Talk:Schizophrenia

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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)

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)

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)

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)

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)

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 • contribs) 20:46, 18 February 2008 (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)

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)

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#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" as 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 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)

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)