorted cognitions and distorted perceptions.

Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:28, 11 December 2013 (UTC)

The ref you use to support the first bit does not even mention schizophrenia [2]. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:29, 11 December 2013 (UTC)

Hello User:Jmh649, The other editor from this morning appeared to request clarification on DSM5 updates to the outmoded DSM4 which was given in the reference you refer to in your comment (User:Cas Liber). "Schizophrenia" can now be diagnosed in at least one of its forms under Cluster A within the DSM5 "Personality Disorders". The remainder of my edit clarifies "Cluster A" which appeared to be unknown to the Talk participants this morning due to its "recent" publication, with further citation given. If you have a psychiatrist with the DSM5 on duty in your ER, then you can confirm this directly. BillMoyers (talk) 03:20, 11 December 2013 (UTC)

The first ref does not mention schizophrenia. This looks like WP:OR. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:38, 12 December 2013

Hello User:Jmh649, We have all already discussed in the presence of 4 editors above that ICD10 defines schizotypal personality disorder as a form of schizophrenia, which is covered in the citation given.(Cas Liber (talk), User:Tryptofish, User:SandyGeorgia)If you want to overcite this text with ICD10 cross-refs this can be done. This issue has been addressed in full and in your presence on the Talk section directly above. Your pointed vigilance here is unclear and unsupported by any other editor. Four editors have recognized that the ICD10 reading of the DSM5 personality disorder as schizophrenia is acceptable, and has already been edited into this wikipage with your acknowledgment, "Where Trypto put it is fine." Please note that the multiple references to DSM4 in this article are outmoded and defunct, they are super-ceded by the new DSM5 since last Spring over six months ago. This situation of DSM5 replacement edits for outmoded DSM4 references will be system-wide for Wikipedia in the coming months. Even if you do not have a DSM5 and the benefits of its expertise, this is a current issue. BillMoyers (talk) 13:23, 12 December 2013 (UTC)

I have not seen the book, but the table of contents indicates schizotypal PD is classified within the Schizophrenia Spectrum and Other Psychotic Disorders. In which case this would best be discussed on an umbrella page such as psychosis (I need to read up on that to see how synonymous it actually is) or something else, but it is not included within schizophrenia so there is no place to discuss it here. Cas Liber (talk · contribs) 13:51, 12 December 2013 (UTC)

Hello User:Casliber(Cas Liber (talk)), My suggestion is not to disassociate the reading of DSM5 from ICD10. Can you speak to the larger issue of DSM5 updates to system-wide wikipedia use of outmoded DSM4 references. The issue of introducing "Cluster A" (not present in DSM4) in PD for use in schizophrenia diagnosis is only one single issue. BillMoyers (talk) 14:06, 12 December 2013 (UTC)

No-one is suggesting we do that.we also have pages on ICD10 and DSM5. There are other target destinations for material that you mention. We are fully intending to update (once I (or any other editor) get a hold of DSM5 and reads it) Cas Liber (talk · contribs) 19:52, 12 December 2013 (UTC)

Typically when one uses refs to write about a topic that the ref does not mention it raises concerns of WP:OR. The article does need updating I agree. The DSM 5 is however controversial and just because it has been published does not mean all previous work is void. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:27, 12 December 2013 (UTC)

The fact that I didn't comment more recently doesn't mean that I agree or disagree with any particular comment by someone else. In the discussion here, I agree with Doc James and Cas Liber. --Tryptofish (talk) 23:37, 12 December 2013 (UTC)

Hello User:Casliber(Cas Liber (talk)), User:Jmh649, User:Tryptofish, User:SandyGeorgia, Courtesy first, with appreciation for the quick responses from this morning. Looking at the page count stats from the last day, it is apparent that users want to see the DSM5 upgrades posted and I shall plan to redraft the current edit accordingly to your requests. Is it possible for me to stress the importance that each of you associated with the page management of this wikipage try to get a copy of the DSM5 as quickly as possible. APA has authored the DSM4, and APA has told us that DSM4 is now obsolete and super-ceded by DSM5. DSM4 is over a decade old. As a technical point, schizotypal PD is co-listed in both the "Schiz. Spectrum" section and the separate "PD" section under "Cluster A" of DSM5. Since forty to sixty percent of all psychiatric diagnosis, including schizophrenia, include a second co-diagnosis of at least one of the personality disorders, it is no longer practical to completely isolate the discussion of Schizophrenia from Personality Disorder as it may have been done in the past before DSM5. BillMoyers (talk) 05:10, 13 December 2013 (UTC)

I revised it, and I'd like the editors who are MDs to please check whether what I wrote accurately represents what DSM-5 actually says. --Tryptofish (talk) 22:40, 13 December 2013 (UTC)

...the classification of schizophrenia is no longer isolated from personality disorders

- I have no idea what this actually means. Is this about the removal of the axis II arc? I will chase the ref. Whether or not it is in the source is not the issue, the issue that it is really tangential to the article and has no place here, but is better in the article on personality disorders or on DSM5. I'll try and get the other ref but unless I find something really surprising, I sill think the whole lot should be removed. It makes this article look more like an essay. Cas Liber (talk · contribs) 23:31, 13 December 2013 (UTC)

Feel free to remove it. I have no objection to doing so. --Tryptofish (talk) 23:40, 13 December 2013 (UTC)

Update

Just looked in DSM5 online - this is all general info - there is nothing really specific and hence it is all tangential and best removed. Cas Liber (talk · contribs) 00:24, 14 December 2013 (UTC)

I agree. --Tryptofish (talk) 00:27, 14 December 2013 (UTC)

Agree that is the issue. I have ordered a copy of the DSM 5. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:50, 14 December 2013 (UTC)

From what I can tell so far, Moyers is using the pretense that this article (badly) needs a DSM5 update to shoehorn in a bunch of other stuff, and he's not familiar either with our standards, policies and guidelines in general, nor our FA standards specifically. SandyGeorgia (Talk) 07:06, 18 December 2013 (UTC)

I have no intention of paying what it costs to obtain a copy of DSM5, but have long fretted that we need to update this article. The concern now is that BillMoyers understand WP:WIAFA, WP:MEDRS, the citation style on this article, and the sourcing and prose standards that this article should maintain as the updates are done. His list of needed updates is a starting point. SandyGeorgia (Talk) 18:25, 17 December 2013 (UTC)

Hello User:Casliber and User:Jmh649, Both of you have seen this post and others placed by User:S. If he/she is claiming to be indigent then possibly one of you can help her obtain a copy or at least the relevant material of DSM5 to at least give him/her a chance of being a responsible editor. My emphasis is strongly that editors who wish to contribute to the DSM5 transition edits are aided by having the DSM5 in hand. Her ad hominems and false ascriptions to me are tiresome in spite of her enthusiasm, something like an ardent RN wishing to take over the department. BillMoyers (talk) 15:02, 18 December 2013 (UTC)

BillMoyers, you've got issues. Both Casliber and Jmh649 know exactly what my qualifications are to edit medical FAs. SandyGeorgia (Talk) 17:43, 18 December 2013 (UTC)

Is there anything left to address in this section, or is it ready to be archived? SandyGeorgia (Talk) 18:08, 18 December 2013 (UTC)

Hello User:Casliber and User:Jmb649, This material should be retained for the normal archival period of 60-90 days. The material here also shows that User:SandyG is not a nurse practitioner nor a registered nurse in psychiatry, along with her/his boycott of the purchase of a DSM5 manual. Both of you have confirmed the importance to editors on this Page for obtaining the DSM5 this past week-end by your example. This Talk section should be retained at least for the normal archival period of 60-90 days. BillMoyers (talk) 13:37, 19 December 2013 (UTC)

I will attempt one more time to do something constructive about BillMoyers approach to editing Wikipedia on his talk page. SandyGeorgia (Talk) 14:09, 19 December 2013 (UTC)

BillMoyers a talkpage with a wall of text is unhelpful. It is often helpful to archive addressed or duplicated sections manually to assist in addressing points systematically. Cas Liber (talk · contribs) 14:24, 19 December 2013 (UTC)

Hello User:Casliber, No-one wants a "wall of text". This material clearly shows that User:S is boycotting the purchase of a DSM-5 manual and the other material should be retained for the normal 60-90 archival period. It is urged that you counsel User:S on the importance of this manual to the integrity of this wikipage. Both you and User:Jmb649 have indicated that you now have the manual and your edits have been enhanced. User:S has sadly also stated on my Talk page that she/he has no knowledge of the difference between a medical doctor and a registered nurse, a peculiar comment for which your counsel to her may help. Your counsel to her on boycotting DSM-5 as she states above would be important. I request that she confine her outbursts to this Talk page alone, such as her/his Schacter errata below for all to see. This subsection on Talk here should be retained for the normal 60-90 day archival period. BillMoyers (talk) 14:23, 21 December 2013 (UTC)

Whoa there

OK, yes, the article is out of date for DSM5. Other than that, some folks please read WP:WIAFA and WP:OWN#Featured articles, and stop introducing MOS errors and various other issues. The lead is a summary of the article; we don't just plop new text into the lead. Text is developed in the body of the article, then summarized to the lead. I've removed this new text, plopped into the lead, for three reasons: 1) it goes in the body; 2) is 2004 really the most recent source for this info; and 3) Featured articles must maintain a consistent citation style-- if you're going to drop something in, at least follow the established citation style. I find it hard to believe that an almost ten-year-old review is the best we can do here. SandyGeorgia (Talk) 01:50, 17 December 2013 (UTC)

Janitor and secretary checking in

Please be familiar with WP:WIAFA and WP:OWN#Featured articles when editing a [[WP:FA|featured article:

1. We don't use "ibid" on Wikipedia, since text and their citations move around in a dynamic article; we use named refs.[3] Please review WP:CITE.
2. Books require page nos; BillMoyers, please provide a page range for the Schizophrenia section of DSM5.[4] Why are you citing ICD-10 to DSM5? Please provide a quote of what the DSM says on ICD for verification.
3. Jinkinson I have dozens of times on other pages explained to you how citations are written in this article and at Autism; please stop dropping in cite pmids that I have to clean up. You are by now an established editor and I should not have to clean up after you. [5] Will someone with full journal access please check the source to make sure we have sufficiently paraphrased? The APA guards their copyright stridently and has approached Wikipedia several times in the past when we have duplicated too much of their info (which they make money off of).
4. Speaking of APA and their copyright, the DSM-IV-TR definition in this article needs to be checked; it looks too close to the APA, and they will go after us. Will someone with DSM-IV-TR please review and paraphrase substantially? We should be eliminating DSM-IV-TR and paraphrasing the new crit for DSM-V, rather than continuing to list DSM-IV and saying what DSM-V changed.
5. This mess needs to be either cleaned up or removed entirely.[6] First, why was it in Symptoms, when it discusses history and ICD-10? Second, there is no complete citation. I have commented it out pending discussion.

This article is going to end up de-featured if editors don't start taking more care to discuss edits; I am not going to play secretary indefinitly. SandyGeorgia (Talk) 19:05, 17 December 2013 (UTC)

BillMoyers are you even reading the talk page? Why have you now added this text twice, still in the wrong place? And still poorly sourced? [7] Now it's there twice. Please read the talk page. SandyGeorgia (Talk) 23:31, 17 December 2013 (UTC)

The NIMH has stated they are not switching over to the DSM5 from the DSM4TR. The lead editor of the DSM4TR does not consider the DSM5 an update but a disaster. The DSM 5 is not the end all and be all of psychiatry. Agree we need to add details from it and mine just arrived today but this should not replace all mention of the DSM4TR just yet. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:06, 18 December 2013 (UTC)

The other thing to be mindful of is copyright issues and using DSM IV or 5 - the most detailed discussion was at Wikipedia:Copyright problems/2010 March 9#DSM Complaint .28Ticket:2010030910040817.29 and as Moonriddengirl is still active, we can discuss with her to what extent and detail we can discuss the criteria. Cas Liber (talk · contribs) 04:20, 18 December 2013 (UTC)

Cas, I was involved last time, so I can answer that. Even though for as long as I've been on the internet, I've known the APA defends its copyright and I was very careful in the articles I wrote, they were tagged too when the APA contacted legal last time. My articles-- which had no copyvio-- were tagged and had to sit there with a copyvio tag until the entire investigation was finished, and that included darn near any psych article that mentioned DSM. APA defends its copyright staunchly; everything was tagged until it was cleared. They don't want our articles being used in place of DSM for diagnosis. We have to go beyond paraphrasing; we have to do a very good job of rephrasing in our own word such that they can't say we've duplicated enough info that our article can be used for diagnosis. Right now, the DSM-IV-TR info in this article is probably a trigger; it needs to be rewritten. That's why we write from secondary sources, and should not be writing these sections at all from the DSM. SandyGeorgia (Talk) 06:49, 18 December 2013 (UTC)

Hello User:Jmh649 and User:Casliber, First my direct note that both of you now have the DSM5 available following Talk discussion last week which I must acknowledge fully. The transition of DSM4 to DSM5 is highly reminiscent of the transition from DSM3 to DSM4 along with all of the acrimony which took place then as well. To my knowledge most are accepting that there is to a be a re-gearing period of hopefully no longer than 12 to 18 months before DSM5 becomes fully prevalent, very similar to the re-gearing period which occurred at the DSM3 to DSM4 transition when it occurred years ago. This re-gearing period for DSM5, although recognizing that DSM4TR shall "briefly" continue during the re-gearing period, nonetheless recognizes that it is meant to be completely replaced by DSM5. This is not to say that all the acrimonious debates have suddenly disappeared or that they shall not continue until a future DSM-six eventually comes out, however APA has emphatically stated its commitment that DSM5 is to replace DSM4 and DSM4TR fully after the transition period. With regards to the five point outline at the top of this subsection, it may make sense for someone, perhaps either of you, to begin to consider integrating its usable points with the action list of 12 transition edits listed in the previous separate Talk page entry above, and putting it into some sort of preliminary priority (Urgent-Medium-Nonurgent) in order for some over-all tentative plan to start to emerge. With both of you having DSM5 in hand now, you are in a stronger position now to try to do this either singly or together. BillMoyers (talk) 06:25, 18 December 2013 (UTC)

First, the argument that has been tossed about on Wikipedia that DSM5 was controversial so editors have not wanted to do the update is bullroar-- DSM5 is DSM5, like it or not, there's controversy with every update, and if an article is to retain Featured status, it has to be updated. We don't need any more long discussions about the need.

Second, for copyright issues, we should not be writing from the DSM5-- we should be writing from secondary reviews. You, BillMoyers can be thanked for finally forcing a DSM5 update here, but your other edits are damaging the article. Please engage the talk page competently, and become familiar with Wikipedia's standards, policies and guidelines. SandyGeorgia (Talk) 06:54, 18 December 2013 (UTC)

More

Here's another chunk of text dropped in to the wrong place (BillMoyers please familiarize yourself with WP:MEDMOS#Sections and without a complete citation. I had commented it out pending correct sourcing, but Moyers re-added it.

The definition of schizophrenia was substantially refined in 1990 by the ICD-10, as covering a range of specifications which included paranoid schizophrenia (F20.0), hebephrenic schizophrenia (F20.1), catatonic schizophrenia (F20.2), undifferentiated schizophrenia (F20.3), post-schizophrenic depression (F20.4), residual schizophrenia (F20.5), and simple schizophrenia (F20.6). The ICD-10 states that, "The schizophrenic disorders are characterized in general by fundamental and characteristic distortions of thinking and perception, and by inappropriate or blunted affect. Clear consciousness and intellectual capacity are usually maintained, although certain cognitive deficits may evolve in the course of time. The disturbance involves the most basic functions that give the normal person a feeling of individuality, uniqueness, and self-direction."

cited to: ICD-10, Introductory paragraph on Schizophrenia.

The citation is incomplete, this was dropped into a random heading that breached WP:MSH, it overquotes, and it's unclear to me whether it belongs at all, and if so, whether it belongs in Diagnosis or History, but he had placed it in neither. SandyGeorgia (Talk) 07:12, 18 December 2013 (UTC)

Hello User:Jmh649 and User:Casliber, The url was added to this edit to more fully elaborate it as User:Trypt can confirm. This edit is fully documented and can be restored to this Wikipage at any time as consistent with its content. BillMoyers (talk) 15:36, 19 December 2013 (UTC)

User:Tryptofish would like to confirm that I agree with Sandy Georgia, Doc James, and Casliber about this point. --Tryptofish (talk) 20:45, 19 December 2013 (UTC)

Unable to verify

"people with schizotypal personality disorder have symptoms similar to schizophrenia, though of milder (subthreshold) intensity. The ICD-10 lists the schizotypal personality disorder as a form of schizophrenia."

What page number in the DSM 5 supports this?

The ICD 10 ref [8] does not even mention "schizotypal personality disorder" thus how can it support the text in question? Need page on the DSM 5. Removed until this data provided. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:24, 18 December 2013 (UTC)

Okay found it on page 104. Will add some back in. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:12, 18 December 2013 (UTC)

I added the bit from DSM5. Thx for finding the page number....cheers, Cas Liber (talk · contribs) 04:24, 18 December 2013 (UTC)

 Done SandyGeorgia (Talk) 18:06, 18 December 2013 (UTC)

Hello User:Casliber and User:Jmb649, The sentence about ICD-10 reading of SPD from the above edit is still to be returned to the wikipage. This material has already been rehearsed several times on this Talk page that SPD is listed as F21 in the Schizophrenia section of ICD-10. If you wish to add another url for this or a direct reference to the print edition of ICD-10 for this then you may do this, and return the edit as presented above. Certainly you must know that ICD-10 has singled out this PD for the very purposes of such elaboration. BillMoyers (talk) 18:01, 19 December 2013 (UTC)

Age of onset

In the Epidemiology section:

It occurs 1.4 times more frequently in males than females and typically appears earlier in men—the peak ages of onset are 20–28 years for males and 26–32 years for females.

The cited work by Castle et al does not mention the peak ages of onset for males and females. It only mentions that the period of greatest risk for schizophrenia for all people is in the age range 15-34 years.

Hum thanks. Will fix with better ref. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:42, 9 January 2014 (UTC)

Schacter

Where did this come from? There is no such ISBN. SandyGeorgia (Talk) 07:25, 18 December 2013 (UTC)

A child of two parents with schizophrenia has a 46% chance of developing the disorder.

Schacter, Daniel L. (2011). Psychology Ed. 2. 41 Madison Avenue New York, NY 10010: Worth Publishers. p. 578. ISBN 1–4292–3719–8. {{cite book}}: Check |isbn= value: invalid character (help)CS1 maint: location (link)

Is this text even needed? SandyGeorgia (Talk) 07:26, 18 December 2013 (UTC)

@User S, Please do your research responsibly, this is a very well know text on Psychology. Please explain to all of us how your opinion on the inclusion of this material is of more significance than that of Professor Daniel Schacter at Harvard University in Cambridge Massachussettes who had the opinion of including it in his general book on Psychology. The original edit is worth restoring on this wikipage.

• Hardcover: Schacter, et al,
• Publisher: Worth Publishers; 2 Har/Psc edition (June 1, 2011)
• Language: English
• ISBN-10: 1429283068
• ISBN-13: 978-1429283069 BillMoyers (talk) 14:46, 18 December 2013 (UTC)

There are a number of refs that support this. Risk is 13% if one parent is affected and nearly 50% if both parents affected. [9] Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:32, 18 December 2013 (UTC)

Jmh649, my IP can't access that google book. Will you handle this fix? The citations in this article have fallen into considerable disrepair since its last review. SandyGeorgia (Talk) 17:48, 18 December 2013 (UTC)

Okay will do. I use the cite tool in the edit box for adding refs. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:52, 18 December 2013 (UTC)

No worries-- I don't mind cleaning up citations, when necessary, after an editor who carries more than his weight :) :) SandyGeorgia (Talk) 17:55, 18 December 2013 (UTC)

 Done SandyGeorgia (Talk) 18:05, 18 December 2013 (UTC)

General

It's not hard to tell just form the mess of citations needing cleanup[10] that this article has not been closely watched since the last FA version; some marginal sourcing has found its way in here, and there has been prose deterioration. The article needs more than a DSM5 update; it needs a thorough check of some of the cruft that has crept in since its last review. SandyGeorgia (Talk) 07:56, 18 December 2013 (UTC)

DSM-IV-TR and copyvio

This version of Schizophrenia#Criteria is copyvio. [11] SandyGeorgia (Talk) 14:36, 19 December 2013 (UTC)

Could someone with access to PMID 23800613 please check it for copyvio or close paraphrasing in the Criteria section? SandyGeorgia (Talk) 14:43, 19 December 2013 (UTC)

The numbered list here closely paraphrases material in the article's abstract. Alexbrn ^{talk|contribs|COI} 15:00, 19 December 2013 (UTC)

This is vague:

* 2. adds new psychopathological dimensions,

* 3. clarifies cross-sectional and longitudinal course specifiers,

SandyGeorgia (Talk) 15:25, 19 December 2013 (UTC)

These are just listifications of the abstract text: "addition of unique psychopathological dimensions, clarification of cross-sectional and longitudinal course specifiers". For a discussion of "psychopathological dimensions" the article refers us to PMID 23706415; the course specifiers are explained as follows: "the distinction of course specifiers according to their cross-sectional (state) and longitudinal character allows the clinician to document both the current status and the previous course up to the present observation period." Alexbrn ^{talk|contribs|COI} 15:48, 19 December 2013 (UTC)

We could address the too-close-paraphrasing and listification by prosifying that section, while expanding on points 2 and 3. Are you interested?  :) :) SandyGeorgia (Talk) 15:51, 19 December 2013 (UTC)

I'm a bit out of my comfort zone with the very dense and jargony text on an unfamiliar subject, but I'll have a go. I'll re-write the list to avoid the paraphrasing and it more approachable to a non-expert; we can then see if that can be re-worked into prose. Yes? Alexbrn ^{talk|contribs|COI} 15:57, 19 December 2013 (UTC)

Go for it :) If it's not stellar, someone will fix it! SandyGeorgia (Talk) 16:03, 19 December 2013 (UTC)

Done. I'm not sure exactly what PMC 2833126 is trying to say about the relationship between catatonia and schizophrenia in DSM 5; it rather abstractly mentions a "divorce" between them. Alexbrn ^{talk|contribs|COI} 16:58, 19 December 2013 (UTC)

One of the sources is an editorial? [12] (BTW, I've never understood why this article needs 158 citations-- is there not one good, recent overview?) SandyGeorgia (Talk) 17:54, 19 December 2013 (UTC)

Yes, both the "lesser" sources are pointed-to by PMID 23800613 for fuller information information on the changes in DSM 5. Alexbrn ^{talk|contribs|COI} 18:06, 19 December 2013 (UTC)

Alexbrn, my free time is very patchy at present - I am happy if someone has a go and we come in after to tweak. I do not think updating this section will be as difficult as thought. Just need a clear stretch of time to focus. Cas Liber (talk · contribs) 23:11, 19 December 2013 (UTC)

Internal quality control at Page:Schizophrenia in relation to general Wikipedia quality control.

Not really directly related to a suggestion for improving this article, please pursue elsewhere
The following discussion has been closed. Please do not modify it.
Recently, one of the users on this wikipage expressed no knowledge of the difference between a "medical doctor" and a "registered nurse", and no knowledge of why this would be important to the writing a wikipage related to medical issues dealing with mental health in general. Most wikipedia users are already familiar with the two-axis approach which Wikipedia takes to the internal quality control of its millions of pages. The one axis is the rating of articles by"Importance" ranging on four gradations from high to low. The second axis used by Wikipedia for internal quality control is that of the "Upgrade" status of the article itself which ranges mostly on an eight part scale from FA and GA articles down to Start and Stub class articles. This is presented as a general frame to explain the gradation scale, also pertinent, of the gradation of hierarchy as it is seen in the medical profession and how this affects the two-axis internal quality control model which Wikipedia uses system wide. The most established medical doctors are those who have become department chairmen at either hospitals or medical schools, and they begin this list intended to be used for discussing related Wikipedia internal quality control issues: (1) Medical doctors who have become chairmen at hospitals or medical schools, often having written multiple books and medical articles, and supervising multiple research grants and programs, highest level of accomplishment. (2) Medical doctors who are full Professors and who hold tenured faculty positions and leading universities such as Harvard University. (3) Medical doctors who have become Attending Physicians at a hospital and have specialized in one of its many branches of medicine, such as Psychiatry, who organize the efforts of lower ranking medical doctors at the hospital and medical interns who are MDs. They may or may not have written journal articles. (4) Medical doctors who have specialized in one branch of medicine such as Psychiatry and have become board certified in this specialized branch of medicine. They may be treating physicians at a hospital or in private practice with affiliation to a hospital. (5) Medical doctor who may have specialized in a branch of medicine yet who are unaffiliated with a hospital, medical school, or university, and who are in private practice. (6) Medical doctors who are general practitioners without any specialization or interns, who serve an important service in their communities in providing needed health care. (7) Nurses of various degrees of accomplishment who usually assist medical doctors. This list presents the gradations of advancement within the medical profession in general terms and identifies the importance of this quality among doctors, much as Wikipedia uses standards for internal quality control of its wikipages as described above. There is a significant discussion of the quality of writing of specialized articles in, for example, the medical and/or the legal disciples, which has yet to fully take place at Wikipedia, as to whether an article submitted to Wikipedia benefits if an article is submitted by a high raking medical doctor from the enumeration above, or, if it is no different from a specialized medical wikipage written by a registered nurse of even a bright student. This table enumeration is presented here for general comment of how it might affect the Wikipedia internal quality control for this Schizophrenia wikipage and perhaps other medical wikipages. Is there any benefit to having medical articles written by doctors at the higher levels of the list? Can it potentially have a beneficial effect on Wikipedia quality? BillMoyers (talk) 15:09, 21 December 2013 (UTC) There are big problems with this as it undermines the review of the quality of a page itself. What is to be done if an expert writes an article that others find exception to? And while we have anonymous editing, we have problems with verification of an editor's credentials. This discussion should come off this page and be discussed at WT:MED instead. Cas Liber (talk · contribs) 04:31, 24 December 2013 (UTC) We have levels of evidence. Expert opinion is the lowest level of evidence. We want to use the highest levels of evidence if available. All of course must be published. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:54, 24 December 2013 (UTC)

Robert Sapolsky and shamanism

Shouldn't Robert Sapolsky's theory about shamanism and schizotypalism as the source of schizophrenia be mentioned here? He is clearly a notable source on this subject. http://www.youtube.com/watch?v=4WwAQqWUkpI 173.17.92.242 (talk) 15:58, 28 December 2013 (UTC)

Before anyone else objects to Youtube as a source, I'll point out that this is Sapolsky giving a lecture. That said, this strikes me as a better fit for Causes of schizophrenia#Evolutionary psychology than here. It's a very speculative theory, albeit from a clearly notable commentator, with little experimental evidence, and it also focuses on what he calls schizotypical personality disorder, and not on schizophrenia per se. --Tryptofish (talk) 21:05, 28 December 2013 (UTC)

Pretty much what Tryptofish said...Cas Liber (talk · contribs) 21:49, 28 December 2013 (UTC)

Only pretty much? --Tryptofish (talk) 21:56, 28 December 2013 (UTC)

(chuckle) look at my userpage at how I use language - I generally understate things - "hypobole" - just a habit...maybe a self-soothing behaviour...just keepin' it casual....Cas Liber (talk · contribs) 22:08, 28 December 2013 (UTC)

--Tryptofish (talk) 22:15, 28 December 2013 (UTC)

Removed for discussion

Psychosocial interventions, particularly family support and education, cognitive behavioral therapy, supported employment, social skills training, and case management services, also significantly improve functioning and quality of life.

The current sentence in the introduction is: "Psychotherapy and vocational and social rehabilitation are also important in treatment." Problems with this sentence include:

• Most forms of traditional psychotherapy do not help patients with schizophrenia. Linking to the psychotherapy article will mislead readers into thinking broadly-defined psychotherapy improves functioning for persons with schizophrenia.

• The term "vocational rehabilitation" connotes traditional vocational rehabilitation services, which help many people, but do not generally help people with schizophrenia.

• What is "social rehabilitation"? I recognize this is an introductory section meant to briefly summarize the topic, but vague terminology only serves to muddy the waters.

• Passive voice. My suggested change was: "Psychosocial interventions ... significantly improve functioning and quality of life." Mark D Worthen PsyD 02:38, 17 December 2013 (UTC)

Thanks for collaborating, and for starting over. Part of my concern is that a new editor has gone out and asked a lot of folks to help with the long overdue and much needed update here, but it isn't clear to me that he understands WP:WIAFA, WP:MEDMOS, WP:MEDRS, WP:CITEVAR and the gazillion other prose, sourcing and MOS issues that a featured article must conform to. It would be helpful if changes were proposed first to the body of the article, based on the most recent (last five years) and highest quality secondary reviews, then summarized back to the lead, per WP:LEAD. Boghog citation filler template for generating citations from a PMID, and Wikipedia:Wikipedia Signpost/2008-06-30/Dispatches to help understand how to search for review articles. The help is needed and appreciated, but let's make sure the article comes out on the other side of the update without losing its featured status. SandyGeorgia (Talk) 02:46, 17 December 2013 (UTC)

As an Army buddy of mine says, Roger that. Translation: I have received your message, understand it, and intend to carry on as advised. :+) Mark D Worthen PsyD 03:26, 17 December 2013 (UTC)

Hello User:Markworthen and User:SandyGeorgia, The two of you appear to have indicated two green lights that this edit should be restored by first posting it in the main text and then referring to it in the Lede as needed. If you need a third green light then here it is. It looks like a useful contribution. From the edit pages I did see that both of you had gone through handshaking ops yesterday which took up some time. If either of you or both of you have a chance to look at the list of action items in the subsection above this one on DSM5 transition edits, then your comments would be appreciated. I am assuming there is a similar list of action items on other similar psy. pages which shall also require attention. I look forward to seeing the Markworten edits restored soon since there appears to be general agreement. BillMoyers (talk) 18:15, 17 December 2013 (UTC)

No, I would not complete the badly needed updates to this article with a 2004 source (almost ten years old); see WP:WIAFA and WP:MEDRS. Your list looks like a good starting place, but you should be providing a recent, high-quality secondary source to back each item. SandyGeorgia (Talk) 18:27, 17 December 2013 (UTC)

Hello User:Markworthen and User:SandyGeorgia, Not sure what is suggested by this reference to a 2004 source. The wikipage for schizophrenia is filled with references to ICD10 which is from 1990. The Markworthen edit is validated is worth posting as described above. BillMoyers (talk) 19:11, 17 December 2013 (UTC)

BillMoyers would you mind please reading the talk page guidelines posted at the top of this (and almost every) talk page, and threading your responses properly? Once you've read and understood MEDRS, then perhaps we can discuss further the problem with adding 2004 sources. Of course ICD-10 and DSM versions are sourced to when they were published. Also, please familiarize yourself with WIAFA and WP:UNDUE. If you keep asking the same questions without listening to the response, you are likely to exhaust the patience of those dealing with you (assuming you haven't already). SandyGeorgia (Talk) 23:23, 17 December 2013 (UTC)

Another

Removed for discussion and sourcing. See WP:CITEVAR, WP:WIAFA, and WP:MEDRS; there is no reason to drop a line in that requires five sources. If it belongs here, it can be sourced to one, recent, high-quality secondary review, and please use the citation style used in the article. That is, you can get a cite journal template by plugging the PMID into the Boghog Cite template filler, and then change the cite journal to vcite journal. Why on earth is text being dropped into a Featured article that uses 1974 and 1992 sources ?SandyGeorgia (Talk) 01:54, 17 December 2013 (UTC)

Removed for discussion and sourcing

Hypofrontality, a decrease in cerebral blood flow in the prefrontal cortex below that of control subjects during tests of executive function, may be a cause of the negative symptoms of schizophrenia, though support for this idea is mixed.

Sorry, I added back the above thinking someone had just added it and I had mistakenly erased it. I'll leave it for you to remove so I don't muck it up. Mark D Worthen PsyD 02:05, 17 December 2013 (UTC)

Markworthen you readded it, I'd appreciate it you removed it, as I don't edit war. I have long appealed to editors to do the necessary DSM5 updates here, but the kind of editing that is occurring here will result in this article being defeatured; slow and steady wins the race. Please familiarize yourselves with the citation style in the article, various MOS pages, and the FA standards before dropping text in here based on outdated sources, and into the lead without developing correctly the body of the article. WP:OWN#Featured articles applies. If a statement needs five sources, it doesn't belong in a Featured article, which should be based on the most recent, highest quality secondary reviews. SandyGeorgia (Talk) 02:12, 17 December 2013 (UTC)

I removed the section that someone else had added that you removed that I thought I had removed my mistake and added back and that you pointed out had too many citations, which were old and crusty to boot, which is why you removed it. ... I think Wikipedia needs to add an instant messenger so we can instantly message each other, like, "Hey wait! Before you make all those good faith edits, there are a couple of things you should know..." Mark D Worthen PsyD 02:46, 17 December 2013 (UTC)

Yes, I know the feeling. Actually, there should have been an editnotice on this (and all FAs) long ago, warning new editors of the FA standards, but that's a whole 'nother long story ... OK, not sure where we stand now, it's my bedtime, but before you move forward, Mark, could you be sure you are updating first the body of the article, and always to recent secondary reviews, and please with a consistent citation style or someone (like me) will end up having to clean up the citations. Thanks again for the help-- I don't have a copy of DSM5, or would have done this long ago myself, as I've been grumbling for months that no one has updated our FAs to DSM5. (You should see the mess we've got on our hands in the autism suite ... ) SandyGeorgia (Talk) 02:50, 17 December 2013 (UTC)

Here is a more recent source that mentions hypofrontality in the context of the negative symptoms of schizophrenia:

Menon V, Anagnoson RT, Mathalon DH, Glover GH, Pfefferbaum A. Functional neuroanatomy of auditory working memory in schizophrenia: relation to positive and negative symptoms. Neuroimage. 2001;13(3):433–46. doi:10.1006/nimg.2000.0699. PMID 11170809.

PMID 11170809 is a primary source. In general, medical content should be sourced to secondary reviews; in a Featured article that is a broad overview, it should be sourced to recent, high-quality secondary reviews. SandyGeorgia (Talk) 18:28, 17 December 2013 (UTC)

I'm not sure if the DSM-IV/V conversation is intended to pertain to this edit, but I don't expect hypofrontality to be mentioned in either, considering that it is an experimental observation, rather than a clinically-observable symptom. Indeed, the DSM-V makes no mention of it (http://dsm.psychiatryonline.org//content.aspx?bookid=556&sectionid=41101758#103437013), though I don't consider its exclusion from that text an indication that it is not a relevant part of the current thinking about schizophrenia. Rob Hurt (talk) 16:26, 17 December 2013 (UTC)

Hello User:Rob Hurt, Regional cerebral blood flow under the oxygenation hypothesis has a long established history in fmri research and this Talk page is fortunate to have someone look up the actual citations for the related research in schizophrenia. There is substantial justification in the literature for inclusion of this material here and 3 cites should be enough, perhaps the other editors can suggest which three they prefer. BillMoyers (talk) 18:00, 17 December 2013 (UTC)

Please familiarize yourself with WP:MEDRS and WP:WIAFA; this talk page is going to grow extremely large if folks keep chatting without providing recent high-quality journal reviews to support proposed additions. Wikipedia:Wikipedia Signpost/2008-06-30/Dispatches may aid in understanding how to locate and use appropriate sources. SandyGeorgia (Talk) 18:31, 17 December 2013 (UTC)

I think that we can agree that there is substantial mention in the literature of hypofrontality as a contributor to the negative symptoms of schizophrenia, even if much of it is old. I think that the fact that there was/is so much discussion of it merits inclusion in this article in at least some capacity. If we aren't comfortable presenting it as a current hypothesis, might we present it as an old one? If the primary critique of the sources presented is that they are old, but not that they are inaccurate, then perhaps we should present it as an antiquated theory that has dropped out of the literature recently. I think that we can reach some sort of compromise here.... Rob Hurt (talk) 23:04, 17 December 2013 (UTC)

Please review WP:MEDRS, WP:WIAFA, and WP:UNDUE. If hypofrontality is important in schizophrenia, you will find mention of it in a recent, high-quality, broad overview. I feel that I may be repeating myself; perhaps you could familiarize yourself with these pages? SandyGeorgia (Talk) 23:26, 17 December 2013 (UTC)

Hypofrontality first came into the literature about maybe 20 years ago (darn, I feel old!), and I'm pretty sure that it remains accepted in present-day research. Rob is correct that it's primarily in the research literature, and not the diagnostic literature. I'm pretty confident that high quality reviews about it exist (whether or not those are the sources that have actually been mentioned here, so far). Tim Crow is the primary researcher associated with the concept, so I would suggest looking for reviews where he is one of the authors. It should be possible to find appropriate sourcing, and I'm inclined to think it's an important enough concept that it's worth a sentence or so on this page. --Tryptofish (talk) 23:36, 17 December 2013 (UTC)

Thanks, Trypto ... perhaps these editors new to the page can be encouraged to read the multitude of posts I've made here explaining to them where and how to find high-quality secondary reviews that are used to source medical articles, and particularly medical FAs. As things stand, I'm too busy cleaning up after the edits made here to have time to go do the research as well ... there's a huge list in the next section, and now we have duplicate text, added twice by BillMoyers, who doesn't seem to understand how to read a talk page or to have read WP:BRD. SandyGeorgia (Talk) 23:40, 17 December 2013 (UTC)

I hear you, Madame Secretary/Janitor! Per WP:BRD, I just made a revert. The quantity of edits is more than what I can take in yet, but a quick perusal makes me think that most of the new editors here are being cooperative, and are going to look for sources, and it's really a single editor where WP:COMPETENCE is an issue. --Tryptofish (talk) 23:52, 17 December 2013 (UTC)

Thank you for helping, Trypto; much appreciated. I'm seeing plenty of competence issue in that folks aren't reading talk, and I'm doing and redoing the janitorial cleanup. SandyGeorgia (Talk) 07:00, 18 December 2013 (UTC)

Thank you. And Casliber and Doc James. --Tryptofish (talk) 22:18, 18 December 2013 (UTC)

Here are two recent meta-analyses:

• Hill K, Mann L, Laws KR, Stephenson CM, Nimmo-Smith I, McKenna PJ. Hypofrontality in schizophrenia: a meta-analysis of functional imaging studies. Acta Psychiatr Scand. 2004;110(4):243–56. doi:10.1111/j.1600-0447.2004.00376.x. PMID 15352925.
• Glahn DC, Ragland JD, Abramoff A, et al.. Beyond hypofrontality: a quantitative meta-analysis of functional neuroimaging studies of working memory in schizophrenia. Hum Brain Mapp. 2005;25(1):60–9. doi:10.1002/hbm.20138. PMID 15846819.

Tim Crow's work is older, but if he is the prominent expert in the field, then I'm sure that his work would useful to include.... Rob Hurt (talk) 23:54, 17 December 2013 (UTC)

Meta-analyses are nice. But. This is a broad, overview article that must meet not only our medical sourcing standards, but also the featured article criteria. Please review our policy on due weight; recent, high-quality secondary reviews help us assign weight to items to be mentioned in a broad, overview FA. Again, if this theory is significant enough to be included here, it will be mentioned in recent high-quality secondary reviews. What this means, to all the folks that BillMoyers pinged in here who have never worked on FAs before, is that you need to do the research if you want to add something. Go find a high-quality secondary review. Wikipedia:Wikipedia Signpost/2008-06-30/Dispatches may help. You can find a meta-analysis on just about anything; to know if something warrants inclusion in an overview FA, please find a review that mentions it. SandyGeorgia (Talk) 06:59, 18 December 2013 (UTC)

Hello User:Rob Hurt and User:S, Yes we all know it is an FA article, and we all know that it is under the shadow of becoming increasingly obsolete if the DSM5 transition edits issues are left unaddressed. If you are somehow suggesting that FA articles should be artificially protected against the progress of time, then I am not sure that is as realistic as DSM5 editors would normally expect. Your comment on "high-quality journal reviews" cannot possibly refer to the use of the journal "Neuroimage" which is a journal of considerable academic standing. Your ascription that Dr. Glover and Dr. Menon are not of a high quality of research must be very carefully worded since these are living authors with significant standing in the medical community. The current edit by Rob Hurt is verified and worth restoring. @User:Rob Hurt, Recommend glancing at Toga and Mazziotta remarkable books on fMRI in their multiple volumes and possibly expanding your edit into a short new subsection. Especially their volume on Disorders, Ch 21, "fMRI Studies of Schizophrenia," pp523-541. Its very useful material which has been supported since the 1990s to the present and your edit should be restored. BillMoyers (talk) 14:21, 18 December 2013 (UTC)

It would be beneficial if you would learn to read what is on the page. Please add WP:IDHT to your recommended reading. SandyGeorgia (Talk) 17:45, 18 December 2013 (UTC)

Still pending sourcing

Text removed for sourcing: SandyGeorgia (Talk) 18:26, 19 December 2013 (UTC)

Hypofrontality, a decrease in cerebral blood flow in the prefrontal cortex below that of control subjects during tests of executive function, may be a cause of the negative symptoms of schizophrenia, though support for this idea is mixed.

Should anyone want to undertake writing this, here two recent reviews: SandyGeorgia (Talk) 18:26, 19 December 2013 (UTC)

• Marek GJ, Behl B, Bespalov AY, Gross G, Lee Y, Schoemaker H. Glutamatergic (N-methyl-D-aspartate receptor) hypofrontality in schizophrenia: too little juice or a miswired brain?. Mol. Pharmacol.. 2010;77(3):317–26. doi:10.1124/mol.109.059865. PMID 19933774.
• Liemburg EJ, Knegtering H, Klein HC, Kortekaas R, Aleman A. Antipsychotic medication and prefrontal cortex activation: a review of neuroimaging findings. Eur Neuropsychopharmacol. 2012;22(6):387–400. doi:10.1016/j.euroneuro.2011.12.008. PMID 22300864.

"Does not lend itself easily to a linear narrative" - correction "facts does not look good".

This is an extremely pseudointellectual article.

Psychiatry is based in the ancient witch-doctor, who "consulted the ancestral-demons" or similar concept, on LSD-like substances, where afterwards he would drill holes in peoples heads "to let the demons out". This was called "trepanning". Obviously these demons were the same as what is called "schizophrenia" now.

Later this was excused by the same pseudointellectual nonsense, and called "lobotomy".

Which resulted in anti-psychotics, which really aim to do the same as lobotomy, chemically.

Nodoby ever got well by this. While many become completely cured by religion.

Fundamental religious monotheistic logic is "God has no partners". With one God there is no schism. It makes completely perfect logical sense.

However if you expect the simple mindset that results in the psychiatry we have today, to understand this, I think you would be very enthusiastic. People on that level of retardation will never understand sanity.

These facts should ofcourse also be included, but as people of the previous mindset can edit or even work as moderators, it is probably a futile post, unfortunately. This is what people who are diagnosed should know, not the pretensious clowns that belief in ancient mad customs, completely without basis in science.

PBWY. — Preceding unsigned comment added by 84.211.129.189 (talk • contribs)

Wikipedia articles need to be based on reputable published sources. You are free to have whatever opinion you like, but it can't be imposed on the article unless there are high quality references to support it. Looie496 (talk) 18:14, 6 January 2014 (UTC)

Sources of information

There is a large amount of material available for usage from the Military Industrial complex.

The content would require evaluation prior to use for intellectual stimulation.

If a picture can explain a thousand words.

Then adequately moderated content can perhaps

Stimulate all people's interest.

2.121.192.36 (talk) 20:22, 9 January 2014 (UTC)

You lost me .Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:18, 9 January 2014 (UTC)

Updates from new manual II. DSM5 replaces outmoded DSM4.

Discussions regarding updating the article to reflect DSM5 are archived beginning at Talk:Schizophrenia/Archive 8. SandyGeorgia (Talk) 20:02, 11 January 2014 (UTC)

DSM5 manual has been out since Spring of 2013 for over half a year now, and this article needs to be updated and redrafted to maintain assessment. It is oriented almost exclusively to DSM4 which is now defunct and super-ceded. This issue of DSM5 updates is to become system-wide for Wikipedia during the coming months and is a current concern system-wide. At a minimum, each of these listed items should be addressed on this wikipage.

1. Article as a whole appears to completely overlook the comparison and relationship of this diagnosis with "Personality Disorders" as presented in ICD10 and DSM5, the discussion is completely missing. ICD tells us that Schizophrenia can be diagnosed under "Personality Disorders".
2. Lede does not mention relevance of associated personality disorders to Schiz. diagnosis and treatment. 40% to 60% of all psychiatric diagnoses are accompanied with a diagnosis of associated personality disorders. See: Saß, H. (2001). "Personality Disorders," pp. 11301-11308 in Smelser, N. J. & Baltes, P. B. (eds.) International encyclopedia of the social & behavioral sciences, Amsterdam: Elsevier doi:10.1016/B0-08-043076-7/03763-3 ISBN 978-0-08-043076-8.
3. "Schneiderian" classification should be discussed under "History" section. It is secondary to both the ICD10 and the DSM5 classification categories and the section should reflect this. They (DSM5 and ICD10) presently do not appear in discussion until section 4 here as "Diagnosis". Unless this wikipage updates/replaces all DSM4 references with DSM5, it becomes outmoded and obsolete.
4. "Causes" subsection completely ignored diagnostic Personality Disorders; possible correction may be with a new subsection, or as a subsection to present "Genetics" subsection; Or, possibly under "Developmental." If Schizophrenia is related to Genetics, it is related to Personality Disorders as well.
5. Very scant and sparse "Psychological" subsection under "Mechanisms" compared to more fully developed "Neurological" subsection; Personality Disorders completely ignored in this subsection. Expertise of psychiatric background is visibly lacking in this subsection.
6. "Diagnosis" opening paragraph in subsection mentions only DSM4 and needs to be updated; no mention is made of disagreements and contrasts between DSM5 and ICD10 regarding "Schiz." diagnosis and assessment.
7. "Diagnosis" subsection on "Criteria" is outdated and does not mention DSM5 updates for schizophrenia. DSM4 is outmoded and obsolete for over half a year now.
8. "Diagnosis" subsection on "Subtypes" is outdated to DSM5 standards and needs to be re-drafted. ICD-10 classifies the DSM-5 schizotypal personality disorder as a form of schizophrenia rather than as a personality disorder.
9. That forty percent to sixty percent of psychiatric diagnoses for schizophrenia include a co-diagnosis of at least one of the personality disorders underscores the issue that a separate subsection is needed and justified for "Personality Disorders as a Component of Schizophrenia." The statistics inform the medical community that approximately every second or third diagnosis of schizophrenia by a psychiatrist is accompanied with a co-diagnosis of at least one personality disorder. This is far from "obscure" or "tangential." It covers between one third and two thirds of all psychiatric diagnoses for schizophrenia. It would be of high importance to include such a subsection during the time period of the DSM5 transition edits and neglectful if it is excluded.
10. Key explanation is needed of the full change of diagnostic format of specification for schizophrenia as a category of diagnosis by the DSM5 re-organization of the diagnostic classification for schizophrenia which now excludes subtype classification of variant forms of schizophrenia.
11. Mortality statistics and-or mortality tables for schizophrenia recovery need significant elaboration for each of the following categories, (a) with medications, (b) without medications, (c) with supportive therapy, (d) without supportive therapy. Also, the progress of chronic schizophrenia needs to be substantially differentiated and addressed to include at least the topics of (i) the extended control of symptoms, and (ii) the intensification and development of symptoms over longer periods of time, along with co-morbidity issues.
12. Cluster A significance to the discussion of schizophrenia in general can no longer be responsibly excluded from the discussion as currently displayed on this wikipage. The significance of Cluster A along with its heightened association to schizophrenia within this cluster of personality disorders as opposed to the other clusters, Cluster B and Cluster C, is presently entirely absent from this wikipage. The issue is presently fully neglected on this "Schiz." wikipage. The current Section4.2 on this wikipage is completely outdated and obsolete according to DSM5. Its material is now out of print and is no longer in use by an entire new class of medical students entering studies since Autumn 2013.
13. Fundamental misunderstanding of statistics on this wikipage must be clarified and its direct presentation enhanced. The statistics are that of 2.4 million adults (for example in 2004) in the United States diagnosed with Schizophrenia, that an estimated 960,000 to 1.44 million are co-diagnosed with at least one of the personality disorders. This material and its analysis are completely missing and lacking on this wikipage, and it should be consistent with DSM-5.
14. Page management at this wikipage has shown resistance to the inclusion of the crucial statistics linking PD to schizophrenia following the 2004 statistics and other supportive material as outlined above. Even with statistics as high as 1.44 million sufferers co-diagnosed with schizophrenia and PD, page management on this wikipage continues to neglectfully exclude the discussion of the active need for a sub-section on PD related to schizophrenia as found in DSM-5 and supportive literature.
15. The time frame for the discussion of schizophrenia and its related research literature must be clarified and made explicit to recognize fully the relationship of DSM-5 (2013) and ICD-10 (1990) with immediate emphasis. Any arbitrary time frames for identifying useful research material must be excluded. Statistics on chronic forms of schizophrenia can go back several decades (to the 1950s and 1960s) and still be highly useful in this wikipage. The time frame of 1990 for ICD-10 is a reasonable one, and the edit on this Talk page for a "Modern assessment" subsection has not received comment from User:Casliber or User:Jmb649. The material would responsibly bracket this wikipage as a whole to 1990 ICD-10, until such time as ICD-10 and DSM-5 are replaced. All arbitrary time frames must be excluded. This subsection should be added to protect this wikipage from becoming obsolete and outdated by DSM-5 standards. User: BillMoyers (talk) 14:01, 12 December 2013 (UTC)

@BillMoyers, can you provide the citation that supports the statement that 40% to 60% of all psychiatric diagnoses are accompanied with a diagnosis of associated personality disorders, and in fact another one with co-diagnosis in schizophrenia of personality disorder? Cas Liber (talk · contribs) 03:52, 15 December 2013 (UTC)

@Casliber, Yes, certainly, the full citation was deleted by someone editing the "Schiz." page over the week-end. You may find the full citation by clicking on the (Cur-prev) tab of my 13Dec edit on the "Schiz." edit history page. BillMoyers (talk) 15:53, 16 December 2013 (UTC)

BillMoyers, alright, found it - I tried looking this source up but am unable to see the fulltext of it - what does the source sentence actually say? Does it somehow mention schizophrenia directly and if so how? If not it is too general and not relevant to the article. Cas Liber (talk · contribs) 13:34, 17 December 2013 (UTC)

Hello User:Cas Liber, This reference is from an established International Encyclopedia which should be available at your University. Ascribing it as "too general and not relevant" without your even seeing it is a task normally outside the domain of Wikipedia editors. As I am certain you already know, unless you have a citation to the contrary, then this source must stand as verified and from a reputable international publisher. The original edit should be restored as validated and verified. See, Saß, H. (2001). "Personality Disorders," pp. 11301-11308 in Smelser, N.J. & Baltes, P.B. (eds.) International encyclopedia of the social & behavioral sciences, Amsterdam: Elsevier doi:10.1016/B0-08-043076-7/03763-3 ISBN 978-0-08-043076-8. BillMoyers (talk) 18:35, 17 December 2013 (UTC)

So 2-3 times greater than that of the general population which is at 10-20%? [13][14] Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:21, 18 December 2013 (UTC)

Hello User:Jmb649 and User:Cas Liber, My reading would first be to compare the two refs you cite as consistent with each other and telling us that morbidity is twice as high for PD during college age for adults. The 40%-60% statistic above looks like it is more closely related to the other NIH statistic given in the citation you give which states that "1 in 4 adults is diagnosed w. a mental disorder each year." Therefore, so the statistics would infer, 40% to 60% of these 1 in 4 adults with a diagnosed mental disorder should be expected to be co-diagnosed with at least one personality disorder. BillMoyers (talk) 06:46, 18 December 2013 (UTC)

Moyers, you are seriously suggesting a 2001 (13-year-old data) source for an update to this page? We don't infer on Wikipedia; if you want to add text here, please find a recent, high-quality secondary review that covers it. Your post above addressing Casliber is off base; the onus here is on the person wanting to add the text to provide a recent citation compliant with WP:MEDRS, and in this case, also with WP:WIAFA. Have you read any of those pages yet? SandyGeorgia (Talk) 07:05, 18 December 2013 (UTC)

P.S. @User:S, This wikipage is filled with multiple references to ICD10 which is from 1990. Is this a 1990 issue for you or a 2001 issue. Your reasoning appears deeply flawed on this issue. BillMoyers (talk) 14:30, 18 December 2013 (UTC)

Agree that we should be using a source from the last 3-5 years preferably. Yes the ICD10 is old however we give it a "pass" as it is the WHO's most recent diagnostic criteria. The ICD11 should be out in 2015 I think. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:46, 18 December 2013 (UTC)

Hello User:Jmh649 and User:Casliber, The time span you mention here of "3-5 years" does not correspond to any time frame I am aware of currently in use in medical research or medical authorship. (As one example, this is not like the semiconductor industry of rapid technological change.) Medical research and medical authorship guidelines normally follow wording such as "most recent reliable report" or "date of most recent research," which could easily refer to certified data and journal research outside of the "3-5" year frame. Your two statistics citations directly above to me from the NIH are from 2007 and are perfectly suitable for use here as needed. The ICD10 date going back to 1990 would provide a more complete time frame by your own phrase of the "most recent diagnostic criteria," for any material included on this wikipage or other psy related pages. Please clarify. BillMoyers (talk) 13:59, 19 December 2013 (UTC)

Please review WP:MEDDATE (that ICD10 dates to 1990 is not something we can change). SandyGeorgia (Talk) 14:10, 19 December 2013 (UTC)

Hello User:Jmb649 and User:Casliber, This material from 19 Dec above is pending your comment. BillMoyers (talk) 15:16, 21 December 2013 (UTC)

Depends on the area - e.g information on drugs changes frequently, so recent is good. We try and get more recent ones where we can.Cas Liber (talk · contribs) 15:20, 21 December 2013 (UTC)

Reboot

How much of the above list remains to be done? SandyGeorgia (Talk) 19:55, 11 January 2014 (UTC)

a sign of schizophrenia can be...

a sign of schizophrenia can be also a movement disorder (e.g. they cannot move properly their extremeties compared to those that are healthy humans). — Preceding unsigned comment added by Traversable47w0rmh0le (talk • contribs) 22:26, 11 January 2014 (UTC)

Outdated (cannabis)

Whether cannabis use is a contributory cause of schizophrenia, rather than a behavior that is simply associated with it, remains controversial.[28][44]

See Long-term effects of cannabis#Schizophrenia for recent reviews (added by ... moi): 2008 Cochrane review PMID 18646115 , and 2013 review PMID 24133461 . SandyGeorgia (Talk) 08:21, 18 December 2013 (UTC)

Everyone agrees that there is a strong association. The question was one of causation. The 2013 ref seems to support more of a causative role. Thus updated. Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:53, 18 December 2013 (UTC)

No, the literature clearly shows that not everyone agrees. Please don't spread disinformation here. Viriditas (talk) 02:36, 19 December 2013 (UTC)

Thanks, Doc, and I added that new review for RexxS attention on cannabis. SandyGeorgia (Talk) 17:50, 18 December 2013 (UTC)

done SandyGeorgia (Talk) 18:06, 18 December 2013 (UTC)

• About association versus causation, I was a little surprised by what Doc James said about the 2013 source, so I read the source for myself. We need to be careful about this. The authors are not, as far as I can see, saying that there is causation (and scientifically, the evidence for causation is pretty thin, I have to say). Rather they are saying (quite reasonably, I think, not that it matters what I think) that there is enough of a possibility of causation that public policy needs to be cautious. That's not the same thing. (By the way, I'm aware that there are major dramas about this issue at another page, so editors here who are also editing there may want to take that on board.) --Tryptofish (talk) 22:28, 18 December 2013 (UTC)

We do not state their is causation in the article. There is a very strong link. Causation is super hard to prove without an RCT. The ref says "Overall, these human and animals studies highlight the significant association between early cannabis exposure and schizophrenia" which is one step removed from confirming causation. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:37, 18 December 2013 (UTC)

Association, yes. Cause and effect, not yet per WP:V. --Tryptofish (talk) 22:43, 18 December 2013 (UTC)

Nonsense, there is no such "strong link" at all, and as usual the evidence is contrary to what Jmh649 claims. The only so-called "evidence" is based on major studies published over a decade ago (1987, 2002, 2003). More recent controlled studies show that cannabis is unlikely to cause schizophrenia[15] and the overwhelming fact that increased cannabis use by young people has not been followed by an increasing rise in schizophrenia refutes the theory. The fact that 40% of schizophrenics self-medicate points to the exact opposite of what is claimed, namely that cannabis helps schizophrenics cope with their mental illness, it doesn't cause their disease. Jmh649 and others appear to be continuing their anti-cannabis campaign across the Wikipedia by injecting undue weight and bias wherever they can. I'm not the least surprised. Viriditas (talk) 02:13, 19 December 2013 (UTC)

Three recent reviews, one primary source. Wikipedia doesn't do original research. SandyGeorgia (Talk) 02:17, 19 December 2013 (UTC)

What recent reviews? Nobody has done any original research. The most recent evidence says exactly the opposite of what is claimed in this article, and the fact remains, WikiProject Medicine is selectively using sources to push an anti-cannabis POV. The evidence shows that cannabis does not cause schizophrenia, and to date, there is no actual evidence that it does. On the other hand, we have strong evidence showing that schizophrenics self-medicate with cannabis to help their symptoms, while we also have evidence that the increasing use of cannabis by young people has not resulted in a rise of schizophrenia cases predicted by the theory. Furthermore, the latest controlled studies do not support the claims of causation. WikiProject Medicine does not get to ignore reliable sources by overruling our policies and guidelines with WP:MEDRS so they can selectively ignore evidence by choosing only reviews that show cannabis is harmful. The majority of the cannabis literature is skewed in this regard, since the majority of studies that get funded are only the ones that claim cannabis is a drug of abuse and cannot be used safely. That's stacking the deck, a misuse of sources, and a complete disregard for our sourcing policies. No local project consensus can override the sitewide sourcing policies and guidelines for this reason. Sorry, you aren't fooling anyone. The latest evidence published this month "suggest that having an increased familial morbid risk for schizophrenia may be the underlying basis for schizophrenia in cannabis users and not cannabis use by itself."[16] It doesn't matter that WikiProject Medicine considers this a primary source. What matters is that WikiProject Medicine is deliberately skewing Wikipedia articles by selectively citing evidence that cannabis causes harm while ignoring studies showing it doesn't. The "cannabis causes schizophrenia" hypothesis has been debated for two decades without any resolution on the matter, yet WikiProject Medicine would have us believe otherwise. No actual evidence for the hypothesis and yet it's stated as close to fact in this article. Meanwhile, cannabis prohibition limits the ability to actually study it closer, while funding is widely available for anyone who can demonize it. Viriditas (talk) 02:30, 19 December 2013 (UTC)

We are using the 2013 review Sandy mentioned. We are not using the small primary research study you linked. WP:MEDRS is completely in line with WP:RS. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:36, 19 December 2013 (UTC)

Again, total nonsense. Your so-called 2013 review is the same old propaganda hit piece that gets trotted out every few months. It starts with the premise that cannabis is bad, selectively cites old and outdated evidence that cannabis is bad, and then concludes "cannabis is bad". This can't be taken seriously. The studies it cites are seriously questioned or discredited, it appeals to debunked notions of cannabis as an addictive "gateway drug" and makes questionable claims to support its preexisting idea that cannabis is bad, resulting in circular logic. More importantly, it states "based on the current evidence available from human and animal models, it is evident that cannabis use during adolescent development increases risk of psychiatric diseases such as drug addiction and schizoaffective disorders with genetic interactions". The only problem is that the current evidence does not actually say that. The authors did not actually review any current evidence that conflicted with their already formed conclusion. On the other hand, we have a recent large December 2013 study that looked at 279 people and found that the development of schizophrenia depends on family history, not cannabis use by itself. The authors concluded "that cannabis does not cause psychosis by itself. In genetically vulnerable individuals, while cannabis may modify the illness onset, severity and outcome, there is no evidence from this study that it can cause the psychosis."[17] The question is, why is WikiProject Medicine pushing anti-cannabis propaganda, not just on this page, but on every page related to cannabis? Viriditas (talk) 04:08, 19 December 2013 (UTC)

I guess we have agreed to disagree than. That primary study will be weighted in future secondary sources and when it is I will support its inclusion. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:32, 19 December 2013 (UTC)

This gives a good overview [18] as does this [19] and is more or less what we have. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:46, 19 December 2013 (UTC)

It's a complex subject; a review was formed to look explicitly at this problem: An overview of systematic reviews on cannabis and psychosis: discussing apparently conflicting results.

• "We conclude that there is insufficient knowledge to determine the level of risk associated with cannabis use in relation to psychotic symptoms and that more information is needed..." (2010) PUBMED 20565524

An October 2013 review, Pathways from Cannabis to Psychosis: A Review of the Evidence says:

• "The nature of the relationship between cannabis use and psychosis is complex and remains unclear." PUBMED 24133460 (free full text)

There are also studies showing ameliorative effects that should be mentioned unless proven invalid by later research:

• "CBD was found to have therapeutic potential with antipsychotic, anxiolytic, and antidepressant properties, in addition to being effective in other conditions. THC and its analogues were shown to have anxiolytic effects in the treatment of cannabis dependence and to function as an adjuvant in the treatment of schizophrenia, although additional studies are necessary to support this finding." PUBMED 20512271

• Another 2010 review, The effects of cannabis use on neurocognition in schizophrenia: A meta-analysis, finds "superior performance in cannabis-using patients". source.

I have seen the full text of the 2013 "Review of Adverse Effects", and it seems an extremely mushy conclusion. It says: more research is needed, strong evidence does not exist to make a clear statement on a causal relationship. The only thing Wikipedia can safely say is: there is conflicting evidence.petrarchan47tc 07:50, 19 December 2013 (UTC)

When looking at cannabis research, it has to be taken into consideration the skewed results that may result from cannabis' Schedule I status:

• "[The] National Institute on Drug Abuse is reluctant to support medical research and has historically focused its efforts (almost) exclusively on demonstrating [cannabis'] harmful effects." PMC 3538401 petrarchan47tc 08:37, 19 December 2013 (UTC)

Hot-off-the-press PMID 24139960 is pertinent. To quote:

Numerous epidemiological surveys have shown a link between cannabis use and the risk of schizophrenia (Andreasson et al., 1987, Arseneault et al., 2002, Fergusson et al., 2003, Henquet et al., 2005a, Konings et al., 2008, Mauri et al., 2006, Stefanis et al., 2004, van Os et al., 2002, Veen et al., 2004 and Zammit et al., 2002), although this is contended by some (Macleod, 2007). There appears to be a dose dependent relationship (van Os et al., 2002 and Zammit et al., 2002) with a higher risk of schizophrenia predicted by the earlier age of cannabis use; findings confirmed with meta-analyses.

Alexbrn ^{talk|contribs|COI} 08:54, 19 December 2013 (UTC)

Hello User:Alexbrn and User:Viriditas, The very fact that there is this much discussion in the published literature on both sides makes this Notable for inclusion on this wikipage. A useful addition to this wikipage with both sides being expressed. BillMoyers (talk) 15:42, 19 December 2013 (UTC)

Are there sides? It seems from the recent reviews there's a kind of consensus ("schizophrenia and cannabis use are linked, quite how is unclear. There's concern about a causal relationship but the evidence again isn't clear") ... which is quite close to what we've got anyway. Alexbrn ^{talk|contribs|COI} 17:05, 19 December 2013 (UTC)

(edit conflict) @Alex: WP:DFTT — RexxS 17:31, 19 December 2013 — continues after insertion below

and WP:RGW. SandyGeorgia (Talk) 17:56, 19 December 2013 (UTC)

@All: I think there are several points that are clear from the literature:

• Cannabis can be a contributory factor in schizophrenia, but cannot cause it alone; its use is neither necessary nor sufficient for development of any form of psychosis.
• Early exposure of the developing brain to cannabis increases the risk of schizophrenia; although the magnitude of the increased risk is difficult to quantify; only a small proportion of early cannabis users go on to develop any schizoaffective disorder in adult life.
• Higher dosage and greater frequency of use are also indicators of increased risk of chronic psychoses.
• THC and CBD produce many opposing effects; CBD has antipsychotic and neuroprotective properties and counteracts negative effects of THC.
• A significant proportion of schizophrenics use cannabis to help cope with its symptoms; consumption of cannabis neither improves nor worsens their condition.

I suggest these references as suitable to support the above:

1. Parakh, P; Basu, D (2013). "Cannabis and psychosis: have we found the missing links?". Asian Journal of Psychiatry (Review). 6 (4): 281–7. doi:10.1016/j.ajp.2013.03.012. PMID 23810133. Cannabis acts as a component cause of psychosis, that is, it increases the risk of psychosis in people with certain genetic or environmental vulnerabilities, though by itself, it is neither a sufficient nor a necessary cause of psychosis. {{cite journal}}: Unknown parameter |month= ignored (help) - Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India.
2. Niesink, RJ; van Laar, MW (2013). "Does Cannabidiol Protect Against Adverse Psychological Effects of THC?". Frontiers in Psychiatry (Review). 4: 130. doi:10.3389/fpsyt.2013.00130. PMC 3797438. PMID 24137134. Cannabis is not a safe drug. Depending on how often someone uses, the age of onset, the potency of the cannabis that is used and someone's individual sensitivity, the recreational use of cannabis may cause permanent psychological disorders. Most recreational users will never be faced with such persistent mental illness, but in some individuals cannabis use leads to undesirable effects: cognitive impairment, anxiety, paranoia, and increased risks of developing chronic psychosis or drug addiction. Studies examining the protective effects of CBD have shown that CBD can counteract the negative effects of THC.{{cite journal}}: CS1 maint: unflagged free DOI (link) - Trimbos Institute, Netherlands Institute of Mental Health and Addiction , Utrecht , Netherlands ; Faculty of Natural Sciences, Open University of the Netherlands , Heerlen , Netherlands.
3. Chadwick, Benjamin; Miller, Michael L; Hurd, Yasmin L (2013). "Cannabis Use during Adolescent Development: Susceptibility to Psychiatric Illness". Frontiers in Psychiatry (Review). 4: 129. doi:10.3389/fpsyt.2013.00129. PMC 3796318. PMID 24133461. Based on the current evidence available from human and animal models, it is evident that cannabis use during adolescent development increases risk of psychiatric diseases such as drug addiction and schizoaffective disorders with genetic interactions. No convincing data exist to support one "common cause" that exclusively predicts which individuals using cannabis as teens will progress to addiction and psychiatric disorders later in life versus those who do not. ... Whether the early onset of cannabis use relates to preexisting pathology that is then exacerbated by the drug is still debated.{{cite journal}}: CS1 maint: unflagged free DOI (link) - Fishberg Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai , New York

The above are (i) recent, (ii) secondary reviews, (iii) from different countries with very different attitudes to the legal and commercial aspects of cannabis use. Feel free to discuss. --RexxS (talk) 17:31, 19 December 2013 (UTC)

Good. SandyGeorgia (Talk) 17:56, 19 December 2013 (UTC)

Excellent summary with pertinent references. Thank you RexxS. Mark D Worthen PsyD 22:56, 27 December 2013 (UTC)

I see that the drama that I mentioned, that I observed at another page, has now arrived at this page. As I said above, there is a big difference between association and causation, and we really need to avoid implying causation when the sourcing does not support it, beyond some very limited contexts. I think that RexxS summarized it very well above. As he said, "A significant proportion of schizophrenics use cannabis to help cope with its symptoms; consumption of cannabis neither improves nor worsens their condition." That's a substantial proportion, whereas the individuals who are exposed at an early age and develop schizophrenia later represent a much smaller fraction of the patient population – and the early exposure does NOT demonstrate causation, so we must not imply it. (Not really surprising: a child who is at risk grows up in an environment where cannabis is around, but the cannabis isn't the cause of the later illness.) --Tryptofish (talk) 20:55, 19 December 2013 (UTC)

Dinner guests tonight, but unless someone else does it sooner, I can write up a couple of sentences tomorrow following on RexxS's post. Of course, if someone else gets to it sooner, I wouldn't grumble ! SandyGeorgia (Talk) 21:23, 19 December 2013 (UTC)

I have one grumble, "consumption of cannabis neither improves nor worsens their condition" has already been disproven: The effects of cannabis use on neurocognition in schizophrenia: A meta-analysis, finds "superior performance in cannabis-using patients". source petrarchan47tc 02:47, 21 December 2013 (UTC)

I didn't get to this yesterday; on my list for today (after Christmas baking). On the "superior performance" vs "improves nor worsens the condition", the first refers to only one aspect in patients (neurocognition), while the second refers to the condition overall (schizophrenia). SandyGeorgia (Talk) 13:55, 21 December 2013 (UTC)

Good point. I have read most of this literature and I concur. Mark D Worthen PsyD 22:56, 27 December 2013 (UTC)

Looks like the article has not been updated to comply with the most recent MEDRS, is this correct? Is there consensus on what the science says? I can certainly update the page if so. petrarchan47tc 03:46, 24 December 2013 (UTC)

Proposal

I've shuffled the paras in the Alcohol and drug use to sort out what we are saying about cannabis and begin working on the proposed changes (above): Current text as of this version: SandyGeorgia (Talk) 20:19, 11 January 2014 (UTC)

Evidence supports a link between earlier onset of psychotic illness and cannabis use. The more often cannabis is used, the more likely a person is to develop a psychotic illness, with frequent use being linked with twice the risk of psychosis and schizophrenia. This increased risk may require the presence of certain genes within an individual.

Next, I've workup the proposal above by RexxS, except that I can't figure which is the source supporting "consumption of cannabis neither improves nor worsens their condition". SandyGeorgia (Talk) 21:13, 11 January 2014 (UTC)

A significant proportion of schizophrenics use cannabis to help cope with its symptoms; consumption of cannabis neither improves nor worsens their condition. Cannabis can be a contributory factor in schizophrenia, but cannot cause it alone; its use is neither necessary nor sufficient for development of any form of psychosis. Early exposure of the developing brain to cannabis increases the risk of schizophrenia, although the magnitude of the increased risk is difficult to quantify; only a small proportion of early cannabis recreational users go on to develop any schizoaffective disorder in adult life, and the increased risk may require the presence of certain genes within an individual or may be related to preexisting psychopathology. Higher dosage and greater frequency of use are indicators of increased risk of chronic psychoses. Tetrahydrocannabinol (THC) and cannabidiol (CBD) produce opposing effects; CBD has antipsychotic and neuroprotective properties and counteracts negative effects of THC.

Two days, no response, so I'll go ahead and install the portions I can source. SandyGeorgia (Talk) 21:24, 13 January 2014 (UTC)

Done. SandyGeorgia (Talk) 21:59, 13 January 2014 (UTC)

A new article about schizophrenia and autophagy

Hi! I have found a new article about links between schizophrenia and autophagy, I added this link in french version of the shizophrenia article.

If you find it interesting, you can also add it: [20]

It says there is a significant lack of Beclin 1 protein, which promote autophagy in schizophreniac's hippocampus. And also an excess of other protein or RNA in blood's lymphocyte.

--Nicobzz (talk) 11:22, 15 January 2014 (UTC)

Am i the only person that article's 2nd picture is somewhat scary??

yeah, I know. i watched this site doesn't censor contents, and I agree. but whenever i visit this article, i feel somewhat scary. Yjs5497 (talk) 13:43, 16 January 2014 (UTC)

I don't think that removing a picture that adds encyclopedic value because it can be seen as scary is a good idea. If it can be replaced by another image with equal encyclopedic value that you find more pleasant to look at, I'd be good with that, but I doubt it can be found. Martijn Hoekstra (talk) 12:59, 19 January 2014 (UTC)

If it wasn't somewhat scary, it wouldn't be doing its job. Looie496 (talk) 16:44, 19 January 2014 (UTC)

just i would read this article only at daytime. That only seems to be my best choice. Yjs5497 (talk) 14:37, 20 January 2014 (UTC)

Source used inappropriately

It has come to my attention, via a twitter discussion with Keith Laws, that PMID 24385461 (Jauhar et al, of which Laws is a co-author) is used incorrectly to support the statement that Cognitive-Behavioral Therapy may be effective. Actually the conclusions of that review are almost entirely negative. Either the statement should be changed or a different source should be found (but probably the statement should be changed). Note that a sentence later in the paragraph states that the evidence for the effectiveness of CBT is minimal. Looie496 (talk) 23:23, 10 February 2014 (UTC)

I made a small edit to clarify. From what I could see, there was not good evidence for the efficacy of any of those interventions. Flatronal (talk) 00:08, 11 February 2014 (UTC)

The ref in questions says "Cognitive-behavioural therapy has a therapeutic effect on schizophrenic symptoms in the 'small' range." which means that it "may" have some effect. Not sure what the issue is? Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:20, 11 February 2014 (UTC)

I can only report that one of the authors of the review considers it to be a negative assessment and did not like it being used as a source for a positive statement. As I understand it, "small" was intended to mean "not large". If necessary, I'll see if I can persuade Keith to comment here. Looie496 (talk) 16:02, 11 February 2014 (UTC)

There was no significant improvement shown in those trials which best controlled for bias. Currently, the wikipeida article does not make this clear.Flatronal (talk) 17:40, 11 February 2014 (UTC)

Were and how does the review state that? Is it in the body of the text? Does the author not agree with the abstract summary of his paper? Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:08, 12 February 2014 (UTC)

The authors have made the data they used available here: http://www.cbtinschizophrenia.com/ Laws also wrote a blog post on the paper here: http://keithsneuroblog.blogspot.co.uk/2014/01/blinded-by-science.html Actually, it looked like one of their measures did reach significance (was going off memory of the paper): http://1.bp.blogspot.com/-0_-UMAxero0/UuQjZ5qgpSI/AAAAAAAAA44/RcxqGwGiN9M/s1600/blindBJP.jpg I looked briefly at the other reviews for psychosocial management cited here, and they also reported concern over poor quality of evidence for efficacy. It is accurate to say that these interventions 'may' be useful treatments, but given the difficulty of accounting for bias in the assessment of psychosocial interventions we should also be clear that they may not, or risk sounding unduly positive to readers. Flatronal (talk) 19:44, 12 February 2014 (UTC)

Of course, I agree with our abstract, which clearly states "Cognitive-behavioural therapy has a therapeutic effect on schizophrenic symptoms in the ‘small’ range. This reduces further when sources of bias, particularly masking, are controlled for." There is a very small effect of CBT on positive symptoms, not negative symptoms (if you choose to ignore study quality). If however you follow standard accepted practice in science and meta-analyses of examining risk of bias (as we did), then the conclusion is that CBT has no significant impact at all on positive symptoms, negative symptoms or hallucinations. And that CBT studies are prone to especially high levels of bias when assessing CBT for schizophrenia in open trials (and this is what produces the small effect to which you allude) — Preceding unsigned comment added by Johnnyxyz123 (talk • contribs) 16:56, 13 February 2014 (UTC)

Note: The comment above is from Keith Laws, at my request. Looie496 (talk) 17:00, 13 February 2014 (UTC)

... and I have revised the article accordingly. Looie496 (talk) 17:10, 13 February 2014 (UTC)

Looie changes looks good. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:57, 14 February 2014 (UTC)

Lede

May I suggest changing the second sentence in the lede from "Common symptoms include delusions, such as the feeling that someone is out to get you..." to simply "Common symptoms include delusions, such as paranoia..." as per the guideline at MOS:YOU. Thanks, -- Gyrofrog (talk) 15:59, 12 February 2014 (UTC)

Actually I've gone ahead and made the change, as this looks like recent verbiage (as opposed to whatever was submitted for FA status). -- Gyrofrog (talk) 16:02, 12 February 2014 (UTC)

Oh dear, when did that creep in...yes agree with tweak. Cas Liber (talk · contribs) 18:53, 12 February 2014 (UTC)

Sorry that would be me. Agree that it was not the best. Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:06, 14 February 2014 (UTC)

Better explanation needed

Could somebody who knows about this please explain the difference between schizophrenia and multiple personality disorder in less vague terms than the existing "Rather, the term means a "splitting of mental functions", reflecting the presentation of the illness.". Thank you. 79.97.64.240 (talk) 14:15, 17 March 2014 (UTC)

Life expectancy

Might be short also, because tobacco use among sufferers is prevalent. --91.158.78.116 (talk) 19:16, 21 March 2014 (UTC)

Correct fact: Schizophrenia - coined by Jung on acid.

Shouldn´t this article actually state the actual FACTS on where the term "schizophrenia" comes from?

More like this: "Schizophrenia was coined by Jung on an acid trip". Please see "Liber Novus".

PBWY. — Preceding unsigned comment added by 84.211.129.189 (talk) 15:00, 4 April 2014 (UTC)

Confusing Sentence

This sentence did not make much sense phrased like this, "About 30 to 50% of people with schizophrenia do not have insight; in other words, they do not accept their condition or its treatment." So I am just going to rephrase it like this, "About 30 to 50% of people with schizophrenia fail to accept their illness or their recommended treatment." --DanaLPanetta (talk) 22:08, 15 April 2014 (UTC)

Sounds good. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:09, 7 May 2014 (UTC)

Changes

Have reverted [21]

1. Not sure what "Many causes of schizophrenia also occur in causing psychosis." means
2. Not sure why "A significant proportion of people with schizophrenia use cannabis to help cope with its symptoms. " was moved
3. This ref does not work http://www.neuroscience.cam.ac.uk/publications/pubInfo.php?foreignId
4. This is a primary source [22] Please use secondary sources per WP:MEDRS
5. Please formatted refs the same as the rest of the article. WP:MEDHOW. Can help. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:46, 11 May 2014 (UTC)

Beans

Can somebody add to the article that beans can cause schizophrenia? The article itself unfortunately seems to be semiprotected. — Preceding unsigned comment added by 87.122.31.224 (talk) 11:54, 19 May 2014 (UTC)

To add that to this article -- or any of the other extremely unlikely claims you are making to other articles -- we would need reliable sources. - SummerPhD (talk) 14:05, 19 May 2014 (UTC)

One sentence simple description of schizophrenia

We are currently having a discussion of what is the best one sentence simple description of schizophrenia. I am okay with "Schizophrenia is a mental disorder characterized by a breakdown in thinking and poor emotional responses" Others thoughts / suggestions? Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:25, 8 May 2014 (UTC)

I am really not a fan of the "poor emotional responses" and it's not something I'd put in a one-sentence encapsulation of the condition. Just trying to think what I would put in.... Cas Liber (talk · contribs) 13:36, 8 May 2014 (UTC)

Pubmed gives four aspects in simple language:[23]

• Tell the difference between what is real and not real
• Think clearly
• Have normal emotional responses
• Act normally in social situations

The first two pertain to thinking and the second two to emotions. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:16, 8 May 2014 (UTC)

How about, "Schizophrenia is a mental disorder characterized by hallucinations, delusions, inability to experience pleasure, and severe emotional distress"? Looie496 (talk) 03:37, 9 May 2014 (UTC)

Umm, "inability to experience pleasure" is not true. Cas Liber (talk · contribs) 04:03, 9 May 2014 (UTC)

We mention delusions and hallucinations in the next line. It is nice to have one simple line of text anyway. I am not sure what is wrong with the current wording. We could change it to "loss of normal emotions and not able to separate real from not real" Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:15, 9 May 2014 (UTC)

Whether or not anhedonia is a cardinal symptom of schizophrenia has been controversial throughout its history, so maybe it's best to leave it out of the introductory definition but discuss the controversy in the body.

DSM-IV's criteria were: disturbance present continuously for six or more months with a month or more experiencing three or more of delusions, hallucinations, disorganised speech, grossly disorganised or catatonic behaviour, negative symptoms and social/occupational dysfunction.

PubMed Health's paraphrase is accurate and simple, but their paraphrase of "negative symptoms" ("have normal emotions and responses") could be more informative, and they say nothing about duration. I'm not sure duration needs to be covered in our lede definition.

Regarding paraphrasing "negative symptoms", Ayd's Lexicon of Psychiatry, Neurology and the Neurosciences [24] says negative symptoms include: alogia, affective flattening, anhedonia/asociality, depressed appearance, avolition/apathy, psychomotor retardation and attentional impairment. How about, "and may involve inattention and reduced activity, social engagement and emotional expression"?

DSM-IV	PubMed Health	Proposed
delusions, hallucinations	tell the difference between what is real and not real	inability to distinguish what is real from what is not (I far prefer PubMed's wording. If we find that wording being used all over the place by all sorts of sources over a long period, we'd be justified in using it - but I haven't done that search yet.)
disorganised speech, grossly disorganised or catatonic behaviour	think clearly	confused or unclear thinking
negative symptoms	have normal emotions and responses	inattention, and reduced activity, emotional expression and social engagement
social/occupational dysfunction	act normally in social situations	abnormal social behaviour

This would produce something like: Schizophrenia is a mental disorder often featuring abnormal social behaviour, inability to distinguish what is real from what is not, inattention, confused or unclear thinking, and reduced activity, emotional expression and social engagement. Is that too much? Looie mentions distress. It isn't in the DSM's criteria but we aren't tied to the DSM. Is there a scholarly consensus outside the DSM that distress is a defining feature of schizophrenia? If so, is it worthy of inclusion in the defining sentence? Anthonyhcole (talk · contribs · email) 06:55, 9 May 2014 (UTC)

There are two important thing when trying to write in simple language. 1) Use short sentences 2) Use simple words. We could have "Schizophrenia is a mental disorder characterized by abnormal social behaviour and the inability to distinguish what is real from what is not. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:53, 9 May 2014 (UTC)

I'm OK with that, but saying it is characterised by these signs may be imprecise, since not all DSM signs and symptoms need to be present for a diagnosis - I think. How about, "Schizophrenia is a mental disorder often featuring abnormal social behavior and problems distinguishing what is real from what is not." Should we mention auditory hallucinations (hearing voices) early in the lede - I think they are by far the commonest kind of hallucination in schizophrenia.

What about changing from the present

Schizophrenia is a mental disorder characterized by a breakdown in thinking and poor emotional responses Common symptoms include delusions, such as paranoia; hearing voices or noises that are not there; disorganized thinking; a lack of emotion and a lack of motivation. Schizophrenia causes significant social and work problems. Diagnosis is based on observed behavior and the person's reported experiences.

to

Schizophrenia is a mental disorder often featuring abnormal social behavior and problems distinguishing what is real from what is not. Common symptoms include distress, hearing voices or noises that are not there, inattention, confused or unclear thinking, inactivity, and reduced emotional expression and social engagement. Diagnosis is based on observed behavior and the person's reported experiences.

--Anthonyhcole (talk · contribs · email) 12:23, 10 May 2014 (UTC)

I've added my proposed change. By all means revert, modify or discuss if you wish. --Anthonyhcole (talk · contribs · email) 15:03, 16 May 2014 (UTC)

Agree a good simplification. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:48, 17 May 2014 (UTC)

Schizophrenia is characterized neurologically by a single nervous subsystem attempting to recruit abnormally extreme amounts of nervous information (oversensitisation) from neighbouring subsystems not usually given to association with the said nervous subsystem (at least in such capacity), usually resulting initially in vary chaotic assemblies of information, such as hallucinations, delusions and voices. The description you have cultivated so far is external and lacking in objectivity, since it does not address the root of the development, nor even really describe it as a development. This distinction between development and disease is what most causes stigma and isolates people struggling with the condition from normal approaches to helping novel developments like this. The point being that such a development also has a synergistic zenith at which a great deal of creativity, insight and understanding is achieved. You might want to consider that.Gottservant (talk) 17:27, 19 May 2014 (UTC)

Ah? Way to complicated and not supported by refs. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:22, 20 May 2014 (UTC)

I think User:Anthonyhcole is on the right track but I would like to make a few modifications in the lead section:

It currently states:

Schizophrenia is a mental disorder often featuring abnormal social behavior and problems distinguishing what is real from what is not. Common symptoms include distress, hearing voices or noises that are not there, inattention, confused or unclear thinking, inactivity, and reduced emotional expression and social engagement. Diagnosis is based on observed behavior and the person's reported experiences.

I'd like it to state:

Schizophrenia is a mental disorder characterized by abnormal social behavior and a withdrawn reality. Common symptoms include distress, hallucinations, delusions, inattention, confused or unclear thinking, inactivity, and reduced emotional expression and social engagement. Diagnosis is based on observed behavior and the person's reported experiences, and the disorder can often lead to the onset of psychosis.

Let me know if anyone agrees, and if so, I will make those changes in the lead section. ATC ^{. Talk} 03:30, 20 May 2014 (UTC)

I don't know what withdrawn reality means. Is that commonly used in reliable sources? Even if it is, if the average reader won't know what it means, then it's not the simple, clear opening definition we were looking for. Am I the only person not understanding the term? Pinging ATC, Doc James, Cas Liber, Looie496, Gottservant. --Anthonyhcole (talk · contribs · email) 07:33, 20 May 2014 (UTC)

Have never heard of "a withdrawn reality" either. Doc James (talk · contribs · email) (if I write on your page reply on mine) 09:01, 20 May 2014 (UTC)

This is not clear either "and the disorder can often lead to the onset of psychosis." One of the symptoms of schizophrenia is psychosis. Doc James (talk · contribs · email) (if I write on your page reply on mine) 09:24, 20 May 2014 (UTC)

I see what you're saying. How about this instead:

Schizophrenia is a mental disorder characterized by abnormal social behavior and a loss of contact with reality. Common symptoms include distress, hallucinations, delusions, inattention, confused or unclear thinking, inactivity, and reduced emotional expression and social engagement. Diagnosis is based on observed behavior and the person's reported experiences.

Let me know if that wording is better. ATC ^{. Talk} 11:14, 20 May 2014 (UTC)

What don't you like with "problems distinguishing what is real from what is not"? Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:15, 20 May 2014 (UTC)

Both the proposed wording and the current "problems distinguishing what is real from what is not" are used in reliable sources in descriptions of psychosis. The proposed wording seems to be more common in reliable sources - judging from a Google Scholar search for "psychosis" and "loss of contact with reality" (1,350 results), "what is real from what is not" (43) and "what is real and what is not" (406). I'm wondering if the lay reader will find the current wording easier to grasp than the proposed wording, though. Doesn't "loss of contact with reality" describe complete unconsciousness? --Anthonyhcole (talk · contribs · email) 12:41, 20 May 2014 (UTC)

Right - I have not heard nor seen "withdrawn reality". I also don't like any form of "what is real/what is not" - what happens is that some people develop delusions - i.e. falsely-held rigid beliefs. Many of these are quite circumscribed, thus a person might develop an idea that they are being followed or filmed by someone, but they still otherwise are oriented to time, place and person, and know and remember friends/family etc. and hence have no "loss of reality" otherwise. Yes occasinally I will see people that are so psychotic they have a global breakdown in reality-testing, but this is rarer than seeing folks with more circumscribed/limited delusions. Hence only a minority of people with delusions have "failed reality testing". Accuracy is compromised too much by the wording.Cas Liber (talk · contribs) 13:03, 20 May 2014 (UTC)

Hence the best wording is

Schizophrenia is a mental disorder characterized by delusions, hearing voices, and disorganised thinking. Disturbed social and interpersonal functioning, cognitive problems, inactivity, and reduced emotional expression are common features. Diagnosis is based on observed behavior and the person's reported experiences.

A little complicated but okay. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:19, 20 May 2014 (UTC)

Thanks Cas. I'm more comfortable with that, as it mirrors the DSM better. It seems to say, though (or may be read as saying) that delusions, auditory hallucinations and thought disorder are all essential, while the other DSM signs and symptoms are common. My layman's understanding of the DSM criteria is that any three of delusions, hallucinations, thought disorder, negative symptoms and social/occupational dysfunction (along with the necessary time profile) are sufficient for a diagnosis. How do you feel about

Schizophrenia is a mental disorder often featuring delusions, hearing voices, and disorganised thinking. Disturbed social and interpersonal functioning, cognitive problems, inactivity, and reduced emotional expression are other common features. Diagnosis is based on observed behavior and the person's reported experiences.

Can you tell me where you're getting "cognitive problems" from? If it is referring to thought disorder, it's redundant. If it's referring to negative symptoms, can you point me to a definition of negative symptoms that you're paraphrasing with "cognitive problems", please? I'm hoping we can find a form of words that is clearer to the lay reader.

What is your reason for replacing the DSM's social and occupational functioning with social and interpersonal functioning? --Anthonyhcole (talk · contribs · email) 13:48, 20 May 2014 (UTC)

I agree with User:Casliber. While it may say "what is real/what is not" in the DSM, it is too wordy for an encyclopedia article in my opinion.

According to DSM criteria, it should state:

Schizophrenia is a mental disorder characterized by delusions, hallucinations, disorganized speech, and reduced emotional expression. Disorganized thinking, catatonia, and inactivity are other common features. Diagnosis is based on whether it impairs the person's social and interpersonal functioning as well as their observed behavior and reported experiences.

ATC ^{. Talk} 20:02, 20 May 2014 (UTC)

@Anthonyhcole - see, to me "characterised" does not mean "essential", but if it does to most others I am happy for it to be tweaked. Yeah remove the cognitive bit - it is not from DSM but from the fact of the findings of deficits in complex task formation when tested. Need to get in there somehow that the hallucinations are almost always auditory in nature - and whether 'hearing voices" is needed/desirable for accessibility over "(most commonly) auditory hallucinations"...the run-on "and" in ATC's version I am not thrilled about, and "while" is a tad contrastive -I like it but I think others would have a problem (???) Cas Liber (talk · contribs) 20:11, 20 May 2014 (UTC)

I was going by DSM's criterion. Also, "characterized" are used in the lead sections for the featured articles Autism, Tourette syndrome, and Asperger syndrome so I'm more comfortable with that word. Plus, by DSM's criterion, it's "hallucination" in general. You are talking about paranoid schizophrenia which is auditory mainly; the other ones vary which is why I wrote in more broad. ATC ^{. Talk} 23:41, 20 May 2014 (UTC)

Actually lets change "reduce" to "lack":

Schizophrenia is a mental disorder often characterized by false beliefs, hallucinations, disorganized speech, and lack of emotional expression. Other common symptoms include confused or unclear thinking, abnormal behavior, inactivity, and impaired social functioning. Diagnosis is based on the person's observed behavior and reported experiences.

ATC ^{. Talk} 23:59, 20 May 2014 (UTC)

When you are saying "there is a problem distinguishing real from not real" actually that is a problem of nerves correctly siphoning information from a dependable source (input source), that is, rerouting reliable information into neurological subsystems that generate delusions, voices and hallucinations. The condition is neither the information itself, nor the way it is used specifically, but the interaction of the two. Once again, you are making a problem of what is symptomatic of the problem as if that is the problem itselfGottservant (talk) 08:57, 22 May 2014 (UTC)

The current classification is dependent on descriptors. So far there are only hints at the pathological processes underneath.Cas Liber (talk · contribs) 13:09, 22 May 2014 (UTC)

The problems are basically objective siphoning errors = hallucinations, balance siphoning errors = delusions and subjective siphoning errors = voices. If its not any one of these you have contextual siphoning errors = disordered thinking.

EDIT: I realize that without sources I am basically delaying the conversation in a wikipedia context, but what I am hoping is that you will a) see the simplicity of identifying it as a procedural deviance (from normal neurological functioning) b) admit a difference between diagnostic and symptomatic definitions (I don't think you should give a symptomatic definition without explicitly stating it as such) and possibly c) adhere to a strict objective definition of it as a discreet state (not a "disease" or "pathological psychosis" et al)

If you sneeze while brushing your teeth, you don't say well this is a sneezism that results in toothpaste going everywhere and possibly some pjama soiling, no! You say it is a nervous reaction to an allergen, that has a spontaneous connection with muscle spasms. But you are currently arriving at a definition that sounds like the former!

Gottservant (talk) 14:47, 22 May 2014 (UTC)

I'm just saying symptomatically it is hallucinations, delusions and voices, but diagnostically in a precise sense, it is obviously some sort of process to do with nervous volatility (specifically the volatility of the siphoning of information, whether internally or externally because the effect is entirely perspectival).Gottservant (talk) 04:09, 23 May 2014 (UTC)

I'm in a remote location with limited internet access. (We were told internet was reliable but for now it involves climbing a rather high hill.) I'll re-engage here when we've secured a reliable connection but don't know when that will be. Please proceed without me. --Anthonyhcole (talk · contribs · email) 06:16, 25 May 2014 (UTC)

It might be helpful to define schizophrenia as being "out of sync" with reality, until such time as mechanisms are known. I can speculate that its a siphoning error, because it pertains to neurological processing and produces particular phenomena, but I can't substantiate that. But again I stress, it is not merely a disease (a term which is used very loosely by most people) nor necessarily pathological.Gottservant (talk) 03:43, 27 May 2014 (UTC)

Gottservant, wikipedia's role is to reflect current consensus usage not to modify, improve or change it. Hence these ideas, although interesting, are not going to get traction here as they are not in general use. Cas Liber (talk · contribs) 04:30, 27 May 2014 (UTC)

Cas Liber, the tracking aspect of schizophrenia has been documented https://www.youtube.com/watch?v=Q9DIW_z6i_E and https://www.medicalnewstoday.com/releases/275019.php and the comments I made about neurological function are purely deductive (though as I said without references you won't be able to use them), the choice of symptoms I chose followed a strict frame of reference, specifically their subjectivity/objectivity and the warning I gave against calling it a disease or pathological, while contradicted in some literature, is by no means contradicted authoritatively (in any of it), much to the contrary there is much, much, much complaint about stigma and the role it plays in the schizophrenic community, stigma that has its root in association with contagion and psychopathy. At the moment there is no authority on what schizophrenia is, so it is quite within reason to expect that a definition would respect these boundaries.Gottservant (talk) 22:16, 27 May 2014 (UTC)

Violence

The sentence "Schizophrenia has been associated with a higher rate of violent acts, although this is primarily due to higher rates of drug use." is not supported by the cited source, which concludes unambiguously, "Schizophrenia and other psychoses are associated with violence and violent offending, particularly homicide." The source goes on to say that the increased odds of violent crime is similar in scale to the increased odds of violent crime in substance abuse populations, which is a much larger population than those with schizophrenia, and thus may be a better target for efforts to reduce violence. "The risk in these patients with comorbidity is similar to that for substance abuse without psychosis." The incorrect clause ("although this is primarily due to higher rates of drug use") should be removed.

The ref says "Schizophrenia and other psychoses are associated with violence and violent offending, particularly homicide. However, most of the excess risk appears to be mediated by substance abuse comorbidity" [25] I do not see the issue? Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:50, 8 June 2014 (UTC)

From the paper:

There were four main findings. The first was that the risk of violent outcomes was increased in individuals with schizophrenia and other psychoses. The risk estimates, reported as ORs, were all above one indicating an increased risk of violence in those with schizophrenia and other psychoses compared with the general population controls, although the risk estimates varied between one and seven in men, and between four and 29 in women. A second finding was that comorbidity with substance use disorders substantially increased this risk, with increased ORs between three and 25. Although there was considerable variation in this estimate between studies, the pooled estimate was around four times higher compared with individuals without comorbidity. Third, we found no significant differences in risk estimates for a number of study design characteristics for which there has been uncertainty. These included: whether the diagnosis was schizophrenia versus other psychoses, if the outcome measure was register-based arrests and convictions versus self-report, and if the study location was the US or Nordic countries compared with other countries. Finally, the increased risk of violence in schizophrenia and the psychoses comorbid with substance abuse was not different than the risk of violence in individuals with diagnoses of substance use disorders. In other words, schizophrenia and other psychoses did not appear to add any additional risk to that conferred by the substance abuse alone.

As substance use disorders are three to four times more common than the psychoses [70],[71], public health strategies to reduce violence in society could focus on the prevention and treatment of substance abuse at individual, community, and societal levels [35],[72],[73].

What this says is that a schizophrenic individual is twice as likely to commit violent crime than a non-schizophrenic individual. If you add substance abuse to the schizophrenia then the individual is from three to twenty-five times more likely to commit violent crime. This does not support the clause: "although this is primarily due to higher rates of drug use." A supported sentence would read: "Schizophrenia has been associated with a higher rate of violent acts, this rate drastically increases with substance abuse, though not significantly above the already high rates of violent crime independently seen in substance abuse populations." I admit that the abstract is somewhat confusing in this regard, but the full paper is quite clear. (one last edit to add: this paper, a meta-regression of the available literature, determines with clear statistical significance that schizophrenia is associated with violence, period. to say that this association is "primarily due to substance abuse" is a fundamental misunderstanding of the results.)— Preceding unsigned comment added by 63.228.164.10 (talk) 20:47, 8 June 2014 (UTC)

What it says is "schizophrenia and other psychoses did not appear to add any additional risk to that conferred by the substance abuse alone." Schizophrenics have greater risk of violence not because of the schizophrenia directly but because of the increased rates of drug misuse. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:11, 8 June 2014 (UTC)

With all due respect, that's not what it says. I don't know if you read the paper, but they have charts and graphs that demonstrate that schizophrenic individuals are (for males) twice as likely to commit violent crime. For females that number is higher (but with a greater variance). To quote again here: "the risk of violent outcomes was increased in individuals with schizophrenia and other psychoses." Period full stop. Please do read the paper and not just the abstract. The quote you refer to is in the context of schizophrenic individuals who are also having substance abuse issues. In those cases the odds of violent crime are the same as the population with substance abuse and no schizophrenia (three- to fifteen-fold). But in the population of schizophrenia without substance abuse, there is a twofold increase in violent crime. — Preceding unsigned comment added by 173.29.134.6 (talk) 02:26, 9 June 2014 (UTC)

The problem persists, the notion that the association between schizophrenia and violence is "primarily due to higher rates of drug use" continues to be completely unsupported by the literature at large and more specifically the referenced paper. Recommend replacing the sentence with: "Schizophrenia has been associated with a higher rate of violent acts.[154]" — Preceding unsigned comment added by 128.255.84.62 (talk) 20:40, 13 June 2014 (UTC)

Bleak introduction

Especially since we are discussion such a stigmatised disorder, should we add a bit of hopefulness in the introduction? Perhaps something around treatment with antipsychotics - that they are partially effective at reducing the symptoms of schizophrenia (especially the positive symptoms) 86.26.99.152 (talk) 17:33, 13 July 2014 (UTC)

Semi-protected edit request on 13 July 2014

Please add "Schizoprenia is a brain disease" to the definition, because it has been shown that the brains of schizophrenics are dramatically different. There is a significant loss of gray matter (up to 25%), as well as enlarged ventricles and neurological abnormalities, which cause decreased pre-frontal brain function, impaired cognitive function, and impaired awareness of the illness. There is a lot of stigma against schizophrenics and their families because it is not understood that this is a degenerative disease, like any other physical degenerative disease. The newest treatments, such as Invega Sustenna, halt and to some extent reverse the disease, thank goodness. Thank you.

76.90.38.87 (talk) 23:11, 13 July 2014 (UTC)

Not done: please provide reliable sources that support the change you want to be made.  NQ  talk 02:56, 14 July 2014 (UTC)

Image standards

I find this image disturbing. I have this disorder, perhaps that does not help. Why do wikipedia's strict guidelines do not apply to art? Must I evaluate artwork as part of finding information?

File:Artistic view of how the world feels like with schizophrenia - journal.pmed.0020146.g001.jpg

Self-portrait of a person with schizophrenia, representing that individual's perception of the distorted experience of reality in the disorder

I am not gonna delete this because that might start some sort of war, also I may be biased. 1.123.164.58 (talk) 23:01, 28 July 2014 (UTC)

It is a fair comment you make. I have no strong opinion either way and would be happy to hear others' opinions. Cas Liber (talk · contribs) 23:48, 28 July 2014 (UTC)

Not sure who added it but do not see any great concern. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:47, 29 July 2014 (UTC)

Recent addition, for discussion

The following text was added, and I moved here for further discussion:

The diagnosis of schizophrenia has been the subject of much study and debate for over a century. The scientific validity of schizophrenia, and its defining symptoms such as delusions and hallucinations, have been questioned. There is an argument that the underlying issues would be better addressed as a spectrum of conditions.

References

Several concerns: 1) Several sources do not appear to meet criteria for WP:MEDRS (a critique of DSM V published in a social work journal, popular books, etc) 2) The location seems odd. The purpose of the section is to describe how it is diagnosed, and adding a paragraph at the lead questioning the existence of the diagnosis seems odd. If we have such a paragraph, it probably needs a more appropriate placement (in the Causes section?). 3) I think we have to be careful with the WP:WEIGHT with which to discuss this topic (not being familiar with the body of literature, I don't know if this paragraph is too much or too little).

Since this is a Featured Article, I think some discussion would be helpful to make sure we have the right material, sources, and location for such material. Yobol (talk) 17:29, 29 July 2014 (UTC)

There is no doubt that all the authors of the books are professors of psychiatry and clinical psychology in universities and scientists. Therefore, their books can be considered scientific, not popular. A lot of wikiarticles cite scientific books. Psychiatrick (talk) 19:18, 29 July 2014 (UTC)

The material is not fringe - most psychiatrists would agree with it I think, but I'd think we could get some secondary sources/review articles saying something similar. The material is best placed in the diagnosis section as it is about the demarcation of the syndrome(s), but maybe let's hunt for some other sources. Cas Liber (talk · contribs) 19:28, 29 July 2014 (UTC)

Thought this recent source, which talks about the "epistemic resistance" of schizophrenia, could be a useful addition: [26] Johnfos (talk) 10:55, 31 July 2014 (UTC)

Modest benefit

Ref says "these modest benefits were principally driven by the ability of second-generation antipsychotics to provide equivalent improvement in positive symptoms along with a lower risk of causing extrapyramidal side-effects"

This basically states that the benefit on positive symptoms is the same, there is benefit with respect to EPS. Overall benefit is modest, therefore EPS benefit is modest. Thoughts? Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:30, 11 September 2014 (UTC)

This is where sticking to secondary sources can be frustrating...when they keep (incorrectly) reifying typical vs atypical antipsychotics. Each group is more heterogenous within itself than different to the other - i.e. typical oddities - chlorpromazine - sedating/anticholinergic, mild EPSE (more like olanzapine than haloperidol) atypicals - ziprasidone and aripiprazole are only antipsychotics not associated with any weight gain at all. Neither is known to cause metabolic issues. Amisulpride is sometimes "atypical" sometimes not as it is a D2/D3 dopaminergic medicine with no serotonergic activity. Hence any publication that continues to lump meds into these two arbitrary groups and make generalisations is plain wrong. However, I have not delved into current literature on this to clean it up. Cas Liber (talk · contribs) 01:20, 11 September 2014 (UTC)

For instance I have prescribed risperidone, amisulpride and chlorpromazine hundreds of times - the first two have more EPSE than the third and any paper that says otherwise is being counterintuitive and I'd seriously wonder how they are getting their data. Cas Liber (talk · contribs) 01:22, 11 September 2014 (UTC)

Right - I am looking online for more current review articles. I have found this and will try to get fulltext and digest. Cas Liber (talk · contribs) 01:28, 11 September 2014 (UTC)

Sorry, that was a conference discussion of this, which I am reading now....it seems to concur more with my experience this :) Cas Liber (talk · contribs) 01:43, 11 September 2014 (UTC)

Excellent points. The advertising for these meds however do lump them into these two groups. Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:04, 11 September 2014 (UTC)

Hi James,

I think we may be talking past each other. The sentence in question currently reads

"While as a whole atypicals have fewer extrapyramidal side effects these differences are modest,[97] and risperidone is comparable to haloperidol.[93]"

Your edit summary states:

" Sited ref says "these modest benefits were principally driven by the ability of second-generation antipsychotics to provide equivalent improvement in positive symptoms...."

But I was reading "differences" in this sentence as referring to extrapyrimidal side effects, and not the relative overall benefits. The source states

"In contrast to their relatively similar efficacy in treating positive symptoms, there were substantial differences among both first- and second- generation antipsychotic agents with regard to their propensity to cause extrapyramidal, metabolic and other adverse effects; second-generation agents have a lower liability to cause acute extrapyramidal symptoms and tardive dyskinesia along with a tendency to cause greater metabolic side-effects than first-generation agents."

which I read as meaning that the atypicals have a substantially lower risk of EPS. I am no longer sure I read this correctly, but don't have access to the full text document to get more color. Could you take a look at this, and if I interpreted it correctly, adjust the text appropriately?

Also, I've done nothing for now, but the second part of this sentence "risperidone is comparable to haloperidol.[93]" seems to have nothing to do with the cited ref, which states

"Cmpared with risperidone Haloperidol may be less effective at improving positive and negative symptoms in people with schizophrenia; however, results were inconsistent (low-quality evidence)'

Given that the evidence is low quality, I'm not quite sure why this particular comparison was called out, but it does seem that the article contradicts the source.

Formerly 98 (talk) 09:46, 11 September 2014 (UTC)

Formerly 98 The sentence was about EPSE not effectiveness - have changed to "Risperidone has a similar rate of extrapyramidal symptoms to haloperidol.". Cas Liber (talk · contribs) 12:57, 11 September 2014 (UTC)

Furthermore I have taken the modest sentence out as it adds nothing. We've already mentioned EPSE once. It makes much more sense to identify some of the significan outlier drugs, as I've done - eg clozapine's effectiveness, olanzapine's metabolic issues, etc. Should all be duplicated and embellished in Management of schizophrenia article Cas Liber (talk · contribs) 12:57, 11 September 2014 (UTC)

@Casliber: yes, it got confusing there with respect to whether that sentence was about efficacy, overall benefit, or EPS. Good to have someone with expertise on the task, some of these articles have been little but soapboxes for anti-psychiatry groups and its good to see them getting pulled into shape. The Management of schizophrenia article is still a real mess, with more space dedicated to a table of adjunctive treatments, mostly supported by single, small trials and primary research articles than to professional society guidelines, the NICE guidance, or meta analyses. I'll try to do what I can, but I'm not really an expert. Formerly 98 (talk) 15:51, 11 September 2014 (UTC)

Genome-Wide Association Studies

A new paper by Arnedo et alia in AJP in Advance looks to have made headway in teasing apart the different clusters of genetic variations associated with schizophrenia, confirming that distinct clusters of genotypes exhibit distinct phenotypes. It is not entirely clear to me, but it looks to be a meta-analysis rather than a primary work. If I am correct, it (just barely) meets MEDRS. It concludes: "Schizophrenia is a group of heritable disorders caused by a moderate number of separate genotypic networks associated with several distinct clinical syndromes." Comments? LeadSongDog come howl! 16:12, 16 September 2014 (UTC)

Humans love simple answers to everything - there have been a few articles over recent years though this looks more comprehensive than most. It is not a Review article but new research. I'll have to read it in depth but am wary right now. Also as of now, its clinical impact is nil. Be very interesting to see how it evolves though. So my vote is, "not quite yet".... Cas Liber (talk · contribs) 20:59, 16 September 2014 (UTC)

Massive changes to the thinking on Schizophrenia (Edit reuest)

Hi all

This article http://news.wustl.edu/news/Pages/27358.aspx points to (I believe) a massive breakthrough in the thinking on Schizophrenia. In essence the researchers were able to group Schizophrenia into eight distinct disorders, each with groups of genes that are responsible for the disorder (that is, if an individual has one set of the genes behaving in a given manner, you are 100% likely to have one variant of Schizophrenia, another set of genes, 70% likely to have another variant.

I believe this to be a massive breakthrough on the grounds that it has long been postulated that Schizophrenia was a generic diagnosis for an unknown number of disorders. Further, in some cases environmental issues have been completely eliminated as causes for some variants.

The actual paper is Arnedo J, Svrakic DM, del Val C, Romero-Zaliz R, Hernandez-Cuervo H, Fanous AH, Pato MT, Pato CN, de Erausquin GA, Cloninger CR, Zwir I. Uncovering the hidden risk architecture of the schizophrenias: Confirmation in three independent genome-wide association studies. The American Journal of Psychiatry. vol. 172 (2), 2014. Published online Sept. 15, 2014. www.ajp.psychiatryonline.org — Preceding unsigned comment added by 122.62.245.135 (talk) 19:37, 19 September 2014 (UTC)

thanks for bringing this up, but this press release is doing exactly what it is meant to do, which is also quite... ugly. Here you are thinking that Something Very Important Has Actually Happened at Washington University when what has happened is some good basic science that, as the press release says "could be a first step toward improved diagnosis and treatment for the debilitating psychiatric illness." Could. first step. Really important words. It takes years to figure out if stuff like this is real, and to translate it into actual clinical care. While I understand why universities put out press releases like that (health news is "hot" and getting into the media is "good" for the university (attracts donors, etc etc etc). But ultimately press releases like this do everybody a huge disservice. They raise expectations that something Big Is Happening Now, and that is not how things work in medicine and the long term result is that people think all the buzz is just bullshit, that conventional medicine and conventional science are worth crap, that government funding of science is a waste of money, and they go swanning off into alternative medicine and other baloney. Ultimately this kind of press release is terribly corrosive. In any case, here in Wikipedia we do not do WP:CRYSTALBALL - we rely on secondary sources (reviews in the biomedical literature and statements by major medical and scientific bodies) to separate reality (as best as those working in the biomedical sciences can ascertain it at any given time) from hype. So neither that press release nor the scientific publication (which is a primary source) will be discussed in this article. In some years, when and if we learn if this is actually true, the diagnostic test would surely be mentioned. Not yet. Jytdog (talk) 23:13, 19 September 2014 (UTC)

Agree not a suitable source Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:47, 20 September 2014 (UTC)

Developmental factors

In Schizophrenia#Developmental factors, replace "The increased risk is about 5 to 8%" with "The increased risk is 508%" as the ref cited [27] uses 508%. I don't know why the article uses a figure orders of magnitude lower than that in the ref it cites. 137.43.188.219 (talk) 13:41, 1 October 2014 (UTC)

Not done: Because that is likely a glitch on that particular website that turned a hyphen into a 0. If you look at the PMID version here, it says 5-8%. Have changed the url to the pub med one. Cannolis (talk) 13:56, 1 October 2014 (UTC)

Text to speech audio

Have I misunderstood the Wikipedia philosophy of edit, then if there is disagreement reach consensus? It is cleary started in the intro flowchart. It seems a bit rude that you just remove all that I did, which was just a copy of the text. What can be wrong with that? Wikipedia has a lot of audio files that are not copies of the text! I will respectfully revert back so others can have a possibility of seeing how it works. It is just an aid for people who are e.g. dyslexic and should be very much in the spirit of Wikipedia. Please let us not get into another edit war!Ex-nimh-researcher (talk) 22:00, 6 October 2014 (UTC)

Are you able to re arrange them and maybe we can but them in a box in the external links section? They should not go in the lead.

Ideally their should be a button beside read that says listen to. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:10, 6 October 2014 (UTC)

Ex-nimh-researcher please see the guideline WP:BRD. That is a most useful way to avoid getting into trouble and most people follow it. Be Bold! But be ready to talk. You seem mostly interested in adding these files to health-related articles. How about if we talk about this at Project Medicine? I will open a thread there, and you can chime in as the originator of the idea. I will do it and ping you there. 22:39, 6 October 2014 (UTC)

posted on project medicine Wikipedia_talk:WikiProject_Medicine#Computer-generated_audio_files_of_articles Jytdog (talk) 22:48, 6 October 2014 (UTC)

Puting 10 audio files in the lead of an FA 3 times without consensus is not cool . Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:59, 6 October 2014 (UTC)

yep, from talk page user is new and somewhat intransigent to learning :( Jytdog (talk) 00:49, 7 October 2014 (UTC)

I'm disappointed that you reverted a good-faith new editor three times in the space of a couple of hours. There wasn't any urgent WP:DEADLINE here. He wouldn't have reverted you twice if you hadn't reverted him repeatedly, either. Please consider leaving it alone next time, even if you think it's m:The Wrong Version. WhatamIdoing (talk) 04:15, 7 October 2014 (UTC)

Readability Simpler language.

I think that much of the laguage in this article is too complex. It is supposed to be highschool level even for normal wikipedia. The section on neorology has a readability average grade level index of 18.3 with a maximum of 21.7. This means that one should probably have a PhD to undertand it. Wikipedia is not a reference source for PhDs, it is supposed to be for normal people. People who want the technical information can read the sources. I will try to simplify a bit. Please revert me with justification if you think I go too far.

Does anybody know how we can link to simple English Wikipedia on the top of the document. To inform about the simpler version is as important as disambiguation. I will put in a link early. Please revert and put in a more official way. Ex-nimh-researcher (talk) 15:46, 11 October 2014 (UTC)

Sorry, I reverted you as there is a link in the side bar. We try to write in as simple and direct language as possible as long as meaning isn't lost. The best way forward is to identify some segments that you think could be written more plainly and figure out how we can do that while preserving meaning. Cas Liber (talk · contribs) 20:14, 11 October 2014 (UTC)

Agree there is a link in the sidebar. Happy to see main English Wikipedia further simplified. This can be difficult to do though. And this article is not as bad as some. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:26, 12 October 2014 (UTC)

The link on the sidebar is extremely difficult to find though

The ones would need the simple English version are also those who would be least likely to search down to pages of links to find simple English in between all the other languages.

If the point with Wikipedia is to inform people, is there any good reason for not putting and easily accessible link high up in the main text. It seems discriminating that two educated persons, probably MDbs would make it more difficult for others to get access to the simple English version 84.209.58.31 (talk) 10:23, 12 October 2014 (UTC)

It isn't done for any other article. In the first instance, let's go through this one - what words/phrases do you want to simplify? Cas Liber (talk · contribs) 11:30, 12 October 2014 (UTC)

It isn't done for any other article. In the first instance, let's go through this one - what words/phrases do you want to simplify? Cas Liber (talk · contribs) 11:30, 12 October 2014 (UTC)

Especially Neurology section. It may seen nice and scientific and with well formed sentences, avoiding repetition etc. But if you have to be a PhD to read it, it is not an encyclopedia.Ex-nimh-researcher (talk) 12:33, 12 October 2014 (UTC)

Here is an example from this section: Studies using neuropsychological tests and brain imaging technologies such as fMRI and PET to examine functional differences in brain activity have shown that differences seem to most commonly occur in the frontal lobes, hippocampus and temporal lobes.[58] I know that the point of wikipedia is the hyperlinks, but to understand this sentence, most people would have to look at 7 hyperlinks. — Preceding unsigned comment added by Ex-nimh-researcher (talk • contribs) 12:42, 12 October 2014 (UTC)

Average life expectancy

The text "The average life expectancy of people with the disorder is 12 to 15 years less " has no source of reference. To my knowledge it has increased from ten years to twenty five years.

http://bjp.rcpsych.org/content/199/6/453

http://usatoday30.usatoday.com/news/health/2007-05-03-mental-illness_N.htm --Mark v1.0 (talk) 00:27, 2 October 2014 (UTC)

It is the next ref. Have added it to that line. We have the 10 to 25 years in the prognosis bit. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:49, 2 October 2014 (UTC)

Have replaced with secondary source per WP:MEDRS Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:53, 2 October 2014 (UTC)

On this same paragraph, in the opening intro, it says "This is the result of increased physical health problems and a higher suicide rate (about 5%).[4][7]" Is "About 5%" referring to -the suicide rate as 5%- or -5% higher than the norm-? — Preceding unsigned comment added by Thevastness (talk • contribs) 13:43, 15 October 2014 (UTC)

link to simple English version

I am just making another heading since we are discussing two things. I don't think it is a very good argument that it hasn't been done before or that nobody else is doing it. If this was the attitude everywhere, we would still be in the stone age. The point is that here, people who are so good with language that they can write Wikipedia articles are making decisions that will limit access to knowledge for people who need it, may be need it desperately, who are maybe in a state where they need things to be explained in simple ways. They will never find the link buried deep on the side. I didn't find it, because I didn't know it existed. Please give me some good arguments for not giving a very visible link. Will anybody be bothered?Ex-nimh-researcher (talk) 12:33, 12 October 2014 (UTC)

The issue is often many people want increasing prominence for what they consider most important. We do not give simple English prominence within the article itself as it is listed in the language links. Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:41, 12 October 2014 (UTC)

I have understood that. Thank you for answering so quickly and patiently to my newbie enthusiastic ideas. Are there any other arguments against placeing a link. I think it could do a lot of good for the people who need the easier version and think this is all there is. Is there any other way of making it a bit easier, just like the loudspeaker for the spoken. Maybe the wikipedia admins could have a say in this. They have spent a lot of time makeing the editing easier on the simple pages too. Just too bad if nobody uses them. Ex-nimh-researcher (talk) 15:29, 12 October 2014 (UTC)

• Note - editors of this article should be aware that Ex-nimh-researcher is editing the Simple English Wikipedia version of this article, and adding and removing content there. I am concerned that this editor may be treating that article as a WP:POVFORK. Zad68 17:31, 12 October 2014 (UTC)

Okay - I am not an admin over there but will take a look later if I get time. Cas Liber (talk · contribs) 19:56, 12 October 2014 (UTC)

I would prefer that you talk to me rather than about me. Please assume good faith, according to Wikipedia guidelines. I have, encouraged by the tag simplified and clarified, added some secondary sources, e.g. NICE and given a simple language translation of that. Please don't assume POV even if I am a bit enthusiastic. Maybe I disagree on some points with some of you, but I have actually done NIMH research on Schizophrenia, published in Archives of general Psychiatry, Schizophrenia Bulletin etc. and I am passionate about the subject. Ex-nimh-researcher (talk) 13:06, 13 October 2014 (UTC)

Happy to see you working on simple English Wikipedia aswell. IMO simple English should be top of the language links. Was unable to get consensus for that Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:48, 14 October 2014 (UTC)

Thanks for trying. Did you move the link for the sound? I tried to put the simple English link at the bottom of the index. Not a good idea? BY the way, I am very impressed at your work capacity. You beat all in edits on the psych articles. Ex-nimh-researcher (talk) 11:58, 14 October 2014 (UTC)

Moved the link for the sound slightly per [28]. Thanks for creating it :-) Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:14, 14 October 2014 (UTC)

It is almopst impossible to fin the link for the simple version. Is there any reason for not putting it at the end of the index so people have the possibility of finding it. I don't understand why anybody would make it difficult for people to find it. Isn't Wikipedia about spreading information?2001:4641:7A49:0:951F:D3DA:B00E:856A (talk) 20:35, 15 October 2014 (UTC)

I am putting back the link to the simple version again, very discretely, all the way at the bottom. Please don't remove it James! Let others see if they like it! Think of the dyslexics! On the main page Simple English is the first of the languages. So until we can keep that standard, please let the link be at the bottom of the index. Maybe on both?Ex-nimh-researcher (talk) 21:56, 15 October 2014 (UTC)

I am still not supportive as it is in the language links. I will allow others to comment and remove / leave as they wish.

Great to see simple English listed first on the main page. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:13, 16 October 2014 (UTC)

Glutamatergic medication

...positive symptoms fail to respond to glutamatergic medication.

Has any new information on this emerged in the decade of drug development and research since that source was published? 137.43.188.209 (talk) 16:41, 15 October 2014 (UTC)

There have been a lot of late stage failures in the clinic, people thought this looked pretty good once but nothing has really worked out. Sadly, schizophrenia research has been like waves against the rocks for the last 25 years, with nothing but dopamine agonists really working out. Novel mechanism of action drugs have failed repeatedly in late stage trials.

The things that currently look most promising are probably the following: A company called Acadia has a serotonin based drug that worked real well in Parkinson's dementia. Its on hold now in schizo for financial reasons, but they will probably put it back in the clinic soon. There are also some compounds in phase 3 based on H3 receptors (tiprolisant), and nicotinic receptors (encenicline) and oxytocin (syntocinon).

I realize that this post broke a lot of rules about using the Talk page to discuss the subject outside the framing of the article, but it was done with good intent. I won't make a habit of it. Formerly 98 (talk) 19:14, 15 October 2014 (UTC)

No, not really - it is a really important subject to discuss at some time - I wanted to find some sourcing discussing the progress (or lack thereof) on the topic of glutaminergic drugs....and there is very little information. At all! And it is significant as it was touted as the Next Big Thing in psychosis treatment several years ago. So all info is critical, particularly how we make treatment coverage as comprehensive as possible. Cas Liber (talk · contribs) 20:02, 15 October 2014 (UTC)

Sorry, that should have read Parkinsons psychosis, not dementia. The H3 and nicotinic compounds are targeted to cognitive impairment. I follow this area somewhat closely and have access to an up to date database of drugs in development if you want to email me (formerly098@gmail.com) for more info, (the database company might notappreciate it if I did a big upload of info from their db to WP). The Arcadia drug looks kind of interesting. Formerly 98 (talk) 21:23, 15 October 2014 (UTC)

And of course antagonists not agonists. Shouldnt do this on my phone....Formerly 98 (talk) 21:25, 15 October 2014 (UTC)

Thanks for the replies. This review from 2008 mentions "promising clinical results" against positive and negative symptoms from an mGluR agonist in a phase II trial. Apparently this "has greatly increased interest in non-dopamine approaches to schizophrenia, as it indicates that glutamatergic approaches to may be clinically viable" 137.43.188.210 (talk) 08:54, 16 October 2014 (UTC)

Promising, yet we know there has been nothing since, which suggests clinical trials have come to nothing. Hence listing it as promising without a downbeat conclusion is misleading. Formerly 98 - am intrigued and will email. You don't have email enabled - just email me with cut-and-pasted text into email. Cas Liber (talk · contribs) 13:15, 16 October 2014 (UTC)

How vast majority of cases cases start (very reliable sources)

For someone who can edit Wikipedia:

In about 75% of cases, schizophreniaa onset occurs with slowly mounting depressive and negative symptoms that involve increasing functional impairment and cognitive dysfunction. Less than 10% of cases start with positive symptoms only. Reports on the duration of the prepsychotic prodromal stage vary widely. Because of differences in study designs and nonrepresentative populations, mean values range from a few months to 9 years.

The onset of schizophrenia usually occurs with depressive and negative symptoms, and functional impairment during a prepsychotic prodromal phase that on average lasts for several years, followed by apsychotic prephase, defined as the period between the first positive symptom and the maximum of positive symptoms, lasting on average for 1 year. Clinical Handbook of Schizophrenia

Approximately 80 – 90% of patients with schizophrenia report a variety of symptoms, including changes in perception, beliefs, cognition, mood, affect, and behavior that preceded psychosis, although approximately 10 – 20% develop psychotic symptoms precipitously without any apparent significant prodromal period (Yung & McGorry, 1996a ). The typical pattern is that the non - specific symptoms and negative symptoms develop first, followed by attenuated, or mild, positive symptoms, together with distress and decreased functioning (Häfner et al., 1998). Schizophrenia - Weinberger

— Preceding unsigned comment added by 93.89.144.5 (talk) 17:56, 7 October 2014 (UTC)

I assume you mean this book [29] How do you think we should summarize? By the way content is on page 102. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:11, 7 October 2014 (UTC)

This is called the prodrome and is already in the article under onset. Cas Liber (talk · contribs) 21:52, 7 October 2014 (UTC)

Excuse me, I don't really know how to even edit this page so I'm seeking your help with you making the small edit steps instead of me. Yes, the prodrome article is there, but I consider the percentages really crucial and very important (that's why I have made the effort in the first place). It is a golden article with such an important thing missing. Here's my suggestion:

... the condition manifested itself before the age of 19.[22] In 75-90 % cases, the onset occurs with slowly mounting depressive and negative symptoms that involve increasing functional impairment and cognitive dysfunction which may be accompanied by changes in perception and beliefs. Less than 10-20 % of cases start with positive symptoms only.

The second source is Weinberger, Harrison - Schizophrenia page 92

- 93.89.144.5 — Preceding unsigned comment added by 93.89.144.5 (talk) 06:24, 10 October 2014 (UTC)

The numbers themselves are from a study (i.e. primary source), right? Hang on will look. Cas Liber (talk · contribs) 13:21, 11 October 2014 (UTC)

These are the studies:

Mueser - Clinical Handbook of Schizophrenia (page 102): Häfner, H., Löffler, W., Maurer, K., Hambrecht, M., & an der Heiden, W. (1999). Depression, negative symptoms, social stagnation and social decline in the early course of schizophrenia. Acta Psychiatrica Scandinavica, 100,105–118.

Weinberger, Harrison - Schizophrenia (page 92): Yung & McGorry, 1996a — Preceding unsigned comment added by 93.89.144.5 (talk) 14:25, 13 October 2014 (UTC)

So what is the problem? Why it hasn't been edited yet? I don't understand it. It has all requirements. Or make this an offical edit request. Such an important thing that can potentially save lives is still missing there. — Preceding unsigned comment added by 93.89.144.5 (talk) 06:12, 22 October 2014 (UTC)

Long term use of AP meds - negative effect

This is a potentially very important secondary document. Where could this be included? Fuultext is free at http://schizophreniabulletin.oxfordjournals.org/content/early/2013/03/19/schbul.sbt034.full.pdf+html

Does Long-Term Treatment of Schizophrenia With Antipsychotic Medications Facilitate Recovery? Martin Harrow* and Thomas H. Jobe, Schizophrenia Bulletin 2013

Antipsychotic medications are viewed as cornerstones for both the short-term and long-term treatment of schizophrenia. However, evidence on long-term (10 or more years) efficacy of antipsychotics is mixed. Double-blind discontinuation studies indicate significantly more relapses in unmedicated schizophrenia patients in the first 6-10 months, but also present some potentially paradoxical features. These issues are discussed Ex-nimh-researcher (talk) 09:50, 22 October 2014 (UTC)

Sure, how do you want to summarize it? Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:41, 22 October 2014 (UTC)

I will work a bit on that, I guess you want it in one or two sentences. Do you think it would fit best in the medication section? Ex-nimh-researcher (talk) 18:37, 22 October 2014 (UTC)

Yes, an important point - probably best there at the end of that section (?). But we can rejig for flow. Cas Liber (talk · contribs) 20:22, 22 October 2014 (UTC)

How about this: "20 year follow up research on the difference between schizophrenia patients who stayed on their drugs long term and others who stopped their drugs, has shown that there is a sub group of patients who do much better in the long term without drugs. However, patients in this group have more relapses in the first two years after stopping, before the good development starts." I have tried to be as concise as possible, without using technical terms. Ex-nimh-researcher (talk) 13:17, 23 October 2014 (UTC)

It more says "it is unclear the long term effects of antipsychotics".[30]

We already say this "There is little evidence regarding effects from their use beyond two or three years" and were already using that ref in the article [31]

The gist of this article is a bit different than "little evidence" It is talking about psychosis becoming wordse in the long run with meds, super sensitivity psychosis, in other words that continuous use creates a chemically induced psychosis through D2 proliferation and/or increased sensitivity.Ex-nimh-researcher (talk) 22:20, 23 October 2014 (UTC)

IMO further details belong in the subarticle not the main article. Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:31, 23 October 2014 (UTC)

I took only a quick pass through this article, but do we know from these observational studies that "there is a subgroup that does much better without drugs"? Or do we simply know that there is a subgroup that does well without drugs? My impression was that there were a lot of statements in the article along the line of "among those who had been stable without drugs for x years (this stated or merely implicit), the relapse rate without drugs was low over the following y years." If the subgroup that does well has substantially different baseline characteristics than the group it is being compared to, the best statement would be "There is a subgroup of patients that does well without drugs", as there is no control group to which one can make the comparison "better". But admittedly I'm commenting on an article I did not read very closely. Formerly 98 (talk) 15:44, 23 October 2014 (UTC)

It says that the evidence of long term effects is mixed. The evidence of harm is "potential". Belongs on the subpage IMO.Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:25, 23 October 2014 (UTC)

Effective for negative symptoms

This line was added "Amisulpride is effective in case of negative symptoms of schizophrenia." It is a 2002 Cochrane review that states "It may also yield better results in some specific outcomes related to efficacy, such as improvement of global state and general negative symptoms."

This is a tentative conclusion and thus IMO not a sufficient summary. We already discuss this agent with newer refs. Here is a 2010 Cochrane review [32] which addresses a slightly different question. Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:12, 17 October 2014 (UTC)

Hey thanks for letting me know about the new Cochrane review regarding Amisulpride. So sorry did not know about this. I was actually trying to look at the Amisulpride's efficacy to improve negative symptoms of Schizophrenia and this was all I could find. I will try to look into some more sources of info. Raysujoy8 (talk) 13:26, 28 October 2014 (UTC) — Preceding unsigned comment added by Raysujoy8 (talk • contribs) 08:14, 17 October 2014 (UTC)

To be honest, a great many patients have negative symptoms that are resistant to all intervention, though some may be ameliorated to varying degrees by various interventions. I am interested as well as personally I have noticed some slight (positive differences) with amisulpride over other medications, but we need to stick to secondary sources. cheers, Cas Liber (talk · contribs) 19:35, 28 October 2014 (UTC)

Semi-protected edit request on 3 November 2014

{{edit semi-protected|Schizophrenia|answered=yes} ... the condition manifested itself before the age of 19.[22] In 75-90 % cases, the onset occurs with slowly mounting depressive and negative symptoms that involve increasing functional impairment and cognitive dysfunction which may be accompanied by changes in perception and beliefs. Less than 10-20 % of cases start with positive symptoms only.

Book: Mueser - Clinical Handbook of Schizophrenia (page 102). Study: Häfner, H., Löffler, W., Maurer, K., Hambrecht, M., & an der Heiden, W. (1999). Depression, negative symptoms, social stagnation and social decline in the early course of schizophrenia. Acta Psychiatrica Scandinavica, 100,105–118.

Book: Weinberger, Harrison - Schizophrenia (page 92). Study: Yung & McGorry, 1996a 93.89.144.5 (talk) 19:50, 3 November 2014 (UTC)

Not done. Secondary sources are needed per WP:MEDRS Best Doc James (talk · contribs · email) 21:22, 3 November 2014 (UTC)

Hafner et al.(1992, 1993) reported on the early symptomatology of schizophrenia and observed that in the vast majority of cases the disease started solely with negative symptoms. http://schizophreniabulletin.oxfordjournals.org/content/28/3/415.full.pdf page 2

These initial negative symptoms are often referred to as the prodromal period of schizophrenia. http://www.nhs.uk/Conditions/Schizophrenia/Pages/Symptoms.aspx — Preceding unsigned comment added by 93.89.144.5 (talk) 08:08, 4 November 2014 (UTC)

Why isn't there, a recovery referential?

I believe it is the preposition of wikipedia and the best interest for the families of schizos to read on this page, an recovery composition. Why isn't there one? Wikipedia is an encyclopedia of informative references with the absence of an 'recovery composition'. — Preceding unsigned comment added by 107.184.185.234 (talk • contribs) 03:21, 23 November 2014‎ (UTC)

i am sorry but what do you mean by "recovery composition"? thanks. Jytdog (talk) 03:35, 23 November 2014 (UTC)

Yes, the expression is lost on me too. Cas Liber (talk · contribs) 06:07, 23 November 2014 (UTC)

Semi-protected edit request on 7 December 2014

I would like to add content relevant to the "Genetic" section of schizophrenia. I found it very surprising that the page was missing information (even mention!) of major susceptibility genes GAD67, RELN, and BDNF. I would like to add content relevant to epigenetic mechanisms of the pathogenesis of schizophrenia, since genetics alone do not cause the disease, but work in conjunction with a number of other factors.

I would also like to add content within the "Developmental" portion of this page. I noticed that there was no clear explanation as to why stress may lead to the genesis of schizophrenia. I provide a mechanism that not only explains a possible link between stress and the onset of schizophrenia, but also relate it to a genetic susceptibility (which I expand upon within the Neuregulin 1 page.)

Jgalvin2015 (talk) 15:59, 7 December 2014 (UTC)

 Not done This is not the right page to request additional user rights.
If you want to suggest a change, please request this in the form "Please replace XXX with YYY" or "Please add ZZZ between PPP and QQQ".
Please also cite reliable sources to back up your request. - Arjayay (talk) 16:37, 7 December 2014 (UTC)

Research Suggesting Cultural Construct

https://www.sciencenews.org/article/hallucinated-voices%E2%80%99-attitudes-vary-culture Research in "hearing voices" in other cultures. In Ghana and India people more likely to hear positivity from voices. They often hear them as voice of family member or attribute them to a god. This would suggest some of the concept of schizophrenia is a Western construction that doesn't completely match reality. This should be acknowledged in the page. — Preceding unsigned comment added by 73.26.167.92 (talk) 05:10, 12 December 2014 (UTC)

Add content about the encouraging research done about pregnenolone

Please add this to the end of the medication section of schizophrenia and before Psychosocial.

Pregnenolone has been shown to help decrease negative symptoms of schizophrenia like problems with attention, memory, and reasoning.

"Treatment with adjunctive pregnenolone significantly decreased negative symptoms in patients with schizophrenia or schizoaffective disorder in a pilot proof-of-concept randomized controlled trial, and elevations in pregnenolone and allopregnanolone post-treatment with this intervention were correlated with cognitive improvements [Marx et al. (2009) Neuropsychopharmacology 34:1885-1903]. Another pilot randomized controlled trial recently presented at a scientific meeting demonstrated significant improvements in negative symptoms, verbal memory, and attention following treatment with adjunctive pregnenolone, in addition to enduring effects in a small subset of patients receiving pregnenolone longer-term [Savitz (2010) Society of Biological Psychiatry Annual Meeting New Orleans, LA]. A third pilot clinical trial reported significantly decreased positive symptoms and extrapyramidal side effects following adjunctive pregnenolone, in addition to increased attention and working memory performance [Ritsner et al. (2010) J Clin Psychiatry 71:1351-1362]. Future efforts in larger cohorts will be required to investigate pregnenolone as a possible therapeutic candidate in schizophrenia, but early efforts are promising and merit further investigation. This article is part of a Special Issue entitled: Neuroactive Steroids: Focus on Human Brain."

--Envisioneerthefuture (talk) 01:59, 20 January 2015 (UTC)

Interesting - we can't use a primary source but I see that it is cited in a Review Article, i.e. this one. Will take a look as I think we can figure something out. Fulltext here Cas Liber (talk · contribs) 02:07, 20 January 2015 (UTC)

Okay, I have added the review article, but it lists a large number of drugs wiht some smidgen of possible benefit and pregnenolone is way down the list.....alot of drugs should be mentioned before it is I think....Cas Liber (talk · contribs) 11:09, 20 January 2015 (UTC)

I think you are correct when you say it is further down the list, on the other hand it is the only supplement that was rated as having "significant" positive effect. Others were not mentioned as being as significant as the pregnenolone.

We should use this quote from the review articles " A proof-of-concept trial evaluating adjunctive therapy with pregnenolone (a neurosteroid) 500 mg/day demonstrated significantly greater improvement in negative symptoms. Two subsequent, small studies also supported the benefit of pregnenolone in schizophrenia."

I believe it is imperative that those suffering from this illness know that there is a very promissing drug for them to try that is over the counter and costs 5 dollars for 90 doses of the amount specified in the study, which is twice as much as is needed. I learned of the research in from a post about it by an adminstrator of the schizophrenia.com forum: http://forum.schizophrenia.com/t/vitamin-pregnenolone-new-treatment-for-schizophrenia-anyone-trying-it/11631

There is more supporting literature listed there as well. Envisioneerthefuture (talk) 21:21, 20 January 2015 (UTC)

I would also add the research of the anti-inflammatory treatment options as well (that are also listed in the other drugs section of the part for emerging treatments for negative symptoms before the pregnenolone mention.)

I have not much experience with inflammation theory of pathology, but I have researched and experimented with pregnenolone, for myself and so many people it has practically eliminated negative symptoms. Example: I have schizophrenia and experienced a lot of attention, memory, sentence verification problems. Before the treatment, I could not read a textbook for more than 10-20 minutes, yet after starting treatment, I can read, research, learn, and work indefinitely for at least 10-12 hours a day. My scores for verbal fluency went from 15 percentile to 53 percentile using the assessments on the cambridge brain science website. What will it take to get this information on the wikipedia page for easy access? Envisioneerthefuture (talk) 21:39, 20 January 2015 (UTC)

It's not our goal here to save the world by spreading the word about the latest new thing, however wonderful it is. Our goal is to be reliable. That means only including information about something when it is sufficiently well documented to give strong assurance that the story isn't going to change in the near future. Personal stories, unfortunately, are not helpful -- actually they are harmful -- because they get in the way of understanding the message conveyed by reliable published sources. Looie496 (talk) 15:57, 24 January 2015 (UTC)

(edit conflict)envisioneer you are new to Wikipedia. Please read WP:MEDRS and WP:MEDMOS. Also WP:OR. What you write in the last paragraph has no place here, and we generally avoid the cutting edge of anything. And we do not give medical advice; please see the disclaimer at the bottom of every page which has a "medical disclaimer" statement. Jytdog (talk) 18:22, 24 January 2015 (UTC)

Thanks for the advice the first responder made an edit that helps people know about the emerging research. He referenced a good review article. I would like to see more about emerging research. Can we expand the Research directions section. There is a lot of research about different etiologies of the symptoms and treatment targets that should be made aware to people learning about it. This review article, not original research, reviews the treatments from the inflammation theories. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3641824/

Envisioneerthefuture (talk) 23:05, 24 January 2015 (UTC)

That is an interesting paper - part of the problem is that the topic is huge and generally sticking to what is common practice has been what we have to do to keep the size of the article manageable. However, I do agree that that paper could do with a line or two sourced to it in this article. NB: There is a daughter article - Management of schizophrenia - where some of this could be looked in more detail. Cas Liber (talk · contribs) 05:42, 25 January 2015 (UTC)

Okay, I made a start - musing on how much detail is necessary in this umbrella article as none of these agents are used in this way in clinical practice, but maybe some limited expansion is ok......hmmmm Cas Liber (talk · contribs) 05:49, 25 January 2015 (UTC)

Semi-protected edit request on 11 February 2015

A medical device that uses H-coil for deep transcranial magnetic stimulation (Deep TMS) as a noninvasive treatment for depression, schizophrenia, and other neurological disorders, depending on licensing in different countries. https://en.wikipedia.org/wiki/Brainsway Germanbrother (talk) 08:27, 11 February 2015 (UTC)

High quality ref per WP:MEDRS needed Doc James (talk · contribs · email) 08:52, 11 February 2015 (UTC)

Disputed tag

The user who tagged the article "disputed" did not give a reason,[33] but

• here is a post to Teahouse, and
• here is a Google scholar search restricted since 2011 on positive and negative symptoms

I suggest removing the tag, unless someone indicates there is newer terminology. SandyGeorgia (Talk) 00:14, 5 March 2015 (UTC)

Yup a little strange. Doc James (talk · contribs · email) 02:49, 5 March 2015 (UTC)

more sad than strange. mental illness just sucks. suffering and very little help. not much positive about it indeed.  :( Jytdog (talk) 02:53, 5 March 2015 (UTC)

I've inquired privately about help in this matter. [34] SandyGeorgia (Talk) 07:18, 5 March 2015 (UTC)

Might be best to close their accounts ability to edit. Doc James (talk · contribs · email) 16:44, 6 March 2015 (UTC)

That's not justified yet. I've run into this sort of thing lots of times. Usually an editor who doesn't accomplish anything after several attempts will just give up. Looie496 (talk) 15:56, 7 March 2015 (UTC)

I have received some concerning emails. Doc James (talk · contribs · email) 17:34, 7 March 2015 (UTC)

You need to flag it with the WMF. Cas Liber (talk · contribs) 19:59, 7 March 2015 (UTC)

They have not edited recently. Doc James (talk · contribs · email) 20:05, 7 March 2015 (UTC)

My emails were not responded to. SandyGeorgia (Talk) 20:48, 7 March 2015 (UTC)

edit semi-protected

change "In 2013 about 16,000 people died from schizophrenia"

to

"In 2013 about 16,00 people died from behavior related-to or caused by schizophrenia"

schizophrenia is a mental not a physiological disease. You cant die directly from it

99.235.23.2 (talk) 04:08, 22 March 2015 (UTC)

 Done Also changed "about" to "estimated" per source. -- haminoon (talk) 04:41, 22 March 2015 (UTC)

chinese / schizophrenia

is there a study on schizphrenia patients in ethnicity? given the large number of symbolic characters that need to be remembered by heart by ethnic chinese and the symbolic interpretation of language, maybe more chinese fit into the schizophrenia symptoms by western standards? — Preceding unsigned comment added by 69.172.72.45 (talk) 21:52, 5 April 2015 (UTC)

Semi-protected edit request on 24 April 2015

replace 'inactivity' with 'avolition' Volkovjames (talk) 01:41, 24 April 2015 (UTC)

Yeah, I'll pay that. done. Cas Liber (talk · contribs) 05:36, 24 April 2015 (UTC)

We should try to use simpler English. "A lack of motivation" is close enough and way simplier. Doc James (talk · contribs · email) 12:56, 24 April 2015 (UTC)

Except that it is not synonymous and carries connotation of laziness...not good WRT stigma and mental health. Cas Liber (talk · contribs) 13:59, 24 April 2015 (UTC)

Time for a thesaurus ... most readers will have to look up the word avolition. SandyGeorgia (Talk) 14:03, 24 April 2015 (UTC)

I had one growing up, but we couldn't figure out what to feed it and it died. Formerly 98 ^{talk|contribs|COI statement} 14:18, 24 April 2015 (UTC)

I suppose I should add that I don't feel strongly enough to argue about it as I can see the merits of "lack of motivation" anyway. Cas Liber (talk · contribs) 14:34, 24 April 2015 (UTC)

I am happy with other wording, but it should be understandable English, at least for the lead. Doc James (talk · contribs · email) 14:42, 24 April 2015 (UTC)

Pronunciation

The pronunciation is wrong: "/ˌskɪtsɵˈfrɛniə/ or /ˌskɪtsɵˈfriːniə/". Instead of ɵ (read th as in thing), it should be ə (read as the a in about).

http://www.oxforddictionaries.com/us/definition/american_english/schizophrenia IPA: http://www.oxfordlearnersdictionaries.com/us/definition/english/schizophrenia?q=schizophrenia — Preceding unsigned comment added by 89.88.98.184 (talk) 14:53, 1 May 2015 (UTC)

Image caption

This caption was awful: unecessarily long and convoluted, off-topic detail, and it wasn't clear to me which was which; can those knowledgeable pls check that my edit didn't get it backwards (which is more active in orange, controls or schizophrenia)? SandyGeorgia (Talk) 15:53, 3 May 2015 (UTC)

Brain training seems to help with neuroplasticity

http://www.human-memory.net/disorders_schizophrenia.html

"Schizophrenics often have difficulty encoding, storing and recalling words, although recent advances in the understanding of neuroplasticity have led to some promising new treatments. It has been shown that schizophrenic symptoms can be improved by stimulation, particularly through the regular repetition of some simple (although progressively more challenging) auditory and visual exercises. As brains change physically through neuroplasticity, many of the abnormal patterns in the brain which characterize schizophrenia are removed. In addition, levels of the protein BDNF (brain-derived neurotrophic factor), which is lower than normal in schizophrenics, are also increased to near normal levels. Similar treatments may even be used to prevent the onset of schizophrenia in people exhibiting early warning signs of the disorder."

I can't really say I enjoy the wiki page, half of it discusses things which most people wouldn't understand and the one photo of a schizophrenic we have never took drugs after his episodes and lived to 86 before he died in a limo-wreck. — Preceding unsigned comment added by 71.167.70.44 (talk) 04:11, 11 June 2015 (UTC)

We simply summarize the best avaliable literature. Meaningful pictures of mental illnesses are hard to come by. Doc James (talk · contribs · email) 07:09, 14 June 2015 (UTC)

On older adults

It says if they have schizophrenia they are twice as likely to have dementia "The rates were 64.46% versus 32.13% for people without schizophrenia."(http://schizophrenia.com/?p=278) observe,

"Researchers from the Regenstrief Institute and the Indiana University Center for Aging Research who followed over 30,000 older adults for a decade have found the rate of dementia diagnosis for patients with schizophrenia to be twice as high as for patients without this chronic, severe and disabling brain disorder."

https://www.regenstrief.org/news/dementia-diagnosis-twice-likely-if-older-adult-has-schizophrenia-cancer-less-likely/ — Preceding unsigned comment added by 71.167.59.130 (talk) 18:02, 20 July 2015 (UTC)

"In a study of long-term in-patients with schizophrenia who had survived into old age, Harvey et al (1999a) followed up a group for 30 months using the Clinical Dementia Rating (CDR). Over this period, 30% of the patients deteriorated, from a baseline of minimal or mild cognitive and functional impairment to impairments severe enough to warrant a secondary diagnosis of dementia."

http://apt.rcpsych.org/content/18/2/144

Schizophrenia, toxoplasmosis, and minocycline

I am surprised to see that there is no mention of the correlation between schizophrenia and toxoplasmosis, a correlation that is stronger than that of any genes yet discovered and schizophrenia and yet genes are mentioned in the Schizophrenia article. See: Toxoplasmosis#Research and specifically Toxoplasmosis#Schizophrenia and especially the meta-analysis.

Related: thus I am not surprised to see there is no mention of minocycline as a possible treatment for both the positive and, even more importantly, the difficult to treat negative symptoms of schizophrenia. See: Minocycline#Research and its references, especially the meta-analysis.

Someone who oversees this Schizophrenia article should add information about this area of research.

Will Antibiotic Fulfill Its Psychosis-Fighting Promise? (2012) http://psychnews.psychiatryonline.org/doi/full/10.1176%2Fpn.47.16.psychnews_47_16_10-a

Successful Use of Add-on Minocycline for Treatment of Persistent Negative Symptoms in Schizophrenia (2013) http://neuro.psychiatryonline.org/doi/full/10.1176/appi.neuropsych.11120376

What you have posted here is a case report and a popular press piece. Please read WP:MEDRS. Will look at the other links. Doc James (talk · contribs · email) 05:37, 9 August 2015 (UTC)

The section on Toxoplasmosis#Schizophrenia was horrible. I have fixed it. Yes a tentative association. This ref states "Toxoplasma gondii, Cytomegalovirus, Chlamydia spp., and all types of Human Herpes Virus or Influenza, is associated to an increased risk for adult schizophrenia" [35] The proposed mechanism of minocycline does not appear to be through an effect on toxoplasmosis. Doc James (talk · contribs · email) 06:18, 9 August 2015 (UTC)

Added a sentence here about the possible association. Doc James (talk · contribs · email) 07:32, 9 August 2015 (UTC)

Suggestion

I would like a doctor to check possible link with demodex. And maybe you can find this article interesting. eye-test-identifies-people-with-schizophrenia — Preceding unsigned comment added by 2A02:214C:8031:4200:F183:D34E:A8F3:B844 (talk) 20:28, 10 September 2015 (UTC)

Cannabis as a contributory factor

As someone who has lived with a schizophrenic for many years, has associated with others and has read most of the literature on the subject, I can say, with confidence that cannabis typically does not induce or exacerbate the symptoms of schizophrenia. In fact, cannabis tends to be used by schizophrenics to cope with the symptoms of their disease. Some of the studies that have come out claiming otherwise tend to have a political agenda, in my educated opinion. Does anyone out there have an opposing opinion? XenoRasta (talk) 20:27, 11 May 2015 (UTC)

this is not a forum for discussing the disease or how people cope. If you are talking about article content, what we rely on are published sources - reviews in the biomedical literature and statements by major scientific/medical bodies. Jytdog (talk) 20:33, 11 May 2015 (UTC)

We just go with the best available sources and many state a link. Doc James (talk · contribs · email) 22:16, 11 May 2015 (UTC)

I can say with much emphasis that cannabis helps schizophrenics with "mundane" problems, if there however is a strain perhaps that doesn't have THC then yes it may give them the social effect without the lackiluster performance. I'd also like to add the schizo's may be more functional better if they have the social means to acquire weed. So the schizophrenic's they're working with may just be the brighter one's. — Preceding unsigned comment added by 71.167.70.44 (talk) 04:13, 11 June 2015 (UTC)

You need a excellent source. Doc James (talk · contribs · email) 22:24, 11 June 2015 (UTC)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3730190/ "schizophrenics with better reaction times" http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3165946/ "the entourage effect" Schizophrenia is really symptom's of something going on at a smaller level. http://www.iflscience.com/brain/scientists-closer-ever-discovering-cause-schizophrenia

So the schizophrenia being treated is mostly just being covered up and in the long run, having too many useless connections in the brain(unneeded copies of DNA uninhibited) may lead to faster aging and dementia/alzheimers, which is largely ignored in favor of the "rotten brain" imagery Pharma produces to scare meth addicts and over medicated people. http://www.medicalnewstoday.com/articles/266102.php — Preceding unsigned comment added by 71.167.70.44 (talk) 07:16, 13 June 2015 (UTC)

this article is medically irresponsible and misleading

In a statistically significant number of people, there is a causal link between cannabis usage and the later development of psychosis; psychosis is a very negative outcome for these people. This article attempts to downplay that causal link by selectively quoting the sources and burying the causal link in disclaimers. My sources are the sources used in the article. For people with the risk factors (genetics, etc.), cannabis use is sufficient to cause their psychosis; just as smoking does not cause lung cancer in all people who smoke cigarettes, cannabis is not sufficient to cause psychosis in all people who smoke it; however, the links are causal. Read the paragraph of the article, then click the links to referenced studies online: they contain the clear recommendation that adolescents avoiding cannabis use would significantly decrease the rate of onset of psychosis. 96.246.59.19 (talk) 20:40, 11 October 2015 (UTC)

Thanks and clarified. Doc James (talk · contribs · email) 22:04, 12 October 2015 (UTC)

Differential Diagnosis: Delusional disorder

The changes that took place in the DSM-5 affected the differential diagnosis between Delusional Disorder and Schizophrenia. I'm proposing that in the differential diagnosis section for the Schizophrenia page, for the sentence about Delusional Disorder, the words 'non-bizarre' should be removed from the brackets that describe the delusions in delusional disorder. For example, at the moment, the sentence reads 'Delusions ("non-bizarre") are also present in delusional disorder ... '. I'm proposing that the sentence be changed to ' Delusions are also present in delusional disorder ...', or alternatively ' Delusions ("bizarre" or "non-bizarre") are also present in delusional disorder... '.

The reason for my proposal is due to the change in the distinction to 'bizarre' delusions between DSM-IV and DSM-5.

In the DSM-IV, if bizarre delusions were present, only one of the criterion A symptom had to be present for this to be diagnosed as Schizophrenia. So essentially, it was formerly enough that if only a delusion was present, if it were bizarre, the bizarre delusions alone were enough to classify it as Schizophrenia.

Also, in the DSM-IV, Delusional Disorder could only consist of non-bizarre delusions, with bizarre delusions being an exclusion.

However, in the DSM-5, this qualification has changed. The such criterion in DSM-IV that if a delusion was bizarre, the delusion alone would qualify it as Schizophrenia has been removed. At the same time, with the diagnosis of Delusional Disorder, there is now a specifier to include bizarre delusions, in the absence of fulfilling criterion A of Schizophrenia, that being 2 or more of the symptoms listed in Criterion A of Schizophrenia. So essentially, previously if only bizarre delusions were present, the DSM-IV would have categorised this as Schizophrenia in the former classifications, but the DSM-5 now currently classifies this as Delusional Disorder in the current classification.

So with regards to the proposal I am making, by removing the words 'non-bizarre' in the brackets of the originally mentioned sentence, or by adding the word 'bizarre', I believe that both Schizophrenia and Delusional Disorder will be more accurately described by this page in the differential diagnosis.

This essentially affects the subset of people who suffer only from bizarre delusions, without any other of the symptoms listed in Criterion A of Schizophrenia. This moves them from a diagnosis of Schizophrenia, to a more accurate diagnosis of Delusional Disorder as per the DSM-5.

As someone who is recovering from the DSM-5 classification of Delusional Disorder, I have found this distinction to be of the utmost importance to my diagnosis and treatment, especially as I have suffered from bizarre delusions, and the content of my delusions are represented by the most significant types of delusions in Delusional Disorder, that being Erotomania, Fear of Persecution, and Grandiosity [so I have had a mixed type of Delusional Disorder]. Without this distinction offered by DSM-5, my treatment and recovery could not have been as pinpoint as it has been, as although I suffer mostly from the features described in Delusional Disorder, I would have been previously diagnosed by the DSM-IV as having Schizophrenia, simply because I have suffered from some delusions that are bizarre during illness, at the absence of any other of the Criterion A symptoms of Schizophrenia. So I believe this distinction has ramifications of diagnosis for this particular class set of people with bizarre delusions at the absence of any of the other Criterion A symptoms of Schizophrenia.

Thanks, Dtar.

Dtar (talk) 15:26, 1 November 2015 (UTC)

I will take a look when I get home and have my DSM5 in front of me. Doc James (talk · contribs · email) 22:39, 1 November 2015 (UTC)