Talk:Schizophrenia

Updates from new manual.

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

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

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

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

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

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

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

7)"Diagnosis" subsection on "Criteria" is outdated and does not mention DSM5 updates for schizophrenia.

8)"Diagnosis" subsection on "Subtypes" is outdated to DSM5 standards and needs to be re-drafted.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

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

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

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

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

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

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

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

Not sure what you are getting at here

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Update

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

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

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

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

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

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

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

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

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

Updates from new manual II. DSM5 replaces outmoded DSM4.

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

1)Article as a whole appears to completely overlook the comparison and relationship of this diagnosis with "Personality Disorders" as presented in ICD10 and DSM5, the discussion is completely missing. ICD tells us that Schizophrenia can be diagnosed under "Personality Disorders".

2)Lede does not mention relevance of associated personality disorders to Schiz. diagnosis and treatment. 40% to 60% of all psychiatric diagnoses are accompanied with a diagnosis of associated personality disorders. See: Saß, H. (2001). "Personality Disorders," pp. 11301-11308 in Smelser, N. J. & Baltes, P. B. (eds.) International encyclopedia of the social & behavioral sciences, Amsterdam: Elsevier doi:10.1016/B0-08-043076-7/03763-3 ISBN 978-0-08-043076-8.

3)"Schneiderian" classification should be discussed under "History" section. It is secondary to both the ICD10 and the DSM5 classification categories and the section should reflect this. They (DSM5 and ICD10) presently do not appear in discussion until section 4 here as "Diagnosis". Unless this wikipage updates/replaces all DSM4 references with DSM5, it becomes outmoded and obsolete.

4)"Causes" subsection completely ignored diagnostic Personality Disorders; possible correction may be with a new subsection, or as a subsection to present "Genetics" subsection; Or, possibly under "Developmental." If Schizophrenia is related to Genetics, it is related to Personality Disorders as well.

5) Very scant and sparse "Psychological" subsection under "Mechanisms" compared to more fully developed "Neurological" subsection; Personality Disorders completely ignored in this subsection. Expertise of psychiatric background is visibly lacking in this subsection.

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

7)"Diagnosis" subsection on "Criteria" is outdated and does not mention DSM5 updates for schizophrenia. DSM4 is outmoded and obsolete for over half a year now.

8)"Diagnosis" subsection on "Subtypes" is outdated to DSM5 standards and needs to be re-drafted. ICD-10 classifies the DSM-5 schizotypal personality disorder as a form of schizophrenia rather than as a personality disorder.

9) That forty percent to sixty percent of psychiatric diagnoses for schizophrenia include a co-diagnosis of at least one of the personality disorders underscores the issue that a separate subsection is needed and justified for "Personality Disorders as a Component of Schizophrenia." The statistics inform the medical community that approximately every second or third diagnosis of schizophrenia by a psychiatrist is accompanied with a co-diagnosis of at least one personality disorder. This is far from "obscure" or "tangential." It covers between one third and two thirds of all psychiatric diagnoses for schizophrenia. It would be of high importance to include such a subsection during the time period of the DSM5 transition edits and neglectful if it is excluded.

10) Key explanation is needed of the full change of diagnostic format of specification for schizophrenia as a category of diagnosis by the DSM5 re-organization of the diagnostic classification for schizophrenia which now excludes subtype classification of variant forms of schizophrenia.

11) Mortality statistics and-or mortality tables for schizophrenia recovery need significant elaboration for each of the following categories, (a) with medications, (b) without medications, (c) with supportive therapy, (d) without supportive therapy. Also, the progress of chronic schizophrenia needs to be substantially differentiated and addressed to include at least the topics of (i) the extended control of symptoms, and (ii) the intensification and development of symptoms over longer periods of time, along with co-morbidity issues.

12) Cluster A significance to the discussion of schizophrenia in general can no longer be responsibly excluded from the discussion as currently displayed on this wikipage. The significance of Cluster A along with its heightened association to schizophrenia within this cluster of personality disorders as opposed to the other clusters, Cluster B and Cluster C, is presently entirely absent from this wikipage. The issue is presently fully neglected on this "Schiz." wikipage. The current Section4.2 on this wikipage is completely outdated and obsolete according to DSM5. Its material is now out of print and is no longer in use by an entire new class of medical students entering studies since Autumn 2013. BillMoyers (talk) 14:01, 12 December 2013 (UTC)

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

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

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

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

So 2-3 times greater than that of the general population which is at 10-20%? [3][4] Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:21, 18 December 2013 (UTC)

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

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

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

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

Whoa there

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

Removed for discussion

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

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

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

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

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

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

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

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

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

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

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

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

Another

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

Removed for discussion and sourcing

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Here are two recent meta-analyses:

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

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

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

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

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

Janitor and secretary checking in

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

1. We don't use "ibid" on Wikipedia, since text and their citations move around in a dynamic article; we use named refs.[5] Please review WP:CITE.
2. Books require page nos; BillMoyers, please provide a page range for the Schizophrenia section of DSM5.[6] Why are you citing ICD-10 to DSM5? Please provide a quote of what the DSM says on ICD for verification.
3. Jinkinson I have dozens of times on other pages explained to you how citations are written in this article and at Autism; please stop dropping in cite pmids that I have to clean up. You are by now an established editor and I should not have to clean up after you. [7] Will someone with full journal access please check the source to make sure we have sufficiently paraphrased? The APA guards their copyright stridently and has approached Wikipedia several times in the past when we have duplicated too much of their info (which they make money off of).
4. Speaking of APA and their copyright, the DSM-IV-TR definition in this article needs to be checked; it looks too close to the APA, and they will go after us. Will someone with DSM-IV-TR please review and paraphrase substantially? We should be eliminating DSM-IV-TR and paraphrasing the new crit for DSM-V, rather than continuing to list DSM-IV and saying what DSM-V changed.
5. This mess needs to be either cleaned up or removed entirely.[8] First, why was it in Symptoms, when it discusses history and ICD-10? Second, there is no complete citation. I have commented it out pending discussion.

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

BillMoyers are you even reading the talk page? Why have you now added this text twice, still in the wrong place? And still poorly sourced? [9] Now it's there twice. Please read the talk page. SandyGeorgia (Talk) 23:31, 17 December 2013 (UTC)

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

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

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

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

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

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

More

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

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

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

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

Unable to verify

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

What page number in the DSM 5 supports this?

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

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

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

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

Schacter

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

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

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

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

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

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

There are a number of refs that support this. Risk is 13% if one parent is affected and nearly 50% if both parents affected. [11] Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:32, 18 December 2013 (UTC)

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

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

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

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

General

It's not hard to tell just form the mess of citations needing cleanup[12] that this article has not been closely watched since the last FA version; some marginal sourcing has found its way in here, and there has been prose deterioration. The article needs more than a DSM5 update; it needs a thorough check of some of the cruft that has crept in since its last review. SandyGeorgia (Talk) 07:56, 18 December 2013 (UTC)

Outdated

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

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

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

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

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

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

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

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

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

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

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

What recent reviews? Nobody has done any original research. The most recent evidence says exactly the opposite of what is claimed in this article, and the fact remains, WikiProject Medicine is selectively using sources to push an anti-cannabis POV. The evidence shows that cannabis does not cause schizophrenia, and to date, there is no actual evidence that it does. On the other hand, we have strong evidence showing that schizophrenics self-medicate with cannabis to help their symptoms, while we also have evidence that the increasing use of cannabis by young people has not resulted in a rise of schizophrenia cases predicted by the theory. Furthermore, the latest controlled studies do not support the claims of causation. WikiProject Medicine does not get to ignore reliable sources by overruling our policies and guidelines with WP:MEDRS so they can selectively ignore evidence by choosing only reviews that show cannabis is harmful. The majority of the cannabis literature is skewed in this regard, since the majority of studies that get funded are only the ones that claim cannabis is a drug of abuse and cannot be used safely. That's stacking the deck, a misuse of sources, and a complete disregard for our sourcing policies. No local project consensus can override the sitewide sourcing policies and guidelines for this reason. Sorry, you aren't fooling anyone. The latest evidence published this month "suggest that having an increased familial morbid risk for schizophrenia may be the underlying basis for schizophrenia in cannabis users and not cannabis use by itself."[14] It doesn't matter that WikiProject Medicine considers this a primary source. What matters is that WikiProject Medicine is deliberately skewing Wikipedia articles by selectively citing evidence that cannabis causes harm while ignoring studies showing it doesn't. The "cannabis causes schizophrenia" hypothesis has been debated for two decades without any resolution on the matter, yet WikiProject Medicine would have us believe otherwise. No actual evidence for the hypothesis and yet it's stated as close to fact in this article. Meanwhile, cannabis prohibition limits the ability to actually study it closer, while funding is widely available for anyone who can demonize it. Viriditas (talk) 02:30, 19 December 2013 (UTC)

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

Again, total nonsense. Your so-called 2013 review is the same old propaganda hit piece that gets trotted out every few months. It starts with the premise that cannabis is bad, selectively cites old and outdated evidence that cannabis is bad, and then concludes "cannabis is bad". This can't be taken seriously. The studies it cites are seriously questioned or discredited, it appeals to debunked notions of cannabis as an addictive "gateway drug" and makes questionable claims to support its preexisting idea that cannabis is bad, resulting in circular logic. More importantly, it states "based on the current evidence available from human and animal models, it is evident that cannabis use during adolescent development increases risk of psychiatric diseases such as drug addiction and schizoaffective disorders with genetic interactions". The only problem is that the current evidence does not actually say that. The authors did not actually review any current evidence that conflicted with their already formed conclusion. On the other hand, we have a recent large December 2013 study that looked at 279 people and found that the development of schizophrenia depends on family history, not cannabis use by itself. The authors concluded "that cannabis does not cause psychosis by itself. In genetically vulnerable individuals, while cannabis may modify the illness onset, severity and outcome, there is no evidence from this study that it can cause the psychosis."[15] The question is, why is WikiProject Medicine pushing anti-cannabis propaganda, not just on this page, but on every page related to cannabis? Viriditas (talk) 04:08, 19 December 2013 (UTC)

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

This gives a good overview [16] as does this [17] and is more or less what we have. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:46, 19 December 2013 (UTC)

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

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

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

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

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

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

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

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

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

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

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

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

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