Talk:Schizophrenia/Archive 5

Possibly Helpful Observation

To get a highly relevant example of schizophrenia, watch the movie Donnie Darko. Donnie was diagnosed as an extreme case of schizophrenia. Also, another example of schizophrenia, watch the movie The Exorcism of Emily Rose. The scene where Emily is in her college at three in the morning, she has her friend come by and spend the night at her college. After the boy falls asleep, Emily goes into a strange, scary, and distorted position, and stays there, motionless.

I've read that apparently, the prevalence of smoking amongst schizophrenics is much higher than that of the general population (at least, in the United States.) The article mentions that the average lifespan of a schizophrenic tends to be about 10 - 12 years shorter than that of the general population, and talks about the higher suicide rate playing a role in that tendency. I would also consider the possibility that a higher rate of tobacco use might also be partly responsible for the discrepancy in lifespans. I suppose that one might also want to point out that the lifespan gap might be different in developing nations, where there isn't very much schizophrenia research going on. —Preceding unsigned comment added by 150.108.235.22 (talk) 23:33, 17 February 2008 (UTC)

Not sure where to put my comment, but this seems like a good place. I just wanted to point out that the antagonist in Psycho probably suffered from schizophrenia. —Preceding unsigned comment added by 71.242.250.160 (talk) 17:09, 8 October 2008 (UTC)

• RE:"Psycho probably suffered from schizophrenia" you do know Psycho is a fiction? No one suffered from anything.--Mark v1.0 (talk) 21:44, 13 November 2008 (UTC)

In The New Harvard Guide to Psychiatry, published in 1988, Seymour S. Kety, M.D., Professor Emeritus of Neuroscience in Psychiatry, and Steven Matthysse, Ph.D., Associate Professor of Psychobiology, both of Harvard Medical School, say "an impartial reading of the recent literature does not provide the hoped-for clarification of the catecholamine hypotheses, nor does compelling evidence emerge for other biological differences that may characterize the brains of patients with mental disease" (Harvard University Press, p. 148).

Belief in biological causes of so-called mental illness, including schizophrenia, comes not from science but from wishful thinking or from desire to avoid coming to terms with the experiential/environmental causes of people's misbehavior or distress. The repeated failure of efforts to find biological causes of theoretical schizophrenia suggests "schizophrenia" belongs only in the category of socially/culturally unacceptable thinking or behavior rather than in the category of biology or "disease" where many people place it.

In his book Schizophrenia Revealed - From Neurons to Social Interaction (W.W.Norton, New York, 2001), Michael Foster Green, Ph.D., a professor in the UCLA Department of Psychiatry and Behavioral Sciences, and chief of the treatment unit of the Department of Veterans Affairs Mental Illness Research, Education and Clinical Center, does his best to promote the idea that so-called schizophrenia is biological. He nevertheless makes the following admissions: "...we do not yet have an adequate understanding of schizophrenia... a specific brain abnormality in schizophrenia has remained elusive. ...schizophrenia cannot be diagnosed by a brain scan" (pages 4, 6, and 95).

URLs vs PMIDs

Some of the references are being linked to their article's webpage. The reason this is avoided is because these URLs are not fixed and can become quickly outdated, whereas the PMID is fixed, it will not change. Links to the journal article's URL can be updated centrally on PubMed but they would need to be individually checked and updated on each wikipedia page. I think a useful exception is where the full text is available online where we've been using the hyperlinked text 'full text' at the end of the reference. - Vaughan 12:57, 3 December 2007 (UTC)

OK, sounds a good thing to do for abstracts anyway. I wasn't aware that the websites changed that much.cheers, Casliber (talk · contribs) 16:00, 4 December 2007 (UTC)

Academic review of this page in Social Science and Medicine

Hi everyone,

Just noticed that the latest edition of the journal Social Science and Medicine has an article entitled 'Schizophrenia, drug companies and the internet' (PMID 17826878; full text here) that reviews the top 50 internet websites about schizophrenia and examines to what extent they espouse a bio-genetic or psycho-social viewpoint. It then examines how much drug company funding influences the viewpoint (interestingly "Drug company funded websites were significantly more likely to espouse bio-genetic rather than psycho-social causal explanations, to emphasise medication rather than psycho-social treatments, to portray ‘schizophrenia’ as a debilitating, devastating and long-term illness, and to link violence to coming off medication.")

Notably, our page is included in the review.

Two things emerge. The Wikipedia schizophrenia page was second in the search engine rankings overall at the time the paper was written (3rd on Google, 2nd on Yahoo). It now ranks top on Google and second on yahoo.com, so congratulations to all involved.

Secondly, the paper uses a self-created scale to score websites on how 'bio-genetic' or 'psycho-social' they are. Our Wikipedia page scores 6.7, which suggests a well-balanced view of the subject. It only gives the page a mark, and doesn't discuss it in detail (although specific sites are typically only discussed where they represent an extreme of the scoring), but something else to be proud of I think. - Vaughan (talk) 13:19, 29 December 2007 (UTC)

Very interesting paper overall, great read. Can be like walking a tightrope really...cheers, Casliber (talk · contribs) 13:54, 29 December 2007 (UTC)

This paper was written by a person who believes the best treatment for schizophrenia is not medication but psycho social. Very dangerous belief there! While it is good to watch the influence of any corporation on our health care there is no big pharma conspiracy that information on these websites is mainly influenced by the drug companies. Thank goodness for empirical evidence because it will at least prevent guys like this from going too far with his "beliefs" so less damage will be done. --Usuallysilent (talk) 06:05, 2 February 2008 (UTC)

• RE: "Very dangerous belief" you mean dangerous to a 20 billion dollars a year$20.7 billion in antipsychotic drug profits . Actions are potentially dangerous. Thoughts and ideas can not be. --Mark v1.0 (talk) 21:56, 13 November 2008 (UTC)
  • and damage to who and what? the seriously mentally ill die 25 years sooner than the average population Life_expectancy#Lower_life_expectancy_in_people_with_serious_mental_illness--Mark v1.0 (talk) 17:00, 14 November 2008 (UTC)

My two cents worth (this is my first time ever reading about schizophrenia, inspired by my symptoms of it).... Quality of life on medication is, in my experience, NOT worth the trade in longevity. Drugs have reduced some symptoms while creating a life not worthy of living. The withdrawal symptoms coming off the drugs was excruciating. My 'basic' symptoms would be so much easier to deal with if my friends and family were simply more accepting, but they push me to take medication. Drambuie 62 (talk) 14:00, 24 December 2008 (UTC)

Older overdiagnosis of schizophrenia by US and Russia - question from Hood Rap

Hi. I'm a newbie, so I apologize in advance if I'm posting in an incorrect manner. Feedback is welcome. Anyways, I read the section on Diagnostic Issues and Controversies, and I think it's missing some info. It seems that American psychiatrists have also been accused of diagnosing this disorder too freely. Failing to mention that fact makes this article politically biased. The book The Oxford Companion To The Mind, edited by Richard L. Gregory, Oxford University Press, 1987, states on page 698 that in the 1960s American and Russian psychiatrists used the term schizophrenia much more freely and loosely that their counterparts elsewhere. It goes on to say that, Russian and American psychiatrists were accused of labeling as schizophrenic people who were perfectly sane, but who were a nuisance to their families or the state. Hood rap (talk) 08:30, 31 December 2007 (UTC)

Hi Hood Rap, thanks for commenting. It was an important historical issue that Americans appeared to diagnose the syndrome more freely than the UK. However the article is huge and we had to do a severe bi of pruning. It has largely been addressed with succeeding classifications. Russia and politics is a whole different ball-game and belongs under political abuse. cheers, Casliber (talk · contribs) 11:28, 31 December 2007 (UTC)

Actually, it is mentioned: "The diagnostic description of schizophrenia has changed over time. It became clear after the 1971 US-UK Diagnostic Study that schizophrenia was diagnosed to a far greater extent in America than in Europe.... etc etc." - Vaughan (talk) 14:51, 1 January 2008 (UTC)

Ahaaa, right. Forgot about that. cheers, Casliber (talk · contribs) 19:06, 1 January 2008 (UTC)

Bifurcation

This article unfortunately discusses less common medical approaches in two sections "other", which is about medical approaches, and "alternative approaches", which largely describes other philosophies. I move that we combine "other therapies" and also combine "alternative understandings" At it is presently, the article can be somewhat confusing.--Alterrabe (talk) 19:37, 4 January 2008 (UTC)

The 'other' under treatments are less commonly used but still used in medical regimens if you like. Alternative approaches are from those which are outside the paradigm of traditional (medical) treatment for schizophrenia. cheers, Casliber (talk · contribs) 06:58, 8 January 2008 (UTC)

Ideally, treatment can be discussed more in depth on Treatment of schizophrenia, as the parent article is at or near the limit of feasible size.cheers, Casliber (talk · contribs) 07:39, 8 January 2008 (UTC)

You are mistaken. Orthomolecular treatments are also used as part of medical regimens by board-certified physicians. Rarely, and much more so outside of the United States. Are there any other reasons you oppose my suggestion?--Alterrabe (talk) 15:04, 8 January 2008 (UTC)

Off the top of my head I can guarantee that Orthomolecular treatments are not mentioned as an effective treatment in treatment guidelines put out by the RANZCP (College of Psychiatrists in Australia), and am pretty sure they are not in NICE or APA guidelines. It is late here and I was just about to sleep so haven't checked the latter two lately but am pretty familiar with them. I concede there are registered medical practitioners who use Orthomolecular treatments but it is certainly not in the mainstream and not used in any hospital I have worked at. I should add here that I am a psychiatrist.

Hence, rather than being removed from the article altogether, it is placed in an alternative approaches section. After I have had some sleep I may look on Cochrane tommorrow. cheers, Casliber (talk · contribs) 15:12, 8 January 2008 (UTC)

There is no disagreement that the APA and peers deny the effectiveness of orthomolecular treatments in psychiatry. The question is whether or not the allegations that it is uneffective are accurate. There is a fair deal of evidence that the APA's investigation of orthomolecular medicine was shoddy, superficial, and even biased. One of the 5 members of the panel that examined and then rejected the claims made by proponents of orthomolecular psychiatry later repudiated his work. Read the wiki article.--Alterrabe (talk) 13:17, 9 January 2008 (UTC)

Ok, 1 of the 5 is entitled to his opinion. The fact is that the consensus is what it is - i.e. not in guidelines and not practised in mainstream psychiatry as a rule. Given they are dietary it should be straightforward to have RCTs show effectiveness if it actually works, and if/when this happens, then maybe there'll be some recognition. cheers, Casliber (talk · contribs) 13:35, 9 January 2008 (UTC)

Another of the five, Mosher of Soteria fame, went into the panel reportedly saying that even if every other psychiatrist in the country would adopt vitamin treatments, he'd refuse to believe they worked. This doesn't sound like a good faith effort to get to the bottom of it. Incidentally, the Pfeiffer Treatment Center is getting extremely encouraging results. It is aesthetically problematic to have orthomolecular psychiatry right next to the theories of a scientist who torpedoed it. At the very least, the "other section" should be separated into "psycho-social" and "biochemical." 7 lines below 40 lines of confusing and woolly language on entirely different approaches doesn't do OMP justice.--Alterrabe (talk) 16:46, 9 January 2008 (UTC)

I am not aware of any positive controlled studies on mega-doses of vitamins (that is orthomolecular therapy) for psychiatric deceases. There have been negative studies on large doses of vitamin C for colds and E for cancer prevention. Linus Pauling should have kept to the chemistry and peace work; his dabbling in medicine was embarrassing. The alternative section is the right place for this 60-s stuff. Paul gene (talk) 02:18, 9 January 2008 (UTC)

Speak clearly

I find that this article largely talks in very advanced lingo that alot of people reading up on Schizophrenia would not understand. There needs to be more proper phrasing of terms and overall language so that more people can comprehend it.

Thanks, Alan 24.184.184.177 (talk) 05:02, 8 January 2008 (UTC)

Thanks for your input. many terms are bluelinked so clicking on them will lead to a definition and explanation. Can you let us know which you think need addressing/explaining? cheers, Casliber (talk · contribs) 06:56, 8 January 2008 (UTC)

Do you think a person really wants to have to go and read every related article just to partially understand what the author is saying? If they did that, they'd never reach the end of the article! This is user-friendly Wikipedia, not a psychiatric convention. If he/she wants to use complex terminology, explain it here on this article without dumbing it down so that we, the reader don't have to go browsing all over the place to comprehend what it's saying.

Alan 24.184.184.177 (talk) 13:56, 8 January 2008 (UTC)

OK Alan, it's a long article. Please tell me which words you feel folks will have trouble with and we'll see what we can do.cheers, Casliber (talk · contribs) 14:06, 8 January 2008 (UTC)

It's not one specific word or section, but largely the advanced diagnostic vocabulary used in the article. Those who are well-versed in the field of Psychiatric Medicine would have no problem following the myriad of terms and descriptions, and I can follow some, but the average reader who might be turning to Wikipedia for a better understanding of the disorder will be completely lost in no time at all. It might be as simple as revising the links to the various related article so that they still link to those articles, but the text of this article is more user-friendly. Otherwise, it is a very nice article, but with all the advanced terms and conditions and the like, alot of people would have a very difficult time reading this article. The same way not every person who reads a Wikipedia article on say, SPDR is somehow directly involved with Wall Street, not every person who reads this article is certified Psychiatrist or studying to become one.

-Alan 24.184.184.177 (talk) 18:04, 8 January 2008 (UTC)

just to put in some input.. i think that Alan is correct with what he is saying. i am simply doing an anatomy project on schizophrenia and the article seemed to have alot of information;; although alot of it i could not understand. —Preceding unsigned comment added by 69.142.105.235 (talk) 21:20, 2 April 2008 (UTC)

I went through the intro paragraphs and simplified some terminology; the rest of the article could use the same thing. -- Beland (talk) 16:55, 3 October 2008 (UTC)

Laboratory Tests for Schizophrenia, etc.

First, greetings are in order. I'm a new user, and I'm already a great admirer of the work that's gone into compiling this trove of schizophrenia-specific information. But, in an attempt to keep the article as up-to-date as possible, and to also spur a commitment to inclusion of current research, I'd like to recommend an addition, which can be found at PMID: 17904833. This article, I believe, might serve as a jumping-off-point with regard to our leaps in testing progress relative to schizophrenia. Of course, there's still the issue of heritability, as mentioned in Smesny's research. Also, the prenatal viral implications as a precursor to developing schizophrenia are more significant than the article lets on. The wealth of research concerning this aspect of schizophrenia acts as a sharp contrast to the article's demonstration of, sadly, only two citations. I'm in the process of submitting a research paper as part of my physiological psychology class here at Portland State University, and while I'm not a practicing psychiatrist, my research leads me to conclude that while the article you've all presupposed might edge toward lengthy, fullness is still an admirable pursuit. Jason M. White (talk) 07:53, 28 January 2008 (UTC)

Hi Jason, Thanks for the link to the paper, it's an interesting study. However, it isn't a lab test for schizophrenia. There are many studies which have found biological differences in people with schizophrenia that have been cited as possible diagnostic tests, none of which have come to fruition (e.g. PMID 15050866; PMID 17894392; PMID 11149951). The critical analysis is to calculate the sensitivity, specificity, positive and negative predictive value. In other words, while these studies typically show that those with a diagnosis of schizophrenia have the biological marker, they rarely look for the prevalence of the marker in the population in those that don't have the diagnosis. This is where they fall down, as it turns out that so far, biological differences tend to be reliable, on average, when comparing groups, but not when comparing individuals. This is almost certainly because the 'gold standard' diagnostic criteria for the disorder are based on relatively vaguely defined signs and symptoms and the fact that the diagnosis cannot be made with 100% agreement between clinicians. - Vaughan (talk) 08:24, 28 January 2008 (UTC)

The link between schizophrenia and early infection is explored in more (if still inadequate) detail at the Causes of schizophrenia article. This article is already approaching the point where WP:SIZE would suggest it must be divided up, and it doesn't even have an Associated features section - which, IMO, deserves space here far more than the viral association, since it could find its place in no other article... AnotherSolipsist (talk) 00:10, 31 January 2008 (UTC)

Alternative Views

The alternative views section is the lengthiest section of this article on schizophrenia. This gives the impression that this is the most important or valued information in the article. These are historical views and not held by the majority today and some have been unfounded. The further reading section is also very biased toward the alternative views. When I read the bipolar or depression articles this is not the case. Even in the HIV article that includes the anti-HIV existence views, it is just a simple stated paragragh. I feel that the causes of schizophrenia should be included in the article and not a separate one and that the antipsychiatry views belong in it's own category. I cannot edit this article...why is that? Thank you --Usuallysilent (talk) 06:04, 2 February 2008 (UTC)

clinical studies info could benefit this article

Countless studies have been done on families of people with schizophrenia. Parents and siblings who are not accepting members within the family with schizophrenia have shown to have a greater negative effect on the illness than the person going off medications entirely have.—Preceding unsigned comment added by Tkweitzel (talk • contribs) 17:20, 12 February 2008 (UTC)

I would like to voice my support for a medical professional to find some sort of clinical study or perform some sort of clinical study which examines the above statement. Myself, I would like a medical professional to examine the possible connection between caffeine consumption in childhood (particularly in the form of coffee and tea) and an imbalance in dopamine levels related to Schizophrenia. I'm speaking from my own experiences with excess coffee consumption as a child and my experiences with Schizophrenia.

Incorrect redirection from "split personality"

According to the article: "Despite its etymology, schizophrenia is not synonymous with dissociative identity disorder, previously known as multiple personality disorder or split personality; in popular culture the two are often confused." Therefore, "split personality" (which is what I was looking for) should redirect to "dissociative identity disorder", not here. Myrvin (talk) 19:23, 13 February 2008 (UTC)

Now fixed - Vaughan (talk) 13:14, 14 February 2008 (UTC)

Alternative approaches and alternative treatments

I don't think that it is sound to lump people who denied the existence of schizophrenia with those who believe its biochemical basis have been elucidated. Parts of the "alternative approaches" pertain to philosophies, parts pertain to treatments. At the very least, I believe a subsection should be inserted.--Alterrabe (talk) 17:36, 18 February 2008 (UTC)

 Done Xasodfuih (talk) 09:56, 1 February 2009 (UTC)

Question neutrality

I would question the neutrality of this article simply on the point that it is highly unlikely that there is any specific condition, illness, or disease, whether biological, psychological or of any kind called "schizophrenia". On present terms there is no way of disproving the existence of "schizophrenia" hence it is not a scientific concept, as according to Karl Popper. I recognise that it is acknowledged in the present article that some parties question the existence of "schizophrenia", however I don't think that is going far enough. I don't understand why some entries - e.g. the entry on Irish Republicanism - have special prominent notices at the start advertising that the neutrality of the article is questioned whereas that is not the case for this article and other articles pertaining to so-called "mental illnesses".It should surely be so with this article, given what is said in the entry itself - namely that some parties question the very existence of schizophrenia. Until the fundamental point is engaged with - we question whether this "illness" exists in any way - then progress is hard. —Preceding unsigned comment added by Nickyfann (talk • Nickyfann (talk) 15:46, 24 February 2009 (UTC)contribs) 20:46, 18 February 2008 (UTC)

The fact that some people question the very existence of this disease is already covered in the article. However, that is a very small minority of people, so what you're proposing is WP:UNDUE. Wikipedia is not meant to do original research and determine whether it is likely or not that schizophrenia really exists; rather, Wikipedia is meant to neutrally describe the current state of knowledge and opinion on any given matter. And that is exactly what the article does at present. The reason why there's no need to put that tag on the page is that it has been established many times in the past here on this talkpage that there are no indications at present that this article violates WP:NPOV. Also, as a final notice, can you please put new responses in the bottom of the section, rather than in the middle? Thanks. -Lilac Soul ^{(talk • contribs • count)} 06:48, 25 February 2009 (UTC)

The neutrality of an article should only be questioned if it doesn't reflect the differentviewpoints about the subject, in a manner in which the most popular viewpoint is awarded most mention, etc. This certainly seems to be the case with this article. Doubting schizophrenia's existence is not a common viewpoint, and so this article shouldn't come across like it was. Doubting that schizophrenia is a uniform disease is beginning to be a widespread viewpoint, but I think the article already reflects this. Lilac Soul ^{(talk • contribs • count)} 21:57, 18 February 2008 (UTC)

I think that the section that you want is already here Schizophrenia#Diagnostic_issues_and_controversies. As for why there is a tag on some articles, but not others, any editor can add such a tag to an article, but must back up that tag with reasoned explanations of why they believe the article is not neutral. In this case, given that the majority of mental health professionals accept schizophrenia as a useful diagnosis, even if they believe that more work needs to be done, the current article reflects the view of the relevant experts. Remember, here on wikipedia, we only present the facts and opinions of the relevant experts; we don't make new decisions about these facts and opinions ourselves, and we do not comment on those, except as to report when other people have done so. Edhubbard (talk) 22:11, 18 February 2008 (UTC) Thanks very much for your comments. I still think the contention that there is an illness called schizophrenia is highly controversial, since, unlike with most (physical) illnesses its existence is disputed by many people, experts and non-experts. —Preceding unsigned comment added by 81.152.241.145 (talk) 21:01, 19 February 2008 (UTC)

I have to agree, my limited research into information available suggests that this label is applied to symptoms that are not diagnosed to find a cause, as in drugs or disease.

The falability of testing for many organic infections suggests that this "falibility" is the source of this label.

Very similar to the history of ulcers and now Crohns diseases. The invovlement of an infection was sometimes suggested, (highly criticized0 but then confirmed.

The old story of The King with the Golden Cape

--Caesar J.B. Squitti: Son of Maryann Rosso and Arthur Natale Squitti (talk) 17:10, 18 February 2009 (UTC)

Yes, the diagnosis of schizophrenia is based on a variety of symptoms, rather than, say, a blood sample. However, as a person working in the world of psychiatry, I have to assert that when you have a group of people with the illness schizophrenia, there are several symptoms that these have in common. Schizophrenia is already divided into subtypes, reflecting that it isn't a uniform disease, and there is certainly discussions on whether there should be more subtypes. But saying that schizophrenia does not exist is, in the best of my professional opinion, purely antipsychiatric ignorance. There is a small minority questioning schizophrenia's existence altogether, and this is already reflected in the article. But the article should, and does, reflect the current state of knowledge and professional opinion on this matter. So can we please stop this sort of general discussion and move on to specific issues, backed up with reliable sources that properly balances the issue? -Lilac Soul ^{(talk • contribs • count)} 17:51, 18 February 2009 (UTC)

To the best of my knowledge the challenges facing the current diagnostic criteria are adequately described from the best available sources in the Controversies and research directions section, which I've updated fairly recently. The issue you have raised is actually mentioned in the opening sentence of that section. If you have some more specific suggestion, let us know. Xasodfuih (talk) 21:44, 18 February 2009 (UTC)

Maybe

This is a well written article, but it would be nice if someone added the disease that follow schizophrenia. Such as schizoaffective disorder in which schizophrenic symptoms are mixed with severe mania or depression. Schizophreniform disorder in which a person experiences schizophrenic symptoms for more than one month but fewer than six months. Schizotypal personality disorder a person engages in odd thinking, speech, and behavior, but usually does not lose contact with reality

This is just a thought, but they do fall under the category. 71.142.214.138 (talk) 04:03, 19 February 2008 (UTC)Cardinal Raven

All these have their own pages and are linked on this page. I've bluelinked so you can see cheers, Casliber (talk · contribs) 04:30, 19 February 2008 (UTC)

Well you know when you have that box that says: See also. You need one of those. Personally those should be accessed through this page since they fall under the category.71.142.214.138 (talk) 06:33, 19 February 2008 (UTC)Cardinal Raven

I have added those three articles to a new "see also" section. Thank you for the suggestion. Lilac Soul ^{(talk • contribs • count)} 07:42, 19 February 2008 (UTC)

why not just type it as a 'search' item in the 'search' box?cheers, Casliber (talk · contribs) 07:43, 19 February 2008 (UTC)

Well lets say I'm a person who doesn't know about those mental disorders.I can't use the search box for it because I don't know about those three diseases. Isn't the point to give people the most information you can. Well why don't you give them the most abundant source of information. I'm talking on the behalf of those people who want to learn about these things. I may know what they are and I can search for them in a search box. But what about the others.71.142.214.138 (talk) 00:16, 24 February 2008 (UTC)Cardinal Raven

Alternative treatments sections

Hi there,

I keep removed the 'medical' qualifier from the 'alternative treatments' header because it is unnecessary. Saying something is a 'medical treatment' as opposed to a 'treatment' means nothing. If you are taking it to mean 'is accepted by mainstream medicine' (surely the most sensible definition) then none of the things in the section qualify. If you mean that it is delivered by physicians, then Soteria certainly doesn't, because the whole point is that it is staffed largely by lay people. However, simply having a physician deliver the treatment doesn't make it 'medical', as there are plenty of 'medical treatments' delivered by non-physicians, and many cases of complete quackery delivered by qualified doctors. Both option seem to suggest removing the description. Actually, I think this whole section heading is a bit OTT for such a minor part.

Also, we could do with replacing many of the scrappy Soteria refs with the recent systematic review published in Schizophrenia Bulletin (PMID 17573357).

- Vaughan (talk) 18:34, 22 February 2008 (UTC)

Well lets replace the reviews with those from the Schizophrenia Bulletin, provided it doesn't change the data we are offering our readers.

I disagree emphatically with your notion that notion that the medical pointer is unnecessary. Psychiatry is rife with allegations of corruption and shoddy research; the fact that doctors put their reputation on the line, and find willing and paying customers is informative. Quackery sometimes is in the eye of the beholder. While Soteria does largely involve lay people, it is highly noteworthy that European countries with high GDPs do allow physiciansto manage such treatment approaches, and even pay for them. Let the readers decide if it is quackery. That such endeavors are deemed to require a physician's oversight underlines the seriousness with which such approaches are pursued.

Orthomolecular psychiatry is another controversial discipline, but the point is that it claims to have its origins in biochemistry and scientific research and expert opinions delivered by experts with crass conflicts of interest. Wikipedia is not about promulgating the one "right" viewpoint, but all notable ones.

By not including the term "medical", one would lump these approaches, that do have a growing minority of physicians behind them in which such therapies as spirit-healing, exorcism(s) ::and whatever else. This would portray these treatments, offered in industrialized countries by licensed physicians, in a false light. Wiki users should have a right to know of these controversies.--Alterrabe (talk) 21:42, 22 February 2008 (UTC)

Hi Alterabe, encyclopedia articles are not intended to present all the possible evidence and let the readers decide on their importance. Quite the opposite, they are intended to reflect the general scientific opinion on the matter. In my opinion, with the info about Soteria should probably into the 'psychological and social treatments' section as it's now been subject to several RCTs and a systematic review. 'Orthomolecular' treatments are rarely given by physicians however, and are mostly the domain of alternative therapists. They make barely a scratch in the scientific literature and are of unproven efficacy. Wiki users do not have the 'right to know' (whatever that means) that every minor quasi-medical treatment gets significant coverage in key Wikipedia articles. - Vaughan (talk) 11:45, 23 February 2008 (UTC)

Vaughan, you seem unaware of wikipedia policy. Allow me to quote WP:NPOV Neutral point of view

"The neutral point of view is a means of dealing with conflicting verifiable perspectives on a topic as evidenced by reliable sources. The policy requires that where multiple or conflicting perspectives exist within a topic each should be presented fairly. None of the views should be given undue weight or asserted as being judged as "the truth", in order that the various significant published viewpoints are made accessible to the reader, not just the most popular one. It should also not be asserted that the most popular view, or some sort of intermediate view among the different views, is the correct one to the extent that other views are mentioned only pejoratively. Readers should be allowed to form their own opinions.

As the name suggests, the neutral point of view is a point of view, not the absence or elimination of viewpoints. The neutral point of view policy is often misunderstood. The acronym NPOV does not mean "no points of view". The elimination of article content cannot be justified under this policy by simply labeling it "POV". The neutral point of view is a point of view that is neutral, that is neither sympathetic nor in opposition to its subject: it neither endorses nor discourages viewpoints. Debates within topics are described, represented and characterized, writing sympathetically about each side; but they are not engaged in. Background is provided on who believes what and why, and which view is more popular. Detailed articles might also contain the mutual evaluations of each viewpoint, but studiously refrain from asserting which is better. One can think of unbiased writing as the fair, analytical description of all relevant sides of a debate, including the mutual perspectives and the published evidence. When editorial bias toward one particular point of view can be detected, the article needs to be fixed. [1]

NPOV requires views to be represented without bias. All editors and all sources have biases - what matters is how we combine them to create a neutral article."

We'll either have to get wikipedia to change its guidelines, or else abide by them as they now stand.--Alterrabe (talk) 09:12, 24 February 2008 (UTC)

NPOV is a policy for dealing with multiple views "as evidenced by reliable sources" (I noticed you failed to highlight this bit - see Wikipedia:Verifiability). If you want to demonstrate that 'orthmolecular' treatments are worthy of significant inclusion, simply reference the experimental studies, randomized controlled trials and systematic reviews that have demonstrated their effectiveness here, and we'll be happy to include a section proportionate to their impact on the field (which sounds perfectly fair, no?). As it happens, that seems to be exactly the situation at the moment. i.e. we mention it as a side-line to the majority of work in the field. If you wish to tackle this topic in more detail (which I have no problem with) I suggest you start a new article.

Furthermore, you are sidelining the actual issue. You are including section headings to deliberately promote and describe alternative treatments as medical when they are not recommended by any medical authorities and unsupported by conclusive evidence (with the exception of Soteria, which should be moved). If you want to make the case for this, it's simple, provide references, not headings - Vaughan (talk) 09:52, 24 February 2008 (UTC)

I'll gladly highlight the RS passages for you. (I hesitate to do it in the above, because it could confuse readers, besides my point was to emphasize WP' inclusiveness.) I'm glad that we agree that there is conclusive evidence for Soteria. Lets move it. If you take the time to look into the controversy about orthomolecular psychiatry, you'll find that the more you look, the dismissal of OMP is controverial. This per WP:RS, as is to be found at OMP on wikipedia. I don't want to comment on OM's effectiveness, (that would be WP:OR) but rather on the existence of a controversy. Yes, my edits to this article are deliberate. Orthomolecular medicine is one of those "he said, she said" stories. One party happens to be the "medical authorities," the other side erstwhile "medical authorities" who claim to have been wronged. As these erstwhile "medical authorities" deal in "medical" thought that has been relegated to the field of "alternative" medicine, they are associated with alternative medical treatments.--Alterrabe (talk) 14:58, 24 February 2008 (UTC)

As I said before, it's also about practice, they are not used in mainstream psychiatry to treat schizophrenia. It can be expanded in a larger subarticle, which is why I created a Treatment of schizophrenia page. Casliber (talk · contribs) 20:05, 24 February 2008 (UTC) —Preceding unsigned comment added by Casliber (talk • contribs)

I agree that practice is also important. Whether or not orthomolecular psychiatry is a legitimate collection of therapies, it's illegal to provide them in many parts of many English-speaking countries, which means that the usual market forces of patients being able to choose their therapy cannot play. Which is all the more reason to let patients known of their existence, and not sequester it yet again.--Alterrabe (talk) 21:09, 24 February 2008 (UTC)

No-one is sequestering it. It is not practised in the mainstream treatment of schizophrenia. It gains a mention but is impossible to expand in this article due to (a) article size and (b) undue weight. It can be elaborated on the subpage. Casliber (talk · contribs) 22:54, 24 February 2008 (UTC) —Preceding unsigned comment added by Casliber (talk • contribs)

Nutriton section

Gnif global, if you want to discuss the scientific evidence do so here rather than posting messages like the one below on my personal talk page:

A review with over a 100 articles cited constitutes a section. Research and clinical trials published in peer-reviewed journals cannot be refuted by you and represent the Wikipedia opinion if you do not agree with them. Revert the article back or someone will. Gnif global (talk) 19:28, 22 February 2008 (UTC)

If you want to make major changes to the article, discuss them here so we can reach a consensus. Just because something has been published in a peer-reviewed journal, it does not mean it automatically deserve equal space to everything else. There are over 78,000 articles on schizophrenia, many of which will have cited over 100 studies. A review article is an opinion piece drawing on published evidence, and the one you cited isn't even a systematic review. - Vaughan (talk) 19:59, 22 February 2008 (UTC)

There are some COI issues to be worked out here, as well as questions about the journal. Lots of links, follow from Gwernol's talk page. I think the content should be removed until this is better sorted out with the highest quality secondary sources, particularly because of the COI issues. SandyGeorgia (Talk) 20:27, 22 February 2008 (UTC)

I'm not taking a stance on who's right and who's wrong here, but this is beginning to look like an edit war. Perhaps you both should read this and take a deep breath before continuing? Note that I am not pointing fingers or anything. -Lilac Soul ^{(talk • contribs • count) • I'm watching this page so just reply to me right here!} 23:06, 22 February 2008 (UTC)

Perhaps you should read WP:COI, and review the contribs of Gnif global (talk · contribs) as well as the deletions GNIF has made on his talk page,[1] where I already advised him about COI editing and that he should propose his changes on talk until others could review. SandyGeorgia (Talk) 23:15, 22 February 2008 (UTC)

Lilac Soul, thanks for chiming in here. First, SandyGeorgia unfortunately claimed the article was self-published. Wrong. Next, she claimed it was not peer-reviewed. Wrong. Then, she claimed it was not scientific enough. Wrong (it covers the best of the medical literature using double-blind randomized controlled clinical trials). Thus, what is left for us to believe is that perhaps there is disagreement on the content -- nutritional therapeutic options for schizophrenia (and other mental health disorders). If thats the case, present all sides of this in the article (based on reliable sources). Do not withhold the data merely due to bias. Gnif global (talk) 11:28, 23 February 2008 (UTC)

Hi Gnif,

I don't see Sandy claiming any of the those things and the disagreement is not over the content. You may notice the article already has some referenced sources on nutritional therapeutics for schizophrenia. The debate is over whether a single peer-reviewed review article is substantial enough to warrant a whole section to itself. This is obviously not the case. - Vaughan (talk) 11:37, 23 February 2008 (UTC)

Vaughan, there is recent, relevant, and quality research in this field to warrant a section. If you disagree and still think a "Nutrition" section is unwarranted, then why not incorporate the articles in another section? Actually, for this reason, I think the issue of nutrition and schizophrenia (and other mental disorders) deserves its own Wiki entry.

Concerning Sandy's claims on the nutrition article, look at her contributions and search for the edit comments for "remove self-published, non-peer reviewed." Abundantly clear mistakes. Gnif global (talk) 11:56, 23 February 2008 (UTC)

For accuracy sake, here is what has been said about that journal (copying from Gwernol's talk page):

From the Nutrition Journal website: Nutrition Journal is an open access, peer-reviewed, online journal that considers manuscripts within the field of human nutrition. Gnif global (talk) 17:11, 22 February 2008 (UTC)

NJ asserts that it is a peer-reviewed journal, but you couldn't necessarily tell that from the end results. It's a relatively new journal, so it's hard to gauge its actual impact with accuracy. My impression is that NJ makes some mistakes (don't we all?), but it's not all bad. It's definitely not top-tier, but not embarrassingly low. There's no scientific organization behind it; it's just a publishing house trying to turn a buck. However, since it makes its articles freely available online, individual articles are likely to get a lot more attention than its reputation suggests. It may attract more than its fair share of "press release science." WhatamIdoing (talk) 17:41, 22 February 2008 (UTC)

The fact that something is in PubMed doesn't mean it must be included here, and not everything in PubMed is of the same quality. See WP:UNDUE, WP:MEDMOS and WP:MEDRS. I'm also concerned about the WP:COI and have made that clear to GNIF on his talk page. The particular article's byline is GNIF, so there's a COI issue here with GNIF adding it all over Wiki. If that content is to be included, it should be based on the best secondary reliable source reviews. Unless reliable secondary source reviews mention it, it's probably WP:UNDUE. And the "self-published" is your blog, which you were also adding. SandyGeorgia (Talk) 21:43, 23 February 2008 (UTC)

(In response to request for input at WT:MED): It's way too much weight to give a single review article in a low-impact journal. Even review articles in the major journals generally don't get their own subsection on a topic like schizophrenia, where there are so many peer-reviewed publications available. The most you could do with this is add a sentence or two under "Alternative treatments" to the effect that "Some researchers suggest that dietary and nutritional treatments may hold promise in the treatment of schizophrenia.^{[Cite review article here]}" MastCell ^Talk 00:45, 24 February 2008 (UTC)

Well, the suggestion by MastCell has been added. However, it must be noted that there are MANY studies published in "high-impact" journals on the subject. Just look in the references section of the article cited -- it shows over 100 citations, many in established and prestigious journals. Gnif global (talk) 15:56, 29 February 2008 (UTC)

Citation needed in the lead

I really stopped by to ask when that cite tag in the lead is going to be dealt with; it's been there for several months. Can that text be deleted or cited? SandyGeorgia (Talk) 21:43, 23 February 2008 (UTC)

Hi Sandy, done. - Vaughan (talk) 09:59, 24 February 2008 (UTC)

Antipsychotics additions and removal

Hi Miclick, I've removed your addition on antipsychotics (as I note has Casliber) as this concerns antipsychotics in general (which can be used in a wide range of conditions), not the treatment of schizophrenia specifically. One study is on monkeys (who certainly don't have schizophrenia) and the other is on a group of patients of which not a single one was diagnosed with schizophrenia, and, in fact, all of whom were diagnosed with other disorders (Alzheimer's disease and other neurological syndromes). Furthermore, we already have a reference to a human study that shows antipsychotic treatment is linked to changes in brain structure specifically in people with schizophrenia (see PMID 15062627). - Vaughan (talk) 09:02, 18 March 2008 (UTC)

Those studies are the best information we have of the effects of neuroleptics on glia and neurons in people labeled with schizophrenia. They are allowed by Wikipedia:Verifiability#Reliable_sources.

I have filed a request for comment on Vaughan. It requires one more endorsement within 48 hours. --Miclick (talk) 21:47, 19 March 2008 (UTC)

I am not disputing the verifiability of the sources, I am disputing their relevance to this specific page. None of the studies you've referenced are on people labelled with schizophrenia, which hardly supports your statement. - Vaughan (talk) 22:54, 19 March 2008 (UTC)

Miclick - it's about having undue weight. Cheers, Casliber (talk · contribs) 23:07, 19 March 2008 (UTC)

Just noticed recent editing issues here; re-watchlisting. SandyGeorgia (Talk) 16:06, 22 March 2008 (UTC)

This change about the desirability of non-drug treatments didn't seem right: the change didn't characterize its source accurately, as the source was a primary study, not a review, and its main point was about factors involved. Here are two sample quotes from that study (Harrow & Jobe 2007, PMID 17502806):

"An important issue is which types of patients with schizophrenia, when studied on a longitudinal basis, are most likely to function adequately without antipsychotic medications."

"Looked at from a different viewpoint, the data suggest that schizophrenia patients with good prognostic features, with better premorbid developmental achievements and with more favorable personality characteristics are the subgroup more likely to stay off antipsychotics for a prolonged period."

Also, the study in question was not about Soteria, so it's not clear what that discussion would be doing in the Soteria paragraph. Furthermore, the study was already summarized (more accurately) in Schizophrenia#Medication. It's just one primary study, and although recent and high-quality it is doubtful that it deserves so much weight; surely there are reliable reviews on this topic. Anyway, for now I undid the change. Eubulides (talk) 19:54, 22 March 2008 (UTC)

The word "schizophrenia" is improperly capitalized in this sentence in the section called "Positive and negative symptoms": "Despite the appearance of blunted affect, recent studies indicate that there is often a normal or even heightened level of emotionality in Schizophrenia especially in response to stressful or negative events." I would have fixed it myself but the page is locked on a claim that it's vandalized too much. A quick review of the history page showed it hasn't been vandalized more than other pages, and the claim that the page is too long to monitor is nonsense. If you go to the history page and click on the "diff" link next to the most recent revision, it shows you in red type what the change was. —Preceding unsigned comment added by 76.124.60.120 (talk) 03:36, 28 March 2008 (UTC)

link to parkinson symptoms..

when the "dopamine antagonists" are given, i understand they could cause parkinsonian symptoms due to decrease dopamine...

I also believe the link between cannabis and schitzophrrenia should be mentioned more as well. cannabis causes a 6 fold increase in getting the disease, again linked to the increased levels of dopamine... —Preceding unsigned comment added by 92.12.76.163 (talk) 16:05, 25 March 2008 (UTC)

What's your source? And please don't tell me it's a newspaper article. —Preceding unsigned comment added by 149.135.121.157 (talk) 13:30, 10 May 2008 (UTC)

It was from a lecture on mental illness, i will try and find the references that she used —Preceding unsigned comment added by 159.92.101.55 (talk) 11:26, 23 January 2009 (UTC)

The excess risk is not sixfold. I have updated the article with a meta-analysis from The Lancet showing a pooled odds ratio og 1.4 to 2.1, depending on dose. The odd study finding very high increased risks probably does exist, but a pooled analysis of several studies is generally more reliable. -Lilac Soul ^{(talk • contribs • count)} 18:13, 23 January 2009 (UTC)

Substance use as alleviation of medication side-effects

Hi Djayjp, the cited Gregg et al. paper (PMID 17240501) does indeed support the statement that one reason patients use drugs is to overcome medication side-effects. See section 5.2.1 of the review on self-report studies, and Table 1 for the prevalence for this motivation found in previous studies. To quote the conclusion of the paper "The self report studies do show that some people with schizophrenia report using substances in an attempt to alleviate specific psychopathological symptoms or medication side effects but there has been little research to show whether substances are selected differentially." - Vaughan (talk) 21:29, 20 April 2008 (UTC)

Additional Cultural References

I think it might be nice if the cultural references section included more examples of references to schizophrenia. In particular, I'm thinking of the book The Center Cannot Hold by Elyn Saks, a law and psychiatry professor with numerous other academic credentials. The book describes in detail her struggle with paranoid schizophrenia, and I think it's a very useful way of getting some insight into what it's like to have schizophrenia.

This paragraph is incomplete without a reference to the beautiful Hindi film '15 Park Avenue' featuring the talented actress Konkana Sen. The film gives a true understanding of Schizophrenia

Vakulgupta (talk) 05:28, 2 July 2008 (UTC)

Additions with references

Hi Jv821, just a note to say that if you add bits to the article, can you reference them with the original research, not secondary sources. It just means someone's got to verify the information and track down the original research. Thanks! - Vaughan (talk) 08:52, 16 June 2008 (UTC)

Prognosis

Hello. Has anyone _read_ the article on 1/3 rate for full recovery? Afaik, "full recovery" er doesn't mean 'full recovery' as in return to premorbid functioning. Am i wrong?? —Preceding unsigned comment added by 86.136.28.193 (talk) 00:05, 20 June 2008 (UTC)

The existing sentence in Prognosis doesn't accurately summarise its source (the landmark Vermont Longitudinal Study) which reports "For one-half to two-thirds of these subjects who retrospectively met the DSM-III criteria for schizophrenia, long-term outcome was neither downward nor marginal but an evolution into various degrees of productivity, social involvement, wellness, and competent functioning. ...The more stringent DSM-III diagnosistic criteria for schizophrenia failed to produce the expected uniformly poor outcome. ...68% of the 82 subjects who met the DSM-III criteria for schizophrenia at index hospitalization did not display any further signs or symptoms (either positive or negative) of schizophrenia at follow-up. Forty-five percent of the sample displayed no psychiatric symptoms at all."

But in any case I think this recent review article of the (N. American at least) long-term outcome studies is probably a better source - even though personally I think its phrasing is a bit negative in highlighting a comparison to other psychotic disorders and presuming to call the findings of sustained recovery "intervals". As a sidenote, return to premorbid functioning isn't the usual definition used in the research or by those in recovery in the real world. 16:33, 20 June 2008 (UTC)

Ok but i'm not sure that that's clear - that schizophrenic patients just don't return to normal as in how they were.

I have no interest in phrasing that negatively, but it doesn't seem at all clear.

Thanks —Preceding unsigned comment added by 86.136.28.193 (talk) 02:52, 21 June 2008 (UTC)

I'm agreeing that it's not clear...and I think this vital issue merits more coverage. There is a review source in there on the definitions used (PMID 16461575), as well as an article on proposed standardization (PMID 16423159). These could be summarised more clearly and there's also other recent review articles on the subject (Recovery from Schizophrenia: A concept in search of research (2005) and Remission and Recovery in Schizophrenia: Practitioner and Patient Perspectives (2008) PMID 17984297)

I know you've only made a brief comment but I think it's such an important issue I'd like to just make a comment at greater length... such a generalization about all "schizophrenia patients" seems to disagree with the review of the US Surgeon General) that (italics mine): "Most do not return to their prior state of mental function. Yet several long-term studies reveal that about one-half to two-thirds of people with schizophrenia significantly improve or recover, some completely", and with this clinical overview by a senior psychiatrist at a leading European clinic group: "After an active episode of schizophrenia there may be a complete return to normal function and no further episode may happen." (consistent with findings of neurocognitive deficits recovering to normal levels after acute episodes PMID 16116942). And as the above reviews point out, recovery may be underestimated because of a "clinician's illusion" from only seeing returning patients (or linked research samples) and not those individuals who go completely out of touch with the system, and may be compounded by discounting anyone who recovers as not having had the "real" disorder - an attitude the Vermont article notes was behind the previous medical consensus of universal deterioration over time. There's also an aspect to this that people who go on to develop schizophrenia may not have been conventionally "normal" anyway (by which I don't just mean prodromal) so getting back to normal for them may not be what you deem normal but doesn't mean they're ill (after all family members often display the same traits). And in the real world even if you've recovered in yourself you may still be pushed down by continued social and economic discrimination and lost life experienecs and the difficulty of recovering confidence and trust after being institutionalized and excluded and equated to a dangerous illness etc, or just having gone through traumatic mental experiences, and there may be physical or cognitive impairments due to past treatments or lifestyle etc etc.

Anyway I'm only raising some uncertainties here, clearly the section needs to be a balanced overview of the range of outcomes found and what is meant by recovery as you say. EverSince (talk) 13:25, 21 June 2008 (UTC)

hi again. "one-half to two-thirds of people with schizophrenia significantly improve or recover, some completely". yes of course 'recovery' should be defined. i came across an article just recently that put the rate of cognitive deficits at 99%: that's nothing like 1/3. but i was unable to read the article and can't easily find it now. —Preceding unsigned comment added by 86.134.75.253 (talk) 13:49, 24 June 2008 (UTC)

Well I've had a go at covering this more, I know there's space constraints.... EverSince (talk) 11:15, 6 July 2008 (UTC)

I don't know if there'll be room in history to mention this, but wanted to note this same debate happening over a hundred years ago, in regard to the then-new concept of dementia praecox (later schizophrenia) and one of the diagnoses it replaced, "adolescent insanity":[2]

"I quite agree with Clouston in that it is unscientific and somewhat stultifying to label a case as suffering from dementia, and then to have to record a recovery, as is often undoubtedly the case..." .... "Personally I think these figures depend a good deal on what one considers constitutes a recovery as in most cases a mental scar is present when the patient has got over an acute attack of insanity. The patient may never be his old self again after such an attack, yet if he is considered to be in a fit state to follow his previous occupation and to earn his living without being a nuisance to his fellows, I think we are justified in saying he has recovered. EverSince (talk) 09:47, 13 July 2008 (UTC)

p.s. have formatted the heading the original commentator was apparently giving this section EverSince (talk) 09:47, 13 July 2008 (UTC)

Cleanup

Since this article is featured, please try to keep citation formatting consistent, to conform to 2c of WP:WIAFA. Diberri's PMID template filler can be used to generate a cite journal template from a PMID. Further information about using PubMed is at Wikipedia:Wikipedia Signpost/2008-06-30/Dispatches. Last accessdates are not required for PMIDs; if there is no URL, a last access date isn't needed. Please see WP:DASH: emdashes are not spaced. There's a lot of new text here, which I haven't reviewed yet, but I'm surprised at the number of new PMIDs. Is this selective use of primary sources, or does the new text rely on high-quality secondary reviews? (See Dispatch link above.) SandyGeorgia (Talk) 02:04, 8 July 2008 (UTC)

Free full text DSM-IV on Schizophrenia and Other Psychotic Disorders

<Discussion moved to Wikipedia_talk:Copyrights/Archive_11#Website_hosting_free_full_text_of_APA_DSM-IV.> SandyGeorgia (Talk) 00:16, 9 July 2008 (UTC)

What is Schizophrenia.

I've been studying Schizophrenia for many years and am dismayed at how often the validity of the concept is misrepresented either: as "there is no such thing as Schizophrenia, etc" or distorted by some MH proesionals as an illness as well defined and understood as allergies. Now allergies are themselves not well understood (which is exactly why I chose that example) but are to Schizophrenia, what a broken leg is to allergies.

But I can not fault this article in its fair and accurate presentation of what is known, what is not known, and more importantly the ambiguities of the word and its uses. Never the less I think the introduction should make the ambiguity and limitation of the concept more clear. But I will not hazard editing a featured article. If my point seems fair and coherent to you, you can take it on board. A well written paper about just this issue by Al Siebert, Ph.D. can be found at:

http://www.successfulschizophrenia.org/articles/ehss.html

You can also use the paper as a source in this article.Esmehwa (talk) 16:16, 11 July 2008 (UTC)

The article is over-simplifying things and because of this material is taken out of context. Psychiatrists agree it is not a diease in the same category as dementia or parkinson, both of which are degenerative diseases of the elderly. Numerous medical conditions will remit given the proper holistic/health-related rather than sickness-related effort. Some peoples type II diabetes will remit with weight loss and exercise, and many psychiatric conditions will improve level of functioning with psychotherapy and maturity. Schizophrenia has tended to be overdiagnosed especially in US studies before 1970, and I would think there would be a clinical lag afterwards. The cause of schizophrenia is unknown - true of many syndromes. As far as treatments, I'd propose anyone recovering from major surgery would be well familiar with 'side effects', as would those having received anticancer drugs. The main issue, however, is the emotive nature of the title, which suggests a major POV of the writer and cherry-picking of facts.

Many of those issues are touched upon in the article anyway, and in a more neutral manner. Which particular bit of the article did you think was misrepresented?Cheers, Casliber (talk · contribs) 22:09, 11 July 2008 (UTC)

I agree the paper is POV, and I re-iterate that the article is fair and accurate, I just added the link as an addition to the discussion, something to consider. I guess I was being a bit perfectionist, I don't think I could edit the article to make it more balanced. I just wanted the authur of the article "mr. wiki" who seems to write so articulately on so many topics to further note this POV that is all.  ;) Esmehwa (talk) 15:20, 12 July 2008 (UTC)

OK, thanks for the heads up. I do ruminate on this quite a bit :) Cheers, Casliber (talk · contribs) 19:33, 12 July 2008 (UTC)

Mental illness

Just noting my change of "a psychiatric diagnosis that describes a mental illness" to "a mental disorder" in the intro sentence, because: 1) My version is both accurate and succinct. 2) It is awkward to call it "psychiatric" but not "psychological." Both psychology and psychiatry have contributed significantly to our understanding of the condition, and both psychologists and psychiatrists will treat those who have it. 3) "Illness" is a medical-model WP:POV, whereas "disorder" is rarely (not always, but rarely enough) contested. And 4) Most to the point, perhaps, mental illness redirects to mental disorder, and it is odd to prefer a redirect over a direct link unless the direct link would pose a grammatical issue. And, yes, I realize that an older version of the article passed WP:FAC, but I still see no consensus anywhere that the rambling "psychiatric-diagnosis-that-describes-a-mental-illness" wording is ideal. Besides, WP:FAC isn't a cue to stop editing (it's an indication that the article "has been identified as one of the best articles produced by the Wikipedia community. Even so, if you can update or improve it, please do so"--emphasis mine), nor is it consensus that every detail in the article is perfect (if that were the requirement, then nominations would last a lifetime). Cosmic Latte (talk) 10:37, 12 July 2008 (UTC)

My two cents: In a recent review ("Schizophrenia, Just the Facts..", PMID 18291627) by three leading authors, it was said that:

...Nevertheless, we feel that we should acknowledge one important perspective.Wewill be using the term“disease” when referring to schizophrenia. This approach differs fromthat taken by theAmerican PsychiatricAssociation's (2000) most recent Diagnostic and Statistical Manual (DSM-IV-TR) and the World Health Organization's (1992) International Classification of Disease (ICD-10), where schizophrenia is described as a “disorder.” In contrast to the vagueness of the termdisorder (“something iswrong”), disease implies a discrete entitywith a specific etiology (even if unknown) and a discernible pathology (even if incompletely delineated) (Evans, 1976; Becker, 2005; Berganza et al., 2005; Steurer et al., 2006). We believe that there is sufficient evidence to call schizo- phrenia a disease related to brain abnormalities that are the final “common pathway” caused by an assortment of specific genetic and/or environmental factors.

Best regards, CopperKettle (talk) 10:56, 12 July 2008 (UTC)

Thanks for pointing that out.. It's an interesting perspective, and one that probably ought to be mentioned somewhere in the article, although I suspect we'd all agree that, at this point, it's something of a minority viewpoint. As mentioned above (I think by Casliber?), "The article is over-simplifying things and because of this material is taken out of context. Psychiatrists agree it is not a diease in the same category as dementia or parkinson, both of which are degenerative diseases of the elderly." I just hope that my slight rewording has helped to remedy this issue at least in the intro sentence. Cheers, Cosmic Latte (talk) 11:17, 12 July 2008 (UTC)

Yes, they themselves say that their terming SZ. a disease differs from APA's and WHO's views. But I doubt that this is a "minority viewpoint", being only a third review in a series that started 20 years ago, and taking into account thousands of new articles that had been written on the topic since 1998, each source scrupulously selected; and also being written by the three authoritative specialists, one, Henry Nasrallah, an editor-in-chief of Curr. Psychiatry Journal. New data, it seems to me, does speak in favor of terming schizophrenia a degenerative disease (loss of gray matter, loss of connections, disruption of normal cellular phenotype) with intermitting psychoses (see Nasrallah's editorial, for example: Is schizophrenia a psychotic disorder?). Based on this I am sure that schizophrenia as a diagnosis is definitely moving closer to the terms "disease" and "illness" than "disorder". I do not know why the "rambling" wording with "diagnosis describing.." had been chosen; maybe it was made to underscore the possibility of misdiagnosis; I just quote the sources that, in my opinion, in recent years moved the concept of schizophrenia closer to that of a distinctive medical disease. From Nasrallah's editorial:

"..Perhaps DSM-V—planned to appear around 2012— should reconceptualize schizophrenia as a neurodevelopmental/neurodegenerative disorder characterized by a deficit syndrome and cognitive dysfunction, with intermittent secondary psychotic episodes..."

Best regards, CopperKettle (talk) 12:17, 12 July 2008 (UTC)

is there a final "common pathway"? I don't think we have a conclusive answer... for the sake of time lets simplify SA to its most common determinitive symptom auditory hallucinations, given the almost unimaginable underlying complexity, I think it more probable that at the very least two quite distinct "pathways" leading to the experience of auditory hallucinations will be found.(Do you agree with this assumption?) would this affect what you call the general phenomenon?

lets use chronic headaches as a comparison, assume one is caused by a slight head injury during childhood, while the other is caused by sensitivity to certain widespread chemicals. Assume we can not distinguish between the two with current technology. Now would you say such headaches have a final common pathway? would you call patients experiencing such headaches as having an illness? a disorder? a disease? should we call the phenomenon of patients experiencing auditory hallucinations as having an illness? a disorder? a disease? Hope this helps.Esmehwa (talk) 16:35, 12 July 2008 (UTC)

I agree that schizophrenia (schizophrenias?) is\are very complex in pathogenesis. I merely quoted the scientists who now seem to have struck upon some basic mechanisms (NMDA hypofunction, GAD67 deficit, epigenetic deregulation, etc., see at schizophreniaforum.org). There might be several downstream pathways that lead to deficit syndrome\cognitive dysfunction and further converge, nudged by the external stressors, into intermittent psychoses and hallucinations (hallucinations are not always observed in schizophrenia). Of course there needs to be more work in elucidating schizophrenia subtypes based on molecular mechanisms. Best regards, CopperKettle (talk) 17:14, 12 July 2008 (UTC)

Regarding the lead changes, I personally appreciated the "diagnosis describing" - a bit of distance from the concept - but it could be confusing up front. I do agree with using the term mental disorder. While the authors of "Just the Facts" say that the term disease has more clarity and heuristic value, the ICD-10 states: "the term “disorder” is used so as to avoid the even greater problems inherent in the use of terms such as “disease” and “illness”." It's hard to evalute the authors' brief assertion of the evidential appropriateness of "disease" because they don't address the specific points made in their summary. Without getting into the neuropsych/neuro vs psych debate, these actually included: "The nosological boundaries between schizophrenia and other psychiatric disorders are indistinct"; "Is schizophrenia on a continuum with bipolar disorder?"; "Exactly how is “nature carved at its joints”?"; "How is the entity “schizophrenia” best defined and operationalized to enable more meaningful study?"; "How does one categorize “the many schizophrenias”? Is there anything that meaningfully binds this construct?"

Also in their intro they say: "its etiology and pathophysiology remain relatively obscure" which "cannot principally be ascribed to a paucity of findings." (the same, funnily enough, as the 1988 review: "The relatively obscure etiology and pathophysiology of schizophrenia cannot be completely ascribed to a paucity of "findings".) It seems from that like they might have addressed why it shouldn't be called a "syndrome"...but they seem to see the term "disorder" as meaning the same thing (though just after they say they're going to use the term disease, they're ok referring to it as an "enigmatic brain disorder"). Incidentally, the prior reviews in the series didn't express a preference on the term, and while clearly excellent we don't know that this one selected the roughly 300 sources "scrupulously" or neutrally - they just say they did a literature search (doesn't say on what) using two main terms and unspecified narrower ones, and then "screened" and "culled". I notice that when it comes to "course" they say and cite very little, not including any of the major longitudinal reviews but including Kraepelin & Bleuler form the early 1900s, the ICD and DSM, and a few apparently tangentially related papers.

As a sidenote since the status of the authors has been brought up - and only as extra context on their point of view, not to invalidate their work or impugn their characters at all (there are of course going to be links given the overlap) - brief searches quickly showed that both Tandon[3] and Nasrallah[4] appear to have been quite extensively tied to pharmaceutical companies financially and professionally. The disclosure statement in this 2006 article on an antipsychotic in schizophrenia published in the same journal says that Dr. Tandon has previously been a consultant for, and on the speakers' bureaus of, five different pharmaceutical companies. He is the first author on that paper followed by 9 employees of 3 different pharmaceutical companies, and they were "assisted in developing the initial manuscript outline" by "Apothecom", a subcontracted company that apparently "develops strategically driven communications plans to ensure that key messages are consistently communicated across all tactical projects. Establishing the product's scientific profile in the medical literature is critical to its successful positioning and provides citations to support other programs.[5] EverSince (talk) 19:01, 12 July 2008 (UTC)

There are so many variables in all this it is not funny. For a start, DSM has actually done a good job hiving off more transient diagnoses which were previously included under schizophrenia (schizophreniform psychosis, schizotypal PD, drug induced psychosis and even the reification of Borderline PD in some cases) - it is an evolving concept and will continue to be so. The other issue with research is the use of structured interviews - which are alot better than nothing but still do not replace clinical assessment (i.e. history and examination-taking by doctors such as me :) There is a core group left with a more chronic course who qualify for the diagnosis and yet they do display differences (though more similarities really). I agree this whole issue is a bit of a headache. I do slightly prefer mentioning DSM IV TR diagnosis as that is the paradigm it is reified (and essentially exists under), but agree it flows less smoothly. Have at it.Cheers, Casliber (talk · contribs)

Yep, reification is definitely an issue. I've changed the wording to "a clinical diagnosis describing a mental disorder..." but if anyone would like to tweak it further, that'd be fine as long as "mental disorder" is not replaced with "mental illness." When speaking colloquially, I (shamefully) say "mental illness" as much as the next guy...but when we get right down to it, unless there turns out to be a necessary-and-sufficient biological substrate to schizophrenia or to any of its subtypes, then "illness" can't really be used except in an inexact or a metaphorical sense. Cosmic Latte (talk) 22:30, 12 July 2008 (UTC)

That's why I sorta like "syndrome" as a purely descriptive term for a cluster of symptoms without any ascribing of causation etc. But not sure how generally understood that meaning is. Cheers, Casliber (talk · contribs) 23:41, 12 July 2008 (UTC)

Agreed, and revised accordingly. As for general understanding, I added a wikilink to "syndrome" for those who'd like to learn more. Cosmic Latte (talk) 18:25, 13 July 2008 (UTC)

Getting pretty weasly in here. SandyGeorgia (Talk) 18:26, 13 July 2008 (UTC)

?. Cosmic Latte (talk) 18:30, 13 July 2008 (UTC)

Browsing some of our reliable sources, I find:

• Schizophrenia is a severe and persistent debilitating psychiatric disorder. It is not well understood and probably consists of several separate illnesses.
• Commonly known as insanity or madness, schizophrenia is a chronic psychotic disorder with onset typically occurring in adolescence or young adulthood.
• A severe emotional disorder of psychotic depth characteristically marked by a retreat from reality with delusion formation, hallucinations, emotional disharmony, and regressive behavior.
• Schizophrenia is a psychosis, a disorder of thought and sense of self. Although it affects emotions, it is distinguished from mood disorders in which such disturbances are primary.
• Schizophrenia is a mental disorder that makes it difficult to tell the difference between real and unreal experiences, to think logically, to have normal emotional responses, and to behave normally in social situations.
• Schizophrenia is a severe form of mental illness affecting about 7 per thousand of the adult population, mostly in the age group 15-35 years.

It's a bit hard to understand why we're avoiding linking to mental disorder. SandyGeorgia (Talk) 18:49, 13 July 2008 (UTC)

Because, I'd say, "syndrome" is more of an umbrella term, taking into account both the client's and the practitioner's perspective. As the editor in the following section rightfully asked, "whose definition of reality" are we talking about? You'll notice that these sources weren't written by schizophrenic patients, whose phenomenal reality might actually be quite ordered. Syndrome, on the other hand, is basic terminology. If you have the signs and symptoms, you have the syndrome. Anyway, we can't deny the sources, and you're right that it's awkward to omit a link to "mental disorder," so I've gone ahead and pointed out the fact that schizophrenia is indeed diagnosed as a mental disorder--wikilink included. Cosmic Latte (talk) 19:07, 13 July 2008 (UTC)

Reference WP:NOT, WP:MEDRS, and WP:UNDUE; we reference reliable sources and we reflect consensus according to due weight. The opening is now a weasle that reflects undue weight to avoid labeling the condition as the preponderance of reliable sources does. SandyGeorgia (Talk) 19:11, 13 July 2008 (UTC)

How's the dictionary for a reliable source? No one denies that it is a syndrome. This is basic medical/psychological terminology. No one denies that it is diagnosed as a "mental disorder," either. Let's not invent debate where there really isn't any. Cosmic Latte (talk) 19:18, 13 July 2008 (UTC)

I hope you're kidding when you ask "how's the dictionary" (particularly a yahoo.com one) as a source on a medical article :-) Your earlier versions were fine; the current version is a weasle, reflecting undue weight. You can call it what it is (a mental disorder) while still introducing the concept of a syndrome. SandyGeorgia (Talk) 19:23, 13 July 2008 (UTC)

Yeah probably better to stick to the more usual "mental disorder" in the lead sentence. nuance later. EverSince (talk) 19:35, 13 July 2008 (UTC)

And I hope you're kidding when you claim that stating common knowledge without a source is a "weasle" [sic]. Do I need a source if I claim that the solar system is "heliocentric"? I think not. Will you even find reliable sources (say, in astronomy journals) these days that bother to assert that the solar system happens to be heliocentric? I think not. No one denies that the solar system is heliocentric, so no original research is going to bother asserting it. But an encylopedia is different. "Syndrome" is as elementary a concept to medicine as "heliocentric" is to astronomy. And if you still find that hard to believe, check out this dictionary. Cosmic Latte (talk) 19:37, 13 July 2008 (UTC)

I have to get going for a bit, but I think it'd be a good idea to see what sort of consensus builds up here. It'd be especially appropriate to see what Casliber thinks, as I'm basically defending his suggestion, at least as I perceived it. "Perceived" being the operative word here, because I may be defending it too strongly or in a manner that he'd disagree with, or I may be misconstruing it, etc. Cosmic Latte (talk) 19:49, 13 July 2008 (UTC)

For the above: NIMH dictionary - "Schizophrenia is a chronic, severe, and disabling brain disorder" (my emphasis added). I'm sure we all know the notability and strength behind the NIMH and its choice of language. Ottava Rima (talk) 19:48, 13 July 2008 (UTC)

And you could find plenty of sources that emphatically disagree with that idea. My point in referencing the dictionary wasn't that dictionaries = truth. But a dictionary (or a comparison of multiple dictionaries/glossaries) isn't a bad place to pull up the consensus on words for which there is undoubtable consensus. Such is the case for "syndrome" (no one debates what "syndrome" means) but hardly for "schizophrenia" (there's plenty of debate about what that is). Also, it's telling that "syndrome" had similar definitions in both a medical and a non-medical dictionary. I would expect a medical dictionary (NIMH tends to be medical/neurological in orientation) to give a medical definition of schizophrenia--the whole WP:NPOV issue centered around bias toward the medical model in the first place! But there is absolutely no agreement among medically-oriented and non-medically-oriented professionals that schizophrenia is a "disease" or "brain disorder" (which is not even interchangeable with "mental disorder," because brain and mind are not identical) on par with, say, Alzheimer's, Parkinson's, or neurosyphilis. Cosmic Latte (talk) 19:58, 13 July 2008 (UTC)

Sources can disagree with the NIMH all they want, but when push comes to shove, NIMH is the final say. They are the largest, most funded institution that works on these matters, and they are connected to the Federal Regulators that can deny the practice of most of the sources that you can provide. I really think that you shouldn't be attempting to fight against what the NIMH declares so easily. Ottava Rima (talk) 20:15, 13 July 2008 (UTC)

The NIMH isn't God; they are a federally-funded organization with federally-funded biases. There are plenty of reliable sources that contest the medical model. There are many credentialed, even mainstream researchers who firmly think that the NIMH and medical model are full of you-know-what. By the way, I just happened to notice their definition of "depression": "Depression is a serious medical illness; it’s not something that you have made up in your head." "Not something that you have made up in your head," eh? This isn't the depression talk page, so I won't bother getting into the serious accuracy issues with that, but...with that sort of wording? I don't understand why I even bothered to call that a "dictionary." Cosmic Latte (talk) 20:29, 13 July 2008 (UTC)

If they contest the NIMH on such a matter as this, chances are they aren't reliable and probably shouldn't be used. Ottava Rima (talk) 21:10, 13 July 2008 (UTC)

I just checked the page and sources for your quote, and could not find it. Please stay on topic. Ottava Rima (talk) 21:12, 13 July 2008 (UTC)

The page is right here. By the way, I fail to see anything about the primacy of the NIMH on WP:MEDRS, WP:MEDMOS, WP:PSY, etc. You also seem to be ascribing to the NIMH some interesting powers, e.g., "connected to the Federal Regulators that can deny the practice of most of the sources that you can provide." In the United States, my friend, psychologists are licensed by the state, not by the federal government. And the NIMH has no control over whom universities hire/don't hire/fire. Cool down. Cosmic Latte (talk) 21:30, 13 July 2008 (UTC)

You keep forgetting the power of the FDA based on the interstate commerce clause. It trumps anything that a state regulation can provide. The NIMH has to verify all tests that deal with a chemical nature. They also have far more power than what I really have time to go into here. Any university professor can say whatever they want, but when it comes to medicine, there is a difference between fact and opinion. Ottava Rima (talk) 22:23, 13 July 2008 (UTC)

And are these mysterious powers of the NIMH perchance mentioned here? /chortle. Cheers, Cosmic Latte (talk) 14:48, 14 July 2008 (UTC)

Hi there, as you've both noted there is a disagreement over whether schizophrenia is a unitary disorder or a syndrome. This is exactly why the original wording was chosen (which I've now replaced) because it accurately describes what it is. "Schizophrenia is a psychiatric diagnosis" - no disagreement there I hope; "that describes a mental disorder" - i.e. the diagnostic manuals describe it as this, as noted in the DSM and ICD; "characterised by..." which goes on to describe the core features of the diagnosis in every system. This is the most accurate and NPOV description we've come up with so far, and it has been there through several FA revisions, so please do not change it. Debates the nature of schizophrenia itself are covered more widely in the article itself - Vaughan (talk) 07:01, 14 July 2008 (UTC)

Yeah, I was musing on this today, and equating it to the DSM diagnosis is the best bet. Cheers, Casliber (talk · contribs) 07:46, 14 July 2008 (UTC)

I agree with that. CopperKettle (talk) 08:14, 14 July 2008 (UTC)

Alright, I'll go along with that. I still think that my argument for "syndrome" holds (at least some) water, but this seems like a reasonable consensus. My two main concerns--1) a serious reification-related concern with the fact that it had said mental illness rather than disorder, syndrome, etc., and 2) a relatively minor concern with unwieldy sentence length--have been alleviated throughout this series of edits, and as long as those particular problems aren't reinstated, I don't plan to raise any objections. Cosmic Latte (talk) 09:41, 14 July 2008 (UTC)

Whose definition of reality?

Well? 199.117.69.8 (talk) 21:25, 12 July 2008 (UTC)

The majority's definition, of course. I've changed "impairments" (i.e., they're wrong/deficient) to the more objective "abnormalities" (i.e., they're not the norm) in the opening sentence. Does this help? Cosmic Latte (talk) 22:37, 12 July 2008 (UTC)

History

We now have a source (thanks to Vaughan) on the "Book of Heart"[6] The relevant statements from this 1999 review of Egyptian historical perspectives on mental health by an Egyptian psychiatrist are:

"Depression, dementia, psychomotor retardation, negativism and subacute delirious states, and thought disorders similar to schizophrenia were described in details in the Book of Heart in Eber's papyrus.". And, referring to several papyri at once, "...we find disturbances of thinking, emotions, intellect, and behavior similar to formal thought disorder, poverty of thinking, retardation and excitement, forgetfulness, etc., which can be labeled in our time as schizophrenia, catatonia, or dementia." There are no details, doubts or diagnostic issues considered (understandably given the remit of the article).

The first paragraph of the history section is a series of individual findings/views, somewhat conflicting, and it would seem it needs to be made into an overview that incorporates general reviews of the balance of findings/interpretations ((which don't actually seem to even mention the egyptian papyri).

This 2001 article concludes (once I could get past the intro half-jokingly equating people with schizophrenia to a saying about "fools"): '"If schizophrenia is an old disease then why are there so few early reports? There are at least four possible explanations..."

This 2003 article seems to be trying hard to give a neutral summary of the findings and opinions on this and says:

"The accounts of Haslam (1809/1976) and Pinel (1809) are often regarded as the earliest cases of schizophrenia in the medical and psychiatric literature (see Gottesman, 1991, pp. 5-6; Shorter, 1997, p. 61). Prior to these seminal contributions, descriptions of “madness” occurred, but it is hard to discern a distinct and unmistakable schizophrenia-like illness." ...

"Madness - in the general sense of irrational, unintelligible, or uncontrolled behavior - can be found in the Bible, in Mesopotamian, classical Greek, and Latin literature, and in the writing of many non-Western cultures (Haldipur, 1984; Hershkowitz, 1998; Jeste et al., 1985; Padel, 1995). However, controversy exists about the historical presence of the kinds of symptoms seen in modern schizophrenia and about the existence of the disease state itself" ...

"Differing conclusions from retrospective diagnosis and the disputed discovery of cases of early schizophrenia illustrate the different standards of evidence applied to the same material by proponents of recency and permanence viewpoints."...

"Therefore, the frequency and adequacy of both medical and nonmedical descriptions of insanity and schizophrenia prior to 1800 have been disputed and supported by advocates of each position."...

"On balance, it seems probable that reports of a schizophrenia-like syndrome will continue to be rare in the historical record prior to 1800. The scarcity may reflect the scarcity of the syndrome itself, or simply the relative absence of its personal and biographical artifacts." ...

"This evidential situation means that it will be hard to resolve the recency-permanence debate concerning the illness."

EverSince (talk) 10:55, 14 July 2008 (UTC)

Regarding the ebers papyrus, the same Egyptian psychiatrist, Okasha, goes into slightly more detail in Notes on mental disorders in Pharaonic Egypt. This was published a year later but looks like it may have been drawn from an earlier 1978 version (PMID 400639), although it doesn't cite it and I couldn't see access (looks to be a few pages shorter). The new article has subsections on Hysteria, Sadness/Depression and Suicide, but doesn't even mention the word schizophrenia. It does list some statements from the ebers papyrus and some brief interpretations (my italics):

'As to faintness (the ib is faint): the heart does not speak or the vessels are dumb, there being no perception of the fingers; it arises through the air which fills them.'. These symptoms may suggest what we may now call negativism.

’As to the feeling of sickness (the ib is sick): it is debility of the heart through heat from the anus.’

'As to the mind kneeling (breaking down): this means that the mind is constricted and the heart becomes small. It is that the heart is hot and weary and eats little and is fastidious' (i.e., psychomotor retardation, probably of a depressive nature).

'As to drying up of the mind, it is that probably the blood coagulates in the heart.' This drying up is equivalent to our present thought blocking, or poverty of thinking.

’As to him wheeling and falling on his heart: this means that he becomes faint, and that his mind becomes powerless. It is the overfilling of his heart with blood, which does it, that arises through drinking of water and eating hot fish.’ This can be interpreted as stuporous or catatonic conditions.

’As to the mind kneeling in the interior of his belly, the purulency falling on his heart,’ probably suggests degradation of thinking.

’As to his mind passing away, it is that the vessels of the heart carry faeces.’ This is equivalent to our present delirium or subacute delirious states.

’To expel ’a a a’ poison from the heart, expel fleeting forgetfulness and injury of the mind.’ This is what we now call dementia.

’As to his mind being dark (i.e., melancholic and depressed) and his tasting his heart, this means that his mind is contracted, there being darkness in his belly and he makes the deep to consume his mind’ (i.e., he repents or he has fits of helplessness).

It seems these brief comments are the basis for the statements in the author's other article. Apparently "drying up of the mind" is enough to conclude thought disorder indicative of schiziophrenia. Incidentally the ebers papyrus doesn't seem to include much more (translation) and the "book of heart" seems to be only a few dozen sentences under the heading "Anatomical-physiological-section". Not exactly "details" as Okasha says in his other article.

I found another article, Psychiatry in Ancient Egypt, written in 1987 apparently by an Egyptian psychiatrist working in the UK. This does not offer the psychiatric interpretations of the Okasha articles. Again there are headings on hysteria and sadness/depression, and alcoholism - but again no mention of schizophrenia. "As for faintness ... the (ib) mind, faint" is interpreted as hysteria-related fainting, not "negativism" as above. A number of the other ebus papyrus statements above are described simply as states of consciousness, "which seem to be rather comparable to the way the patient's concentration and attention is assessed and described in today's clinical examinations." Nothing seems to be suggested about any of this being any more specific to thought disorder or schizophrenia than to any other possible psychological or general medical condition.

Finally, both the above articles cite "Ghalioungui, P. (1963), Magic and Medical Science in Ancient Egypt (Hodder & Stoughton)." as a general source, as well as the papyri themselves. Ghalioungui seems to be a general physician. The varying psychiatric interpretations seem to be from the authors of the articles.

Not sure what all that means for how the history section should briefly relay this whole issue in a reliable NPOV way. EverSince (talk) 10:39, 16 July 2008 (UTC)

For the good of humanity . . .

Add this to the defninition of Schizophrenia:

"At its core, Schizophrenia occurs when a person's full potential cannot be realized. Often, the Schizophrenic person is fully aware of what his or her full potential is, but feels that he or she cannot reach that full potential because the patient believes that the people within the surroundings do not have faith in the patient to achieve that potential. Schizophrenia, like the common cold or the ear ache, can be completely cured by a combination of drugs and psychotherapy." —Preceding unsigned comment added by Engleel (talk • contribs) 19:57, 19 July 2008 (UTC)

"Like the common cold"? Holy Rip Van Winkle, Batman! What have I missed? Cosmic Latte (talk) 09:56, 20 July 2008 (UTC)

Acute Schizophrenia? What does it mean?

This article says very little about the difference between acute and chronic schizophrenia, only that "acute vs. insidious" affects prognosis. Here is a list of 5 review abstracts from PubMed which specifically mention acute schizophrenia in their titles. Orthomolecular psychiatry has made a distinction between the two since the 1960s, and it would be interesting to see what surrounds that distinction. The orthomolecular crowd alleges that their distinction (which was made using something called the Hoffer-Osmond test) was ignored, and that is why their clinical trials failed. Currently a clinical trial for the orthomolecular approach to acute schizophrenia is due to be complete in 2009.[7] II | (t - c) 13:02, 20 July 2008 (UTC)

It's "sudden vs insidious" that is meant. If it comes on more slowly over a longer period of time, the prognosis tends to be worse. "Chronic" vs "acute" refers to the time course and resolution of an illness. For instance, drug-induced schizophrenia can be of relatively short duration. A chronic condition does not resolve quickly, if at all, and must be managed.Vendrov (talk) 10:06, 9 February 2009 (UTC)

There's also such a rare species as "Hypertoxic schizophrenia" (Гипертоксическая шизофрения) which is mentioned only in Russian sources and judged by its description has little in common with typical schizophrenia. CopperKettle (talk) 14:33, 20 July 2008 (UTC)

The Russian usage of the term is significantly broader than elsewhere (actually not too sure if this still holds true). Acute from 6 months (min. for Dx) to 2 years duration IIRC, must check. What was more acute is now Schizophreniform disorder. Cheers, Casliber (talk · contribs) 14:50, 20 July 2008 (UTC)

Self-created Schiztos

Do you think it is possibly for someone who is lonely to create voices within their minds, then allow the voices to take the shape of 'little people' within their minds? Is it possible that these little people can manage seperate divisions of emotion, and have discussions with each other on how to react to situations? Or is this just over-rationalization and common paranoia of reality? I don't know where to go for answers, and everyone in my head just keeps arguing and I can't always get them to shut up. —Preceding unsigned comment added by 75.91.86.21 (talk) 17:44, 21 July 2008 (UTC)

Lots of things are possible with the human imagination, but I'm aware of absolutely no research suggesting that schizophrenia is caused by loneliness or creativity or...what exactly are you asking, anyway? Perhaps a psychiatry forum is what you're looking for. You might simply want to Google "psychiatry forum" or something to that effect, but I'm afraid there's not a whole lot that we can do for you here. But if there's anything that you can do for the article, then feel free to chime in. Cosmic Latte (talk) 20:04, 27 July 2008 (UTC)

Schizophrenia and German Researches

German researchers know the real cause of schizophrenia. Schizophrenia is caused by the bacterium Borrelia burgdoferi in connection with environmental stress and external influences. The people of this bacterium in them react to stress overly frustrated, sad or otherwise. I hope that this information could help the people! Further information can be found in the German Wikipedia and under http://www.lymenet.de/lymchckd.htm # checklist —Preceding unsigned comment added by Germanresearch (talk • contribs) 19:39, 23 July 2008 (UTC)

A translator's question

(I've decided to translate this article into Russian)

In the phrase

The United States of America and Australia are two countries with laws allowing the forced administration of this type of medication on those who refuse but are otherwise stable and living in the community.

- what does "the community" stand for? Some special community of patients or the general community, like the usual neighbourhood? CopperKettle (talk) 18:08, 29 July 2008 (UTC)

Yeah it means the general community, in own home etc...rather than just in the kind of institution, like a psychiatric inpatient facility, where forced treatment laws have traditionally applied. EverSince (talk) 06:49, 30 July 2008 (UTC) It should probably clarify that any actual forcing still usually takes place in a psychiatric facility. EverSince (talk) 08:03, 30 July 2008 (UTC)

White matter abnormalities

A good number of recent studies using Diffusion Tensor Imaging (DTI) have pointed to abnormalities in connections between brain regions as a potential reason behind some of the symptoms seen in schizophrenia. It would be nice to see a part in the article about this (see http://www.spl.harvard.edu/extensions/PubDB/publications/download_bitstream.php?bitstreamid=223 for a review of some of these studies). Emelon8 (talk) 19:55, 29 July 2008 (UTC)

Would be great to add this in the causes of schizophrenia. CopperKettle (talk) 07:20, 30 July 2008 (UTC)

Missing causes.

I have seen in other related links, references to PPA a pharmaceutical drug component that can cause schizophrenic like symptoms, as well as B 12 deficiencies.

Possible areas of expansion ?

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 15:18, 12 August 2008 (UTC)

Since some people are labelled 'Schizophrenic' are later found to have 'causes', so therefor some other 'schizophrenics' could be so because 'the cause' has not been identified and treated.

Case in point:

Schizophrenic Society

Tumors, infections, etc.etc.etc..

I hope you can understand the need to add a section for 'causes' that include identified causes.

It is based on the assertion that some, (perhaps many) schizophrenics are in fact 'untreated' ill people, because the source of their problem has not been correctly found.

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 15:34, 12 August 2008 (UTC)

Schizophrenia Diagnosis and the DSM IV text revision

This article needs to state the difference between negative symptoms and major depression. Can anyone address this? —Preceding unsigned comment added by 76.169.29.127 (talk) 02:15, 28 January 2009 (UTC)

Look at the last sentence of the first paragraph under DIAGNOSIS. The goal would be to list diagnosis that are psychotic but not schizophrenia (such as the sub classes). Using thew Diagnostic and Statistical Manual of Mental Disorders IV TR (which is referenced elsewhere), three disorders need to be deleted: bipolar disorder, borderline personality disorder, drug intoxication. Others in the psychotic diagnosis include

    Delusional Disorder 
    Brief Psychotic Disorder 
    Shared Psychotic Disorder 
    Psychotic Disorder due to a General Medical Condition 
    Substance-Induced Psychotic Disorder 
    Psychotic Disorder Not Otherwise Specified 

If the intent is to list other diagnosis with "hallucinations" (as if that alone constituted the criterion) one has another undesirable situation to be modified. This discussion is going too far in the medical pathogen version of mental illness. Sarah72Jane (talk) 21:05, 31 August 2008 (UTC)

PS If this is discussed elsewhere, I apologize for not threading this comment. I am visually impaired and regret that I cannot throw all four pairs of glasses at the doctor. (You do it by following his voice.)

Hello Sarah72Jane and thanks for commenting. These common conditions listed (bipolar, drubg intoxication and borderline PD) may exhibit psychotic-looking processes and resemble schizophrenia at some point and are listed because of this. The other psychoses are identical in symptoms but not in cause or duration. I will think about how to add this. Cheers, Casliber (talk · contribs) 02:26, 6 September 2008 (UTC)

IT should be noted the the DSM-IV-TR states clearly that those other D/Os (bipolar d/o w/ psychotic features, substance induced psychotic d/o, and so on)should be ruled out prior to dx of schizophrenia. It should also be noted that there is a high prevalence of substance abuse/dependence among clients w/schizophrenia and other serious mental health disorders. The DSM-IV-TR is clear (as mud anyway) concerning differential diagnosis concerning these disorders. To the authors of the article "good job." —Preceding unsigned comment added by 199.190.155.2 (talk) 07:53, 14 January 2009 (UTC)

Prescription Drugs as a possible cause is missing

Prescription Drugs

In some cases prescription drugs or their components like dextromethorphan/guaifenesin/Phenylpropanolamine have been known to create symptoms that resemble and or lead to the label of schizophrenia.

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 21:24, 3 September 2008 (UTC)

There appears to be some who would rather censor this information from the site.

It has been documented that errors of 'labelling' have occured and will occur. Failure to identify 'prescription drugs' as the cause, will result in the label of a schizophrenic.

We need a review by editors here.

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 15:38, 5 September 2008 (UTC)

Taking these drugs would cause a delirium maybe, not schizophrenia. This is possible with just about any medication and is really rare. So its inclusion is undue weight and obfuscates the real problems, Cheers, Casliber (talk · contribs) 21:21, 5 September 2008 (UTC)

My research suggests that 'delirium' can be mistaken, and a person labelled as schizophrenic, depending on how the evaluation is. People should know. We cannot assume that all decisions are correct. How rare is rare ? We don't have accurate info, because of the reluctance to divulge and to study. Look at PPA, the first studies were in the 60's and the drug was taken off the US market only, in 2000.

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 22:04, 5 September 2008 (UTC)

Your research? Erm, what would that be? Listen delirium is generally an acute condition. Many drugs with anticholinergic or antihistaminergic activity can make people acutely delirious - usually distinguished by visual hallucinations, a fluctuating level of consciousness, and/or disorientation to time or place. Some drugs, notably bromocriptine (for parkinsons) and drugs that mimic amphetamines, as well as interferon, can cause a psychosis-like picture. Again, this is pretty rare, like maybe 1 in 1000 or much less of cases of schizophrenia seen. Cheers, Casliber (talk · contribs) 02:11, 6 September 2008 (UTC)

Without careful assessment, delirium can easily be confused with a number of psychiatric disorders because many of the signs and symptoms are conditions present in dementia, depression, and psychosis.

If you read between the lines 'confusion' or (wrong conclusion) can lead to the label of schizophrenia. Now if you tell me that some over the counter drugs can cause schizophrenic like conditions, then this should be part of the site. There may be some, a few, many, or most cases attributed to some unknown drug, be it over the counter, or prescription.

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 05:10, 6 September 2008 (UTC)

Look at the diffs Caesar - due weight considered, I thought about it and [ http://en.wikipedia.org/w/index.php?title=Schizophrenia&diff=236577662&oldid=236574173 added] this. The other two drugs for which it is worth noting are Zyban (bupropion) and interferon. Once you are actively looking to distinguish delirium vs. schizophrenia, this is relatively straightforward in most cases if you have experience in the area. Cheers, Casliber (talk · contribs) 05:19, 6 September 2008 (UTC)

Episodes and treatment.

This article does not include a section about the duration of episodes, and the chances of a reoccurence.

It also does not reflect the opinion by some that long term treatment of the first episode is always necessary, which may reflect the reality that the episode may be organic in nature.

No evidence that early episodes of schizophrenia without medication result in long-term harm

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 20:47, 5 September 2008 (UTC)

...except for the catastrophic impact on vocational and social development. This is a very complicated area and there are issues in equating research with clinical practice. It is hard to elaborate on practice here actually I come to realise. Cheers, Casliber (talk · contribs) 05:20, 6 September 2008 (UTC)

It's a good point that the article should include something on the duration/frequency of episodes.

The "seminal" review finding of no evidence of harm from non-medication (and the bogus science behind the neurotoxicity hypothesis used to justify an assumption of harm), which made the New York Times etc[8][9] incorporated work and social outcome measures. If anything meta-analyses of approaches like Soteria have found a trend to better functioning. It's not possible to generalize about patient experiences either, some find them helpful sometimes but in other cases people feel too slowed and foggy, too much obesity, diabetes or other physiological effects etc, and not necessarily a help to social inclusion, workign though experiences, or recovery, e.g.[10] EverSince (talk) 00:17, 10 September 2008 (UTC)

Higher incidence in women.

It appears one study examined the higher incidence of schizophrenia and women, compared to men, and found a possible link to schizophrenic like conditions and diet pills.

All Psychosis is Not Schizophrenia, Especially Not in Women

The conclusion of the research was that more "screening" was required.

It is great to have more people informed of this through wikipedia. Congratulations for providing the venue.

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 22:00, 5 September 2008 (UTC)

Misdiagnoses warning.

Misdiagnoses due to not looking at over the counter drugs, issued warning.

Organic affective psychosis associated with the routine use of non-prescription cold preparations.

This case highlights the need for better training to avoid mistakes, or false labelling.

I suspect incidence of these are underreported, and suggests a section be added to this site.

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 22:23, 5 September 2008 (UTC)

This reference is one patient with a delirium. Cheers, Casliber (talk · contribs) 02:14, 6 September 2008 (UTC)

The patient developed symptoms for a few times, before the source of his or her "schizophrenia" was discovered.

The similarity, or cross over between delirium and schizophrenia is a judgement call, as in there is no test to conclude one over the other.

The inability to find a cause results in the label of schizophrenia suggesting the problem is in the testing in some cases.

The case in point highlights the need for better research on behalf of those involved.

To NOT divulge this in the listing is a grave error of misrepresentation.

I find it quite revealing that there has been no mention of this potential as of yet, but then again, 'the system' does not have a an answer.

(my speculation is the schizophrenia is indeed a result of a variety of facters, ie genetic, undetected infection, a adverse drug reactions, damages to internal organs ie liver....I will try to locate actual resources...)

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 05:02, 6 September 2008 (UTC)

A judgement call???? - sorry, but in the vast majority of cases they are quite different - one has auditory hallucinations, delusions, non-fluctuating consciousness and comes on over months or years (or weeks at fastest), the other comes on in days or hours, and may have visual hallucinations, fluctuating consciousness and disorientation. How is that a judgement call?? There are well-developed consensus criteria on both so I have no idea where you get this from. Cheers, Casliber (talk · contribs) 06:09, 6 September 2008 (UTC)

Logical analysis of the research suggests that we should look at colds of a flu same cause many different symptoms, depending of many factors. For one we are not all equal, different blood types, different diets, different genetic makeup. Why should one cause have the same effect on all people. (sounds like communism philosophy - we are all equal....not)

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 12:06, 6 September 2008 (UTC)

Different personalities, different IQ's, different histories...

By the articles own admission if one of the factors is genetics, then we all know that genetically we are similar yet different. Some people like peanuts, the other may die from them.

Different allergies.

Remember we still don't know what cause this disorder, except to say that we know what causes this disorders symptoms, then we conclude that it is not this disorder.

Seems the disorder is actually not knowing or not finding the possible cause from a list of known causes.

Etiology may be similar to understanding abuse we know then we don't want to know, or we slant the issue.

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 12:14, 6 September 2008 (UTC)

Caesar, stop trying to cloud the issue; yes there is individual separation, but there is a consensus among the medical community about the (broad) defining features of each condition, and they are quite distinct. Yes there is higher than expected history of abuse in schizophrenia, and yes we don't know the cause. Doesn't mean we start from scratch. The article tries to reflect waht we know and what we don't know. Cheers, Casliber (talk · contribs) 13:32, 6 September 2008 (UTC)

Undue Weight

the difference between these two versions is, I feel, giving undue weight to the latter version. I tried to accommodate, but rather than continue reverting I will ask for other opinions. Cheers, Casliber (talk · contribs) 06:03, 6 September 2008 (UTC)

How about we reject the new version because it's factually inaccurate? It says: Some prescription medications such as dextromethorphan, (DXM or DM) an antitussive (cough suppressant), guaifenesin an expectorant, [64] , [65]phenylpropanolamine,and bromocriptine may also cause or worsen psychotic symptoms.[66][67]

Looking only at the first reference, I find these problems:

• dextromethorphan and guaifenesin and are over-the-counter meds (and PPA used to be), not prescription meds;
• the first ref is specific to the combination of DM/G/PPA, and makes no claim that any drug here is at all dangerous individually;
• the first ref says only that the combination (actually, it's probably PPA component alone) causes hallucinations;
• temporary, drug-induced, schizophrenia-like symptoms are not the same thing as schizophrenia; and
• the first ref is a really pathetic source and could be replaced with something substantially better.

I definitely support reversion to the previous, factually accurate statement. WhatamIdoing (talk) 06:48, 6 September 2008 (UTC)

• PPA is still available in some countries.

• PPA has been isolated as a contributing factor.

• temporary schizophrenia conditions, treated and labelled without the deduction of a drug cause, may indeed lead to a schizophrenic label as in the case of the person who had several incidents.

• It is noted that these drugs, and I am sure others are possible causes.

• we still have not isolated a third contributing cause such as underlying illness, as in giardia. One must not analysis these issues, incidents, causes in a linear black and white fashion. Disease can operate in a matrix form.

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 12:19, 6 September 2008 (UTC)

These are some pretty big logic jumps. There have been some anecdotal cases (30 in 45 years!) of this drug. We don't go against established consensus because of anecdotes. Cheers, Casliber (talk · contribs) 13:34, 6 September 2008 (UTC)

Perhaps you Casliber can undertake research to identify the commonalities based on your observations.

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 19:25, 6 September 2008 (UTC)

The issue is already 'cloudy' as there is no acceptable cause for schizophrenia, except for some cases that are known to mimic schizophrenia but are known to have a cause. Is it possible that some cases are undetected known causes ?

Why not give those with this label a hope, a door to possibly examine.

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 15:49, 6 September 2008 (UTC)

This is not the place for speculation. It is for accurately communicating established research with due weight to the significance of the findings. - Vaughan (talk) 17:39, 6 September 2008 (UTC)

I have removed the unsupported information, and restored the original references to scientific reviews. WhatamIdoing (talk) 19:56, 6 September 2008 (UTC)

For reasons having nothing to do with this article, I have searched the medical literature concerning guaifenesin; I found no connection between guaifenesin and schizophrenia. --Una Smith (talk) 00:18, 8 September 2008 (UTC)

Another possible 'facet' of this label.

The complexity of this label schizophrenia, reflects what the pioneers of this disease noted, IT IS A COMPLEX WEB OF FACTORS.

Here is one possible factor, that combined with others may make sensitivity to drugs, and disease more pronouced.

Problem is that some links suggest even common infections like giardia are difficult to diagnose in the first place. This may set into motion the complexity of symptoms.

Combine this with a genetic liver problem or sensitivity to some disease, ie beaver fever, or giardia... Cirrhosis of the Liver - Toxins of the blood

The mental confusion symptom found in such situation may then again be complicated by the environmental factors that may become part of the greater puzzle.

Anyway, that is why I have suggested links to these other relevant sources, foggy brain, mental confusion, that may be further aggravated by 'sensitive conditions' such as child birth, underlying disease, or comprised organs such as liver or kidney.

The complexity of contributions and the difficult of diagnoses is the greater problem.

(oh and by the way, we have not included spiritual and religious forces that may be at play that are already suggested in some cases.

There are sites to all these half-truths already.

This label may be a matrix of conditions, and it is probably worth while showing possible links.

It is also worth mentioning the phenomena of paradoxical effect that adds another dimension to the complexity of this disease.

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 14:48, 6 September 2008 (UTC)

To add section on medical error ignoring drug ingredients that cause schizophrenia.

• Some medications like bromocriptine, and prescription or nonprescription drugs containing the drug ingredient phenylpropanolaminemay also cause or worsen psychotic symptoms.

Some doctors are not aware or ignore that possibility that ingredients or drugs, be they over the counter or prescription can cause 'schizophrenic' like conditions.

As some historic cases show, failure to identify these drug elements as the cause of the psychosis, and its many variants, results in the label of schizophrenia.

Perhaps that is why there is no known cause. It is (in some or many cases) the result of not identifying the cause at work. Be it a side effect or bacterial cause.

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 14:49, 9 September 2008 (UTC)

Upon thinking about it, this is best placed at psychosis, which I have done. By definition under DSM IV TR, if "schizophrenia" hasa clear cut cause, it is a drug-induced psychosis, or one due to a General Medical Condition, and hence should be there and not here. Cheers, Casliber (talk · contribs) 15:00, 9 September 2008 (UTC)

Let me play the devils advocate if a patient is unknowingly given a street drug, and the doctor does not check for one, perhaps based on the assumption that this person does not do drugs, then the label may be applied?

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 16:52, 9 September 2008 (UTC)

Poor Stigma Strategy

If the line betweeen 'known causes' of schizophrenia conditions is unclear, human falibitlity, why are not the known causes being communicated to down grade the label of 'mental illness' ?

Can for example 'mental confusion' caused by an infection be mistaken if testing for infections is not perfect ?

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 16:55, 9 September 2008 (UTC)

This is the talk page for discussing improvements to the Schizophrenia article. It is not a general chat board for identifying and countering societal prejudices. WhatamIdoing (talk) 19:18, 9 September 2008 (UTC)

• Perhaps I have not made myself clear, why are the logical, organic or biological causes for schizophrenic like conditions being used to expose the treatable causes of this disease and eliminate the stigma ? Are we dealing with political pressures similar to those we encountered with the cigarette industry. Case in point, the article failed to discuss any prescription drugs that could cause schizophrenic symptoms. (Now remember if they identify the drug, then is not schizophrenic, merely schizophrenic like, if they can't or they do not identify the drug, then it is schizophrenia.

Looking at the article in a logical way, as we did with spousal abuse to show that it was flawed.

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 03:35, 10 September 2008 (UTC)

Perhaps I have not made myself clear: the content of Wikipedia is limited to what reliable sources say. Your personal, original theory that physicians are unaware of schizophrenia-like drug side effects and the prevalence of drug abuse or idiopathic reactions to chemicals, or that they are unable to tell the difference between drug side effects (which normally wear off in a matter of hours) and persistent mental illness (which can go on for years) is irrelevant. Contrary to your apparent belief, if a new patient turns up in the emergency room with afebrile hallucinations or other schizophrenic-like symptoms, the ER doc's first thought is that there is probably an unfortunate drug (including alcohol) reaction, not that the person must have a persistent mental illness.

This article correctly reflects what the reliable sources say on this subject. Unless you can produce reliable sources that support your view, then your comments here amount to general chatting about the subject, instead of an effort to improve the article.

There are many general chat boards on the internet that I'm sure would welcome your presence. WhatamIdoing (talk) 18:22, 10 September 2008 (UTC)

First of all my opinion is based on actual cases, and references provided such as PPA, that show clearly that 'some' cases were in fact incorrectly labled as schizophrenic.

---

A report from the Dept. of Psychiatry, F. Edward Hebert School of Medicine, Bethesda, Maryland in Pharmacopsychiatry states:

We have reviewed 37 cases (published in North America and Europe since 1960) that received diagnoses of acute mania, paranoid schizophrenia, and organic psychosis and that were attributed to PPA product ingestion. Of the 27 North American case reports, more reactions followed the ingestion of combination products than preparations containing PPA alone; more occurred after ingestion of over-the-counter products than those obtained by prescription or on-the-street; and more of the cases followed ingestion of recommended doses than overdoses.

Failure to recognize PPA as an etiological agent in the onset of symptoms usually led to a diagnosis of schizophrenia or mania, lengthy hospitalization, and treatment with substantial doses of neuroleptics or lithium.

---

(I suspect that many cases of schizophrenia are in fact a combination of critical factors, ie a weakened system, caused by an undetected infection and a stress factor like a PPA drug, that is I belive some type of amphetamine...

It is also important to this topic to understand the paradoxical effects of some sedative drugs..Serious complications can occur in conjunction with the use of sedatives creating the opposite effect as to that intended. Malcolm Lader at the Institute of Psychiatry in London estimates the incidence of these adverse reactions at about 5%, even in short-term use of the drugs. The paradoxical reactions may consist of depression, with or without suicidal tendencies, phobias, aggressiveness, violent behavior and symptoms sometimes misdiagnosed as psychosis.

Oh and by the way, here is a timely report on "Scientific and Educational influences" by the Pharmaceuticals, and their students, many doctors.

In Canada the government has moved to remove the influence of drug companies on the medical system. "The influence that the pharmaceutical companies, the for-profits, are having on every aspect of medicine ... is so blatant now you'd have to be deaf, blind and dumb not to see it," said Journal of the American Medical Association editor Dr. Catherine DeAngelis.

My conclusion is that this article is failing to include important critical information that can be verified by those who are regular posters and defenders of this site.

This article needs more balance.

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 04:18, 12 September 2008 (UTC)

Problem is Caesar, I doubt your ability to separate signal from noise. we could cherry-pick articles stating all sorts of obscure, weird and wonderful causes and observations only tangentially linked to this article. I hate to 'pull rank' as it were, but I work in the field, and I am trying to veer away from material that is just not seen clinically, despite being published in a peer-reviewed article. Yes, drug company influence is a general concern and there is clearly a place for discussion o nthat somewhere in WP, paradoxical agitation from sedatives is pretty rare, much rarer than that study, but every clincian has been reminded of it far more often than it actually occurs. Cheers, Casliber (talk · contribs) 04:39, 12 September 2008 (UTC)

Caesar, accountants have a notion that they call material. That is, if you're reporting the companies earnings to the nearest million dollars, the price of a single box of paperclips is not material. You cite a source that reviews thirty-seven misdiagnoses across two continents, over four decades. Out of what, five million people that have/had this condition in those populations and over those years? Do you really think this article would be improved by saying "One in 150,000 patients are misdiagnosed with schizophrenia or related conditions when they actually have a strange reaction to PPA"? Is the misdiagnosis of 0.0007% of patients really material to this article? WhatamIdoing (talk) 17:40, 12 September 2008 (UTC)

Error

Oh and by the way, PPA is not a drug but a drug ingredient.... Health Canada withdraws drug products containing phenylpropanolamine (PPA) from the market

I have made the correction if no one objects.

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 03:35, 10 September 2008 (UTC)

This is wrong. PPA is a drug -- technically, a nonmonograph (Category II) drug over safety concerns. A drug plus other drugs and/or non-drug ingredients is a drug product. The two terms ("drug" and "drug product") are not interchangeable. WhatamIdoing (talk) 18:07, 10 September 2008 (UTC)

schizophrenia is idiopathic. Scientists don't know why people are diagnosed. But they know for sure that it cannot be caused by anything before birth nor early life. The theries metioned in the article on drugs and genetics however, could be correct. —Preceding unsigned comment added by Kh1995 (talk • contribs) 06:09, 14 September 2008 (UTC)

Cannabis causing schizophrenia?

I'd like to see a source on that in the article. —Preceding unsigned comment added by 24.70.132.87 (talk) 14:16, 21 September 2008 (UTC)

Causes and Irish wave

Patrick Tracey claims [11] that having an older father is a risk factor due to sperm mutations, that famine might be a cause, and that there was a wave of schizophrenia in Irish immigrants to the U.S. Have these claims been studied or verified? -- Beland (talk) 17:40, 3 October 2008 (UTC)

A bit of Google-Scholaring tells me that (1) there is a lot of high-quality evidence that having an older father increases the risk of schizophrenia, although it isn't necessarily caused by sperm mutations; (2) some evidence that first and second generation immigrants (not necessarily Irish) have an increased schizophrenia risk; and (3) strong evidence that prenatal famine increases the risk of schizophrenia. One shouldn't necessarily make too much of this: there are lots of things that increase the risk of schizophrenia. Looie496 (talk) 01:59, 4 October 2008 (UTC)

Also see the hypothesis by Dolores Malaspina at Schizophrenia Research Forum. Might be added to the causes of schizophrenia article. --CopperKettle 05:08, 10 January 2009 (UTC)

Dissociative disorder

Are a dissociative disorder and schizophrenia related in any way? And which one would the movie/book Fight Club go under?----Kingforaday1620 (talk) 22:12, 3 October 2008 (UTC)

It would go under 'fiction', someone with a florid fantasy world..more like dissociative identity disorder (renamed Multiple personality disorder) really. I wouldn't put it in until you have an authoritative ref discussing it though...hmm...I may have a look myself... Cheers, Casliber (talk · contribs) 23:19, 3 October 2008 (UTC)

Cleanup list

Recent edits have introduced some breaches of WP:MOS, and have been reverted by the editor making them, so I'll leave a list here of MoS cleanup needed:

• Wikipedia:MOS#Bulleted and numbered lists these edits incorrectly introduced numbering and capitalization, and do not comply with MOS: [12] [13]
• WP:PUNC, logical quotation review needed, I caught a couple
• This edit introduced WP:HYPHENs instead of endashes, will also need to be fixed.  Done one anyway
• This edit, to correct a left-aligned image under a third-level heading, per WP:MOS#Images and WP:ACCESS was reverted, needs repair.  Done
• The image caption in "Schneiderian classification" needs serious shortening per WP:MOS#Captions.  Done

SandyGeorgia (Talk) 01:00, 11 October 2008 (UTC)

OK, I'd like to begin MoS cleanup again. The bulleted lists are still out of compliance. The numbers shouldn't be there, and they have to choose between sentence case or lower case, per Wikipedia:MOS#Bulleted and numbered lists. The article previously used lower case, and there's no reason for one editor to change long-standing article convention without talk consensus, so unless you all want sentence case used for some reason, I'll restore a correct version of lower case. If you do want Sentence case, then I'll do it correctly. Right now it's neither-nor. Pls let me know. And I'll start going through for other MoS issues. SandyGeorgia (Talk) 04:50, 13 October 2008 (UTC)

Go for it. I could argue either way for numbers or bullets, so happy to go with the flow. For some reason I have been doing sentences WRT various lists such as subspecies of various birds etc. so that is what I am more used to, though lowercase and words would be fewer words. Again, whatver is more aesthetically pleasing style-wise is fine by me. Cheers, Casliber (talk · contribs) 05:13, 13 October 2008 (UTC)

• The numbered list is there for clarity; otherwise, nested bullet points would make it difficult to see the distinction between the "all 3 must be present" and "pick any 2". I'm not sure this strictly follows the Manual of Style recommendation, but the MOS allows for common-sense exceptions where it would improve an article. I think the numbering is an improvement; is there a better way to clearly communicate the same thing? -- Beland (talk) 14:56, 14 October 2008 (UTC)

• Wikipedia:MOS#Bulleted_and_numbered_lists conflicts with Wikipedia:Lists#List_styles. I prefer (and generally edit to conform to) the latter, which calls for capitalizing the first letter, and putting no punctuation at the end of sentence fragments. I dislike the need for having a period at the end of only one list item, which I was trying to avoid. I will bring this up on the MOS talk page to resolve the contradiction. -- Beland (talk) 15:07, 14 October 2008 (UTC)

• Yes, I've seen many complaints about that List page, which mostly comes from WP:FLC people and has little to do with the prose people of WP:FA who edit for prose and follow WP:MOS. I follow the main MoS page and cannot recall ever seeing a FAC ask that LISTS be used in place of the main MoS page. It's an artefact of Featured lists and doesn't result in good prose. The current text is unsightly and would be in any professional publication. SandyGeorgia (Talk) 18:07, 14 October 2008 (UTC)

I see no reason to number rather than bullet. Generally, numbering signals to the reader that the order or sequence or total number are at issue, or perform a useful ID function for cross-referencing. In the absence of such functions, numbering is redundant compared with bullets. Minimal formatting is usually preferable. Tony (talk) 06:35, 15 October 2008 (UTC) PS That Lists page has been like an unweeded, unwatered garden for a long time. It needs a thorough renovation. I'd take my cues from other style manuals and plain logic. Tony (talk) 06:36, 15 October 2008 (UTC)

Jargon vs plain english

One of the biggest challenges is to replace jargon with plainer words without losing meaning. I try to do this whereever possible, however, as I use the jargon every day at work, I can lapse slip into using it without thinking. One criticism is that this article is too jargony. Thus, if people list offending words or segments here, we can see if we can simplify them without losing meaning. Cheers, Casliber (talk · contribs) 12:33, 10 October 2008 (UTC)

• insidious was mentioned before. This word is a vital part of the medical vocabulary, as it has a connotation of gradual and ominous and progressive packaged nicely in the one word. I can't see a plainer adjective to use which captures its essence, and thought this word was in common usage anyway.

To me, "insidious" reads as "evil and creeping", like kudzu. As a layperson it sounds like a horror-movie term, not a medical term, so I guess I'm not familiar with the professional definition. -- Beland (talk) 06:33, 11 October 2008 (UTC)

Fair enough, we use the word all the time. The context sounds the same. Actually, reading it back, gradual is not too bad a substitution really. Cheers, Casliber (talk · contribs) 06:17, 12 October 2008 (UTC)

3 more questions copied from the review page... -- Beland (talk) 06:33, 11 October 2008 (UTC)

• What's the difference between a delusion and a hallucination?

  The former is an erroneously held belief which generally resists argument, the latter is mistakenly hearing imaginary voices (in the case of auditory ones, which they usually are). The two key symptoms really. Gotta run - I'll come back later. Cheers, Casliber (talk · contribs) 06:54, 11 October 2008 (UTC)

• What's "derailment"?

  This isn't bad --> Thought_disorder#Specific_subtypes_in_detail. You see all these, derailment specifically is where the subject matter changes and does not return to the original material.

• What's a psychomotor disturbance?

• People look and sound globally 'slowed down' in Psychomotor retardation, or sped up in psychomotor agitation, which is seen in mania. Cheers, Casliber (talk · contribs) 13:57, 11 October 2008 (UTC)

  Your definition of "psychomotor agitation" is different than the article Psychomotor agitation. One of the references says the agitation in major depression should not be confused with mania, but neither of those are schizophrenia. Does the DSM actually use the term "psychomotor disturbance"? -- Beland (talk) 02:30, 12 October 2008 (UTC)

  Sorry, I was tired when I wrote the above and it is a little more complex. Purposeless agitation is seen in catatonia, irregular confused movements. A classic picture of central retardation and peripheral agitation is seen in melancholic major depression. This is where the person is slowed or still, often classically hunched over and ringing their hands and fidgeting, as the muscles of the trunk are still, but of the limbs from elbows to fingers are restless. Global restlessness and increased energy are seen in mania, but can also be seen in anxiety and highyl aroused people regardelss of diagnosis. Cheers, Casliber (talk · contribs) 06:16, 12 October 2008 (UTC)

I'll have a look at the wording. Cheers, Casliber (talk · contribs) 13:57, 11 October 2008 (UTC)

Psychomotor agitation occurs commonly in mania but isn't restricted to it (i.e. it's a symptom that may occur as part of, or independently of, diagnosable symptom clusters). I think we should also be free to use terms that don't appear in the DSM, as despite it's nickname, it's not a bible. It's more important to use the medical literature as a resource - Vaughan (talk) 04:34, 12 October 2008 (UTC)

Vaughan is right - DSM is bare bones-like really and there is a richness of literaure on phenomenology (thought disorder etc) which is not captured in DSM as it is too detailed. Cheers, Casliber (talk · contribs) 06:19, 12 October 2008 (UTC)

I like the image but....

I have been pondering this since it was placed on the page. I love the image of the house with the messages indicative of a florid delusional system of the homeowner, but I have been agonising about BLP issues (of whoever lives in the house) and OR I suppose..Cheers, Casliber (talk · contribs) 04:44, 13 October 2008 (UTC)

I think it's not particularly adding to the encyclopedic quality of the article, and suggest removal. SandyGeorgia (Talk) 04:47, 13 October 2008 (UTC)

I'm in favour of having the image, because I think it is an excellent illustration of the symptoms that could fit with schizophrenia. First of all, this image is already publicly available on Flickr -at least some vital details were omitted when I uploaded the image to Commons. Second, there are multiple images which are worse, in that they show identifiable persons. I know it might feel weird to show someone's intimate thoughts, but I'd like to point out, these are neither thoughts (it's the disease talking) nor intimate (the home owner already shows it to the whole world).

This kind of image might be one of the rare images which actually shows a symptom of schizophrenia; I don't see how we can do something similar like the stacking of objects shown in Autism. The image was removed by Vaughan (talk · contribs), who noted in the edit summary that it is "neither confirmed nor typical of schizophrenia". If you have seen and read the images on Flickr, you know that it is delusional, which is at least a symptom of schizophrenia. So I really don't see how this would not be typical, and confirmed doesn't matter; the kid autism might as well have a different autism-spectrum disorder.

I don't agree with the WP:OR argument either; then we should be removing all dermatology images and descriptions as well. In my initial description, I wasn't putting forth a new theory or something, and I think almost any psychiatrist would agree with this minimal interpretation. It's like the image of the children on childhood obesity; are we violating their personality rights? Is that image OR?

I'm not fanatic about this (contrary to what you might think from this posting), if I can't convince you that this really adds encyclopedic value, than let's leave it out. --Steven Fruitsmaak (Reply) 22:40, 17 October 2008 (UTC)

I think it would be okay to keep the image, but I'm inclined to give it a caption that carefully focuses on the content of the signs (which go on about "hypnotic warfare" and assert that a grocery store is poisoning the inhabitant) and how they illustrate delusions -- but without making any assertions about the inhabitant(s)'s actual health. WhatamIdoing (talk) 01:25, 18 October 2008 (UTC) (See here for the full set of photos; most close-ups are readable.)

No look, I have to say I am very conflicted and I have agonised about this. There is a difference in that there are other phenomena which can/could explain a rather, erm, detailed exposé on the workings of government. There are those with various personality disorders (paranoid and various cluster B come to mind) who may hold some similar views, and don't forget the diverse array of far-right/far-left/extremist/fringe groups in the US and elsewhere many of whose members may have extremely bizarre views. What this then means is that we cannot automatically assume the material is written by one with schizophrenia, unlike a photo of an obese person, or a dermatological picture with pathognomonic symptoms. We can see what some more folsk think for a broader consensus. I'll post a note on WT:MED and the psych wikiproject page too. Cheers, Casliber (talk · contribs) 13:38, 18 October 2008 (UTC)

Even if they could be explained by other things (which we can both agree are less likely), the most likely explanation is schizophrenia, and therefore it is a useful illustration. --Steven Fruitsmaak (Reply) 14:18, 18 October 2008 (UTC)

←Vaughan (talk · contribs) removed the image without discussing so here. I have undone the removal until consensus is determined a bit more clearly. I don't know enough about the subject to get involved so I'll stay neutral on this one. —Cyclonenim (talk · contribs · email) 14:00, 18 October 2008 (UTC)

I don't like the current caption very much. Instead of characterising this as bizarre delusions, I'd much rather mention things like the feeling that ultrasound was used to control thoughts. That's the reason I put it under Schneider. --Steven Fruitsmaak (Reply) 14:19, 18 October 2008 (UTC)

Very difficult to illustrate schizophrenia pictorially. I've seen some cool paintings by schizophrenic patients, but I'm not sure any are licensed usably, or how informative they would be anyway. In some sense the best illustration would be a photo of a guy wearing a tinfoil helmet, but there are obvious issues with that sort of thing. Looie496 (talk) 15:51, 18 October 2008 (UTC)

Unless someone has some proof of schizophrenia, the photo is original research, and we can't have that in any article, much less a featured article. I already opined that I don't think it's encyclopedic, but violating core policies (WP:OR) is not where we want to go here. We don't have anything connecting the image to schizophrenia except a hunch. SandyGeorgia (Talk) 18:46, 18 October 2008 (UTC)

We shouldn't be using illustrations from individuals. As with everything else in the article, illustrations should be taken from the medical and scientific literature - Vaughan (talk) 21:29, 19 October 2008 (UTC)

My point was that we don't need proof: it could fit schizophrenia (have you read the descriptions? unlikely to be something else), and therefore it is illustrative. Just like the ECG's on heart attack could be something else (Takotsubo cardiomyopathy?) unless we have troponins, but we use them anyway. It illustrates a symptom, and diagnosis is based on symptoms. Any photo is borderline OR (take the description of the ECG's or description of a skin rash for example), that's why photos were initially stigmatized on Wikipedia. But I believe we have moved beyond that stage. --Steven Fruitsmaak (Reply) 18:53, 18 October 2008 (UTC)

Sandy's point is why I think the content of the caption requires attention. "Here's the home of a person that probably has schizophrenia" is likely original research. "Here's a house with signs on it that say the government is controlling the occupant's thoughts through hypnotic warfare and ultrasound waves, that the grocery store is poisoning his food, and that the government insisted that he see a psychiatrist to continue getting his disability benefits check" is not. That's a plain, trivially verified description of what is actually in the picture. WhatamIdoing (talk) 19:20, 18 October 2008 (UTC)

It's also just a very poor quality picture that is detracting from the article rather than adding to it; I can't even read the lettering. Anyway, there are at least 400 FAs that need serious attention to real problems, so I'm going to unwatch here now, discussion over one image isn't the best use of time, and I'm not fussed too much about this one way or another ... I just don't think it's a great image. Asthma is in very bad need of attention for anyone who has time to spare, and we also need some guidance on how to close Menstrual cycle at FAR. SandyGeorgia (Talk) 19:24, 18 October 2008 (UTC)

There are images available where you can read the lettering; however, I feel this would add to BLP concerns. --Steven Fruitsmaak (Reply) 20:19, 18 October 2008 (UTC)

Can you provide confirmation that the person was diagnosed with schizophrenia? BTW, I note there was no consensus reached on the talk page before the image was added. - Vaughan (talk) 21:11, 19 October 2008 (UTC)

I think you're right about the fact that our lack of consensus means the image should be removed. But, as I keep telling you: proof of a diagnosis is not needed to illustrate a symptom, or something that could be a symptom. If I see a naevus that has the features of a melanoma, I'll take a picture of it and use it on the melanoma article, even without biopsy results. --Steven Fruitsmaak (Reply) 21:44, 19 October 2008 (UTC)

Then the picture should be removed because it should be taken from the peer-reviewed medical literature. It needs to be verified and cited. As a delusion can present in almost any fashion, you could justify a picture of anything with the same logic. - Vaughan (talk) 02:34, 20 October 2008 (UTC)

I think it would be hard finding such a good example in the peer reviewed literature that is freely available, that almost certainly doesn't exist. Should we verify and cite all images? What is that based on, WP:OR? What about the child stacking items from the fridge in Autism? What about the picture of the child in Down syndrome? Images are almost always partially OR. --Steven Fruitsmaak (Reply) 08:06, 20 October 2008 (UTC)

Vaughan, I think you're missing the point. We don't want to say, "Here's a house occupied by a person with schizophrenia." We want to say, "Here are some hand-written posters that communicate a delusion about hypnotic warfare and poisoning." For all we care, the signs could actually be a public art installation, part of an advertising campaign by a mental health activist, or something put up by a professor of psychiatry as an example for his/her students. It doesn't have to be real to be usefully illustrative -- just like Autism can have a picture of any child stacking blocks as an illustration of a common sign of autism. It also doesn't have to be certified by an official expert to be usefully illustrative -- again, just like Autism can have a picture of any child stacking blocks as an illustration of a common sign of autism, even if that child is a non-autistic child that is being paid as a model, or is just playing for a few minutes in his own house. WhatamIdoing (talk) 20:12, 20 October 2008 (UTC)

Block stacking is a typical behaviour that is widely documented and can be illustrated by a picture. A delusion is a mental state which can express itself it many sorts of behaviour and having lots of hand written signs outside the house is not typical and not illustrative. These atypical presentations needs to be referenced and cited. There are many more typical examples that have been widely discussed in the literature ([[e.g. the air loom as an illustration of passivity delusions). The picture does not typically illustrate delusions, let alone schizophrenia, and should go. If you really believe that this is a typical and informative illustration, just provide reference to the medical literature which backs this up - Vaughan (talk) 22:46, 20 October 2008 (UTC)

It's not the posters outside the house that are typical, it's the content which you can read. The feeling that "they" are using ultrasound to control the brain is a typical Schneiderian phenomenon which needs no citation, certainly not in combination with the other typical phenomena such as the suspicions against the government and psychiatrists. --Steven Fruitsmaak (Reply) 23:19, 20 October 2008 (UTC)

Vaughan, have you actually read the content of the posters? WhatamIdoing (talk) 01:26, 21 October 2008 (UTC)

← Vaughan is right because the behavior can be caused by any number of causes. Can you prove with WP:RS that the inhabitants of the house are diagnosed schizophrenics? I suggest you use some quotations from "Schizophrenic Speech" by McKenna and Oh if you want to illustrate disordered thinking associated with schizophrenia. That's a lot better than having readers squint at some photo to discern the writings on the wall. VG ☎ 12:46, 22 October 2008 (UTC)

Let's close this discussion as "no consensus", as we seem to be going in circles. I like your suggestion: if we can have some quotations without copyright violation, that would be great. --Steven Fruitsmaak (Reply) 12:59, 22 October 2008 (UTC)

Arbitrary break

←Why was the image removed? If a discussion is closed as "no consensus" then I'm pretty sure it's supposed to be default to it's original state, i.e. with the image. I'm not involved in this debate, just curious. —Cyclonenim (talk · contribs · email) 22:40, 22 October 2008 (UTC)

It's a rhetorical question: the image was added without consensus by me (so the default is without the image), then removed without discussion by someone else. I agree that it should be removed, and an alternative has been suggested. --Steven Fruitsmaak (Reply) 22:45, 22 October 2008 (UTC)

Ah fair enough. I didn't realise you added the image before the debate, thanks for the clarification. —Cyclonenim (talk · contribs · email) 22:57, 22 October 2008 (UTC)

Little bit late, but I figured I could add some value by making a contribution to the discussion. Vaughn has made good points, in the fact that the image, though illustrative and useful, is still misleading. A hypothetical picture of a well dressed man sitting on a chair who has schizophrenia would be accurate, but not helpful to the article. Given the nature of the disorder, its good judgment to be extremely careful of the images we use to support what the article says. If we could safely assume that everyone who reads our article had a baseline understanding of mental disorders, then we could be more lenient and the picture is a very good illustration of possible behavior of someone afflicted with schizophrenia. Biologicithician (talk) 15:28, 25 October 2008 (UTC)

DSM-IV-TR

done, just trying out some templates

Why is the "Standardized criteria" section alternately mentioning DSM-IV and DSM-IV-TR? It was my impression that the Text Revision did not affect schizophrenia. Is that incorrect? If correct, why is the TR even mentioned ? SandyGeorgia (Talk) 05:08, 13 October 2008 (UTC) Summary of practice changes relevant to DSM-IV-TR. SandyGeorgia (Talk) 05:44, 13 October 2008 (UTC) Hmm. Strictly speaking, the whole shebang is now DSM-IV-TR and should be referred to as such (even though the cirteria for scz did not change as such). period. I will check this out. Cheers, Casliber (talk · contribs) 05:53, 13 October 2008 (UTC) So maybe we should remove DSM-IV ? We should use only one so as not to confuse readers, who probably don't know what a Text Revision is :-) SandyGeorgia (Talk) 05:59, 13 October 2008 (UTC) By the way, here's my Tony/Eubulides' approved wording: According to the revised fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), ... SandyGeorgia (Talk) 06:00, 13 October 2008 (UTC) Done, FWIW. Cheers, Casliber (talk · contribs) 02:36, 18 October 2008 (UTC)

Violence refs

I combined the five sources (unsightly) to one set of ref tags, but seriously: five citations on a simple statement send up a solid redflag that there is original research rather than reliance on a high-quailty, peer-reviewed secondary source here.[14] SandyGeorgia (Talk) 05:35, 13 October 2008 (UTC)

can ordinary people help people with schizophrenia?

i mean, i havea close friend who said that she had schizophrenia, and i just tought she just feels like that. but then after a while she changed totally to opposite way as she normally didnt like blue but she is a fan of it now! and then she just hated blue and now she is again a fan of blue.. do these kind of disorder things mean she haas schizophrenia? and if she has what shall i do, i mean, i know this is not a form page but this is i think what interest the people most.. i read and i think she is kinda disorganized type and catotanic type but i dont know how can i offer her a therapy to her for a physcothreapist? well i hope someone answers to this and thanks for the time you at least spent on reading.88.244.58.121 (talk) 08:57, 20 October 2008 (UTC)

We don't give medical advice. If you have concerns someone might have a mental disorder, please seek help. --Steven Fruitsmaak (Reply) 15:30, 20 October 2008 (UTC)

Indeed we don't give medical advice, but there is a relevant point here: as the IP points out, one of the things readers will come here wanting to learn is how to tell whether somebody has schizophrenia. The article addresses that, of course, but it might be worth thinking about whether it could do so more directly. Looie496 (talk) 16:51, 20 October 2008 (UTC)

Hgurling's edits

I've reverted the whole of these changes by User:Hgurling for now, since there were multiple issues with biased language ([15] (unfairly, cruelly), [16] (flawed)) and bad sentence structure ([17]). I also think some of the edits adds unneccessary detail ([18]), making the text harder to read for non-professionals. Some of this content might be very much useful in the article. However, I am not qualified to judge this. Assuming Hgurling is Prof. Hugh Gurling, he is an expert on the field, which is very much welcomed, but there could be conflict of interest issues with quoting his own work. I hope someone more qualified can take a closer look at this and similar work at bipolar disorder. /skagedal^... 09:07, 30 October 2008 (UTC)

These seem like minor objections, not justifying a full revert of changes that apparently add a lot of useful information and correct a number of errors that are more serious than the ones you pointed out. Let's try to settle this question quickly, because it seems to me that it would be a real shame to waste all the work that Dr. Gurling put into the article. Looie496 (talk) 16:19, 30 October 2008 (UTC)

I see nothing in those edits that is worth serious concern= it's just the use of wording that in the context of WP amounts to OR, or drawing a general conclusion on the basis of evidence beyond what we normally do. any academic might write that way, and it just take a little orientation to be accustomed to our conventions, which are necessary and appropriate in our special context. DGG (talk) 18:49, 30 October 2008 (UTC)

They are generally accurate but there are some claims which are a little wide of the mark and unreferenced. e.g. "However the genetic linkage studies have shown replicated evidence of linkage using only two or three levels of diagnosis and it seems that isolated "psychotic" symptoms may have nothing to do with the actual disorder". This is contrary to a number of studies suggesting a continuum of psychotic symptoms throughout the population in multiple domains (not just schizotypy) that share both risk factors and neurocognitive mechanisms - e.g. PMID 15935129; PMID 16198238. Furthermore, almost all genetic linkage studies have been done on clinical cases so it is hard to extrapolate to shared risk factors for isolated symptoms. However, a recent twin study has found significant associations between stress reactivity and both frank psychosis and sub-clinical psychotic symptoms (PMID 18822092) suggesting that there may be genetic support for the continuum model. Within clinical cases, genetic research has also found continuums of symptoms rather than syndromes (PMID 17551090). BTW, none of this is at all "inconsistent evidence from identical twins who share the same genes but can have widely different symptoms" owing to the importance of gene x environment interactions in schizophrenia (see PMID 18791076).

"Most authorities do not think further refinement of diagnosis is needed until actual aetiological DNA base pair changes are found in the genes actually causing the disorder. When this has been achieved then diagnostic categories can be revisited." - where is the evidence for this? In fact, some of the most prominent genetic researchers are arguing that the Kraepelinian distinction between schizophrenia and bipolar should be abandoned (see PMID 17551090 again, and various other papers by the same research group; also PMID 16801952). Outside of the molecular genetics world, there is still a great deal of debate about the diagnosis of schizophrenia especially with the forthcoming DSM revision (e.g. review in PMID 18627674).

Deleting statements where people have argued in the published literature against the diagnosis of schizophrenia is just bad form. Deleting reference to the Rosenhan experiment, one of the most widely discussed in the field, is especially so. The material about the caveats of genetic research is useful and was replaced by a long list of (useful) research findings, but these need to be maintained.

"Stressful life events preceding the acute onset of schizophrenia are almost certainly a result rather than a cause of the disorder" - references an old paper when work on gene x environment interactions has moved on (see PMID 18791076 again), plus there is now a number of studies showing childhood abuse raises risk of psychosis (review in PMID 16223421)

"Psychotherapy is not recommended for the treatment of acute schizophrenia and its use should be confined to patients who have already recovered using antipsychotic drugs". This is ambiguous as the use of CBT in acute psychosis is support by RCTs (e.g. [19] although the UK clinical guidelines only recommend it for early post-acute phase (see [20]) although this does not imply recovery, and the treatment of medication resistant symptoms by CBT is also supported by RCTs (e.g. PMID 12668405; PMID 10665619).

Completely deleted the bit on Tim Crow's work! He's certainly got a quite different view to other researchers, but is a widely published researcher on the neuroscience of schizophrenia.

I agree about the use of some rather strong words that deviate from the neutral language that should be used.

- Vaughan (talk) 21:48, 30 October 2008 (UTC)

OK, interesting developments, I have been a little busy elsewhere. I largely agree with Vaughan's analysis above and will plan to look through to see what can be incorporated. I always had heard an esitmate of 40-50% with monozygotic twins, so was surpised to see this study with a much higher one. can'd do this straightaway but maybe in a few days. Cheers, Casliber (talk · contribs) 22:40, 30 October 2008 (UTC)

It's a bit troubling that no one bothered to welcome this new user: I just did that. A full revert was also a bit ... abrupt; there seemed to be some issues worth investigating. I continue to be troubled at the overreliance of primary sources; it would be nice to see generally here discussions and edits based on secondary high-quality sources and reviews and less stringing toghether of primary source studies. It would be helpful to better orient this user rather than reverting without a welcome. I'll leave some additional messages on his/her talk with some editing tips. While a better orientation to encyclopedic vs. journal writing might be in order, there were some very good edits there, perhaps some updates to outdated information, and some cleaning out of some possibly WP:UNDUE sections in this article; I'm not sure I endorse the wholesale revert, but I've encouraged him on his talk page to consider editing more slowly and using the talk page here. SandyGeorgia (Talk) 01:58, 1 November 2008 (UTC)

Someone might also want to have a look at his edits to Bipolar disorder. His expertise is certainly welcomed there as well, but I think WP:COI WP:NPOV might again be an issue. Cosmic Latte (talk) 11:08, 1 November 2008 (UTC)

On second thought, it might be a bit harsh to throw WP:COI at a new user, but there's still a problem. Cosmic Latte (talk) 20:42, 1 November 2008 (UTC)

SandyGeorgia and others – I do recognize that the "full revert" might have been a bit drastic, and I will not oppose a "re-revert" of edits that are appropriate. I just thought that, as a whole, the version I reverted to was an article of better quality than this version, because of several issues like the ones I pointed out above. Being a featured article, I think it should remain at all stages an article of good quality. I could have reverted to just the edits of the "Genetics" section, it is the edits after that I am mainly critical of. I did say "welcome" to this new user; good thing that you, SandyGeorgia, welcomed him in a more appropriate manner. It was not my intention to be unfriendly to a new contributor, I'm very sorry if that was the effect of my action. Looie496, when you say that he did "correct a number of errors that are more serious than the ones you pointed out", what errors are you specifically referring to? /skagedal^... 23:33, 1 November 2008 (UTC)

I think he probably corrected some things relating to the roles of various factors in causing schizophrenia, but I will be the first to state that I know far less about this topic than either you or Gurling, so I don't want to get into an argument. My main reaction was dismay at the mass revert of contributions from somebody who is clearly an expert in the field. People new to Wikipedia don't understand bold-revert-discuss -- my first group of edits were to hippocampus, and were about as problematic as hgurling's in several ways, but if somebody had bulk-reverted them, I'm sure I would have walked away from Wikipedia and never looked back. I think this particular case was probably a lost cause from the moment you did the revert, but I want to try to encourage for the future a principle that new editors who show expertise not be reverted until after thorough discussion. Looie496 (talk) 02:24, 2 November 2008 (UTC)

The edits added some important points that should be re-covered, e.g. about brain maturation, the historical controversy over blaming mothers, detail on the genetics. Seems that temporarily reverting was fair enough on an FA article given the complicated POV, and some of the detail might be more appropriate in the causes subarticle. This recent Nature article gives an overview of the genetics that also relates to the similar issues with the bipolar article; while sympathetic it also addresses the years of inconsistencies and failed replication attempts. It characterizes the recent linkage metanalysis differnetly than was here, and additionally includes the recent failure to find significant associations with any of 14 prior candidate genes[21] and also refers less euphemistically than was here to the limited (nothing significant in some cases) results from the recent genome wide association studies (live listing and summary) EverSince (talk) 22:14, 6 November 2008 (UTC)

induced

i believe it can induced through persistant drug use, notably cocaine. the symptons are the same after repeated and prolonged use of this drug. although most addicts have also remarked that they were attacked by demons which begs the question, is this hallucination or are repeated actions that cause self abuse effectively opening doors to a very malevolent spirit world. where does our belief and then treatment of such people start. give them a bible or medication, or both.

Schizophrenia is, by definition, not the physiological result of substance abuse. Cosmic Latte (talk) 11:10, 1 November 2008 (UTC)

However it is possible for substance abuse to trigger the onset of a psychotic break. Looie496 (talk) 02:27, 2 November 2008 (UTC)

OR Definition

That new definition that propped up recently is obvious OR, at least until proven otherwise by sources. Put back what all authoritative sources say (See refs). Defining a disease as a diagnosis may be a new funny victory for PC, but it contradicts all the sources as well as common sense: read what diagnosis (medical) is: "the recognition of a disease or condition by its outward signs and symptoms". Thus, are we talking about "the recognition" here? We talk about "a disease" itself.Muscovite99 (talk) 14:46, 5 November 2008 (UTC)

That wasn't new, been there ages. Two of the self-published website sources you've added are actually the same material, and the third contradicts them by calling it a mental disorder (as of course do the DSM & ICD). NIMH obviously is prestigious (and just as obviously has certain leanings) but the chronicity point in that brief sentence is contradicted by the World Health Organization (cf Prognosis section). Re. diagnosis, yes but this is to some extent an unclear and contested psychiatric diagnosis (even proponents accept it's unlikely to be a single condition with homogenous causation, which is why it's sometimes referred to as a syndrome), so attribution is more appropriate. EverSince (talk) 23:38, 5 November 2008 (UTC)

• I cannot see what you are saying: what do you mean by "self-published website"? The first is the site of a US government agency, the second is Britannica; there is no contradiction in the third. I am not about fine points (such as "chronic"), the point is that this article is about a disease/disorder/illness (pick whichever) -- not a diagnosis thereof.Muscovite99 (talk) 19:23, 6 November 2008 (UTC)

I personally would not mind if it were "...is a term to designate a disorder..." (the original wording, in fact).Muscovite99 (talk) 19:28, 6 November 2008 (UTC)

Yep I agree the Britannica material is a good comparison source (I see it refers to it as a group of mental disorders with widely varying features). I think "term to designate" would be unnecessary because it's implicit anyway; I think you make a fair point about whether "psychiatric diagnosis describing" was too, not sure. EverSince (talk) 21:57, 6 November 2008 (UTC)

• This is a case of Wikipedia:Verifiability -- pure and simple. If you want to introduce a definition that contradicts all the reliablу sources -- please discuss your proposal here. This OR definition having been here for long does not justify it being here.Muscovite99 21:01, 13 November 2008 (UTC)

I do'nt understand, Muscovite99, I haven't introduced or proposed anything; the lead summarizes the sourced article...you've rewritten the lead sentence citing 2 additional sources (+ a duplicate) which are contradictory (incl. on severity point) and the new wording is only in line with one of them, & contradicts ICD & DSM use of mental disorder (& the Wikilink). EverSince (talk) 23:27, 13 November 2008 (UTC)

The 'severe and disabling' language bothers me. The fact that schizophrenia can be severe and disabling doesn't mean that it will be severe and disabling. Also, what is the reader going to get from 'disabling'? Technically qualifying as a disabled person for legal reasons is different from being unable to work, and I suspect that the typical reader is going to take away the latter idea. Overall, I think that the recent additions are inappropriate. WhatamIdoing (talk) 01:43, 14 November 2008 (UTC)

• As i said above, the adjectives are not the point (i do not mind them being modified). The point is that it is downright wrong (both in terms of WP policies and common sense) to define a disease as a diagnosis. I understand that among the people personally affected this is a kind if established euphemism as the word "illness" tends to get tabooed; but what may be a conventional social norm, is unscientific in an encyclopedia. Muscovite99 (talk) 19:58, 14 November 2008 (UTC)

• That demeaning aside attributing the issue to people clinging to euphemisms, is what is downright wrong. You have no right to exclude any notable views from Wikipedia - as if there's a separate lesser group with homogenous views who do'nt have their own minds & can't be scientific (some of course are actually mental health professionals clinicians and scientists consultants etc). That's not to say there isn't very real suffering and a lot of disability in many cases (for various reasons) EverSince (talk) 09:35, 22 November 2008 (UTC)
• There was recently a consensus to keep the diagnosis wording, see mental illness section above. I did try to say I thought you had a fair point, pending consensus to change, but you try to a priori shut out the issue & dismiss the relevance of construct validity. You linked to diagnosis (medical) but it also says: "It should be noted however, that medical diagnosis in psychology or psychiatry is problematic...different theoretical views.... functional descriptions...vulnerable to circular reasoning due to the etiological fuzziness inherent of these diagnostic categories." Specifically in relation to sz (moved from below) - Deconstructing Schizophrenia for DSM-V --- Should DSM-V Be a Schizophrenia-free Zone?. You say you're not bothered about the adjectives but you restored them - with the same 3 sources noted to be contradictory & a duplicate of a NIMH public pamphlet. Here's what the American Psychological Association has to say about NIMH's perspective: "Finally, we hoped, NIMH would see the merit of critical commentary complaining that the Institute focuses too much on the brain and too little on behavior ... The failure of NIMH to capitalize on recent progress and opportunities within the behavioral and social sciences is disappointing, as work in those areas is critical for understanding the nature and development of the cognitive, affective, motivational, and social processes that go awry within mental disorders"[22] There may be a bit of an EU-US difference as well as an inter-professional one, in that experiential & environmental factors may tend to be more regarded in the former & there is perhaps more institutional skepticism towards psychiatric categories. EverSince (talk) 09:33, 22 November 2008 (UTC)

New Term: Salience Dysregulation Syndrome

It may be nice to link to this term so that it can be found by people that search for it to find this article. —Preceding unsigned comment added by 77.249.194.71 (talk) 11:16, 19 November 2008 (UTC)

It doesn't seem to have achieved enough notability yet to mention in this article. A Google search shows that the only information on the web is in Dutch, and Google Scholar gets no hits at all for the term. looie496 (talk) 16:22, 19 November 2008 (UTC)

Did you want Salience dysregulation syndrome to redirect to this article? WhatamIdoing (talk) 21:01, 19 November 2008 (UTC)

Yes, this is what I meant "a redirect", however, it is up to you to decide if it should ;)

My feeling is that the term needs to be used in an actual publication somewhere in order to justify even a redirect. Note that if we add a redirect, the Wikipedia article will surely become the first web hit for the term. looie496 (talk) 18:44, 21 November 2008 (UTC)

Earliest misdefinition of schizophrenia as "split personality"

The article incorrectly states the first time schizophrenia was (incorrectly) described as "split personality." It was not by T.S. Eliot in 1933 but rather by an anonymous Washington Post reporter in 1916.

The sentence in the entry should read, "The first known misuse of the term to mean "split personality" was in a 1916 Washington Post article about U.S. neutrality during World War I. The offender is an anonymous reporter quoting educational psychologist G. Stanley Hall, who had read Bleuler's work and that of other German psychiatrists. Thus, the misuse was widespread early-on among experts and not the result of the watering down or changing of the psychiatric terminology when it was popularized."

Tchussle (talk) 02:07, 30 November 2008 (UTC)

Looks good. I would say go ahead and put it in the article if you want to. If you're not sure how to format the reference, somebody will fix it. Looie496 (talk) 17:42, 30 November 2008 (UTC)

Suicidal risk in schizophrenia

My bother-in-law is a psychiatrist(Professor of psychiatry) in Chennai.He read teh article and felt that a few sentences or maybe a paragraph on suicidal indicators in schizophrenia along with references may come in handy.I wonder if that seems a good proposition.He in fact lent me 3 papers in reputed journals on this.

(RNaidu (talk) 10:18, 1 December 2008 (UTC))

That would make sense, I think. You should be aware that Wikipedia prefers sources like review articles over primary sources such as reports of specific studies. If you want to discuss any changes you think would be good, please feel free to try them out here. Looie496 (talk) 18:22, 1 December 2008 (UTC)

External links

External Link Submission Request —Preceding unsigned comment added by Optimist46 (talk • contribs) 22:28, 10 December 2008 (UTC) {{editsemiprotected}} Hi: I have an URL that I would like to ad as an External Link (http://www.schizophreniasupportnetwork.com/). I would like the heading to be Schizophrenia Support Network. As this is a semi-protected page I wonder if someone could authorize this and help me post it.

Thanks so much, Optimist46 (talk) 22:22, 10 December 2008 (UTC)

That's an attractive site, but I don't think it should be added yet. It seems to be brand new, and doesn't really have any content except an introduction. External links shouldn't be used as a way to direct attention to a little-known site, instead they should be used to direct readers to sites that are already notable in their own right. Looie496 (talk) 00:46, 11 December 2008 (UTC)

IMO this link violates Wikipedia's rules for external links. Importantly, it violates WP:ELNO #10 (website essentially exists for the purpose of providing a discussion forum), #11 (personal web page), and possibly #4 (purpose of the link is to promote a website) and #5 (objectionable amounts of advertising). WhatamIdoing (talk) 18:31, 11 December 2008 (UTC)

Animal models anyone?

How about making a stub at the animal models of schizophrenia? Would be interesting. --CopperKettle (talk) 07:19, 18 December 2008 (UTC)

• Another point: some serious revert war is warming up in the NARSAD page, someone with the knowledge of the topic should mediate. --CopperKettle (talk) 14:50, 18 December 2008 (UTC)

Introductory sentence

Hi there, I noticed someone changed the introductory sentence. Please leave the original version. It has survived three FARs and is the most POV description of the condition that takes into account the various views about the disorder. Furthermore, referencing with Encyclopedia Brittanica articles and public health information is not appropriate. - Vaughan (talk) 18:26, 20 December 2008 (UTC)

include early intervention section

Prevention, early detection, and early intervention for both psychosis and schizophrenia is considered a reality by those working in the relatively new field of early psychosis (see early intervention in psychosis)

I suggest a write of the paragraph below - but at very least a link to the new page

There are no reliable markers for the later development of schizophrenia although research is being conducted into how well a combination of genetic risk plus non-disabling psychosis-like experience predicts later diagnosis.[152] People who fulfill the 'ultra high-risk mental state' criteria, that include a family history of schizophrenia plus the presence of transient or self-limiting psychotic experiences, have a 20–40% chance of being diagnosed with the condition after one year.[153] The use of psychological treatments and medication has been found effective in reducing the chances of people who fulfill the 'high-risk' criteria from developing full-blown schizophrenia.[154] However, the treatment of people who may never develop schizophrenia is controversial, in light of the side-effects of antipsychotic medication; particularly with respect to the potentially disfiguring tardive dyskinesia and the rare but potentially lethal neuroleptic malignant syndrome.[155] The most widely used form of preventative health care for schizophrenia takes the form of public education campaigns that provide information on risk factors, early detection and early treatment options.[156]. The new clinical approach early intervention in psychosis includes secondary prevention (medical) strategies to prevent the long term disablity seen with schizophrenia.

There appeared three quite startling studies, showing that antipsychotics decrease brain weight and size in macaque, due to a decrease in glial cells (Lewis et al., they are quoted in the antipsychotic article), so preventive D2-blocking treatment that might affect a big percentage of healthy persons is rather dubious, IMHO; that might be added. --CopperKettle (talk) 20:52, 20 December 2008 (UTC)

PMID 17945195, PMID 17063154, PMID 15756305 --CopperKettle (talk) 20:56, 20 December 2008 (UTC)

These are primary sources and they all come from the same lab -- we should wait until they are evaluated by secondary sources before using them here. Looie496 (talk) 19:28, 9 January 2009 (UTC)

Well.. Wait till other 18 macaques are killed? I beleive that is a very rare study, as permissions to use macaques must be hard to get. The study is done by a very known group, it is placebo-controlled, it runs in parallel with findings in human, for example a recent report of increased gray matter density in quietiapine users. P.S. And my remark was not in a separate section, it was a reply to the "early treatment", please, do not move it in a special section again. --CopperKettle 02:48, 10 January 2009 (UTC)

Here's the link, more could be found: Increased grey matter densities in schizophrenia patients with negative symptoms after treatment with quetiapine: a voxel-based morphometry study. And here is the interview of Nancy Andreasen (NY Times), I quote:

"The big finding is that people with schizophrenia are losing brain tissue at a more rapid rate than healthy people of comparable age. Some are losing as much as 1 percent per year. That’s an awful lot over an 18-year period. And then we’re trying to figure out why. Another thing we’ve discovered is that the more drugs you’ve been given, the more brain tissue you lose.
Q. WHY DO YOU THINK THIS IS HAPPENING?
A. Well, what exactly do these drugs do? They block basal ganglia activity. The prefrontal cortex doesn’t get the input it needs and is being shut down by drugs. That reduces the psychotic symptoms. It also causes the prefrontal cortex to slowly atrophy.
.... .....Q. WHAT ARE THE POLICY IMPLICATIONS OF THIS FINDING?
A. Implication 1: that these drugs have to be used at the lowest possible dose, which often doesn’t happen now. There’s huge economic pressure to medicate patients very rapidly and to get them out of the hospital right away. "

And I repeat again: the warning clues are in direct relation to the proposed "early treatment". You might say the clues are not conclusive, well, so is the "early start" concept. That is why, if we are to include the paragraph on early treatment, we should definitely add a clause warning of these possible severe effects that may affect the people for whom the early treatment was started without proper reason (and this is possible with the diagnostic criteria being rather vague). Best regards, --CopperKettle 02:56, 10 January 2009 (UTC)

Macaques aren't that hard to get, especially for studies of human disease. I understand that you think these findings are important, I also think so. (Although I'm not getting what the Stip paper has to do with this issue.) The bottom line, though, is that Wikipedia policy doesn't allow drawing conclusions from primary data, and while I respect Andreasen, a mention in an interview of data that has not yet been published is not something we can act on. We need to wait until a strong mainstream source tells us that this is information that should be acted on. We especially need to be careful about giving people advice to stop taking antipsychotic drugs, because that can be very dangerous on a short-term basis. Looie496 (talk) 03:45, 10 January 2009 (UTC)

If the macaques aren't hard to get, when I wonder why the neuroleptics weren't tested longitudinaly on these species before taking the drugs to the market. I agree that any results should be replicated and Andreasen's study is sadly still not published, so the interview is just an opinion, albeit by a known neuroscientist. I totally agree that in the case of apparent psychosis treatment must be provided (I'm not Szasz or whoever). But if we add the section on prevention strategy that employs D2-blockers (and this is largely in non-psychotic folks), these caveats should be added, IMHO.
As for the Stip et al., I suspect that increased gray matter density reported by his group may be due to overall shrinkage caused by neuroleptics: in macaques, there is also increased density of neurons while the overall matter shrinks due to glial cell loss. Of course it is just my conjecture, but after the macaque study I will cautiously read any report of matter loss in patients.
P.S. Please give a link to Wikipedia's policy on quoting published neurobiological articles - I'm at a loss how to draw a line between conclusions and mere adding of the study results. As I understand, I cannot personally write in a wikiarticle that "macaque study may indicate similar action in human.." But what if another neuroscientist in another article draws a conclusion from the earlier papers of other researchers - that would be O.K. to add in the form " a so-and-so supposes that this is an indication of.."? --CopperKettle 04:41, 10 January 2009 (UTC)

Neuroleptics are sort of "grandfathered in" as far as testing goes—generally there is no requirement for testing things that have been used for decades, even if they were never rigorously tested in the first place. Concerning Wikipedia's policies, my basis is WP:RS#Primary, secondary, and tertiary sources, or more fully WP:PRIMARY. I note, checking this, that the current version is a bit ambiguous: the list of types of sources that are considered primary used to include "experimental results published by the person(s) who carried out the experiments". That's not there now, and I'm trying to figure out why it was removed. Looie496 (talk) 18:45, 10 January 2009 (UTC)

We've discussed this particular study before. It is a study of antipsychotics on monkeys and there says nothing directly about schizophrenia or indeed humans. Antipsychotics are used in lots of disorders. If anywhere, this study belongs on the antipsychotic page. Studies on people diagnosed with schizophrenia are preferred. - Vaughan (talk) 19:01, 11 January 2009 (UTC)

Yes, I agree. I was a bit carried away, sorry. Just wanted to show these studies to illustrate the need to a cautionary remark when\if mentioning the early treatment concept; of course no straight reason to cite the studies themselves in the "Schizophrenia" article. --CopperKettle 19:59, 11 January 2009 (UTC)

I really dont understand your response to my suggestion of including an early intervention paragraph - monkey brains has absolutely no relevance to the topic. I suspect you are not familiar with the significant and growing early psychosis literature, and evidence about the normal pathways for treatment with those with schizophrenia. Most patients experience extreme delays to optimal treatments and there is a direct link between prognosis and delays to treatment . I will continue working on early intervention in psychosis for now and when ready will start to contribe to this topic. Earlypsychosis (talk) 06:50, 14 February 2009 (UTC)