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R.D. Laing

The brief discussion on R.D. Laing portrays him inaccurately (regardless of what you think of him or his ideas).

Are you saying that he doesn't believe that Schizophrenia doesn't exist? -- RM

WikiProject Psychopathology

WikiProject Psychopathology started, please feel free to join. This entry seems to need a bit of work, perhaps this WikiProject might be useful for interested Wikipedians to get their heads together and consider some changes - Vaughan.

rewrite

Hello everyone,

I'm going to try and steadily rewrite parts of this entry, as I think it contains a few factual errors and red herrings. However, I'm keen not to step on anyone's toes, as there's much excellent information here. I'll try and reference the changes I make as I go, and if anyone has any objections, I'll keep an eye on the Talk page so we should be able to thrash them out.

I think I might have to deviate a little from the Wikipedia:WikiProject_Medical_Conditions format. As with all psychiatric diagnosis, the definition is based upon the presentation of signs and symptoms so it is necessary to list them to define the disorder, rather than further down the entry.

-- Vaughan

Changes to the Introduction

I've tried to give a brief summary of the important issues without going into too much detail at this point. The sections below do that quite well, and can be expanded upon where needed later.

The initial description is taken from the Diagnostic and Statistical Manual of Mental Disorders, as it is the most accepted definition of schizophrenia. I've been careful to define it as a label for a diagnosis rather than present it as a cut and dry illness and have mentioned the objections of the antipsychiatry movement and the dimensional approaches below.

People interested in the history of the psychiatric view of schizophrenia may wish to check out Chapters 1 and 2 of Bentall's Madness Explained (ISBN 0713992492) and Turner, T. (1999) Schizophrenia. In G.E. Berrios and R. Porter (eds) A History of Clinical Psychiatry (ISBN 0485242117) (from where the note about T.S. Eliot is from).

Information about the causes, neurodevelopment and medication of schizophrenia are taken from Michael Foster Green's Schizophrenia Revealed (ISBN 0393703347) and David Healey's The Creation of Psychopharmacology (ISBN 0674006194).

I've added Madness Explained and Schizophrenia Revealed to a section at the bottom called 'Recommended Reading' as these are both excellent and accesible books for the non-specialist as well as researchers and clinicians. Please add any other books which take a balanced approach and which you feel readers could benefit from.

I've changed the title of the section 'Famous Schizophrenics' to 'Famous people affected by schizophrenia' to try and not define people by their diagnosis. Have added Vaslav Nijinksy (ballet dancer), Syd Barret (past member of [[Pink Floyd) and Peter Green (from rock group Fleetwood Mac) and James Tilly Matthews.

Let me know if anyone wants references to specific academic papers for any the the points.

Comments, queries, complaints welcome !

- Vaughan

Very good

Very good article, many thanks to all who have contributed to it! -- poco poco 21:07 19 Jul 2003 (UTC)

References

Hello everyone,

I'm going to try and add references to the main body of the text. I'll try doing this by using superscripted numbers (like so1) and adding the reference to the reference list.

I'll try and keep the introduction reference free, and leave that to the sections that go into more detail.

-- Vaughan

Changes to history section plus note on neurocognitive deficits

I've added a note on neurocognitive deficits in schizophrenia and created neurocognitive entry.

History section expanded in light of Evans et al (2003) article (ref 1) and notes on Kraepelin and Bleuler.

-- Vaughan

Changes to diagnosis and presentation (signs and symptoms)

I've merged the Diagnosis and Presentation (signs and symptoms) sections, as the issues are heavily interlinked as with most mental illness.

I've cut some discussion on the types of hallucinations and delusions that might be present as this is general for all psychotic disorders, not just schizophrenia and I think it's adequately covered in the delusion and psychosis entries.

Maybe it's worth moving the 'Categories' section up here as well as it discusses lots of the same issues (the bit on 'sluggish schizophrenia' is great and also highlights the subjectivity in diagnosing mental illness).

-- Vaughan

Changes to Diagnostic Issues and Controversies

I've created this section to discuss the issues surrounding diagnoses of schizophrenia, both in terms of science and politics.

Particularly, added text about concerns about abuse of psychiatry to suppress the Falun Gong movement and form vs content diagnosis.

Moved text about 'one or many schizophrenias' to 'Incidence and Prevalence' section.

-- Vaughan


Changes to Cause section

There wasn't much here before so I've added info on possible causes including genetic evidence, environmental factors and neuropsychology.

-- Vaughan

Changes to Treatment section

Moved the section above Prognosis, and rejigged to reflect current treatment methods.

-- Vaughan

I thought the atypicals only reduced the incidence of EPSE and not the NMS. NMS is already rare to begin with ... and still occurs with the newer drugs. Alex.tan 18:38 26 Jul 2003 (UTC)

Will check up on this and I'll post results here. Thanks Alex. - Vaughan 09:37 27 Jul 2003 (UTC)
After a brief lit search it seems the relatives risks of typical (older) and atypical (newer) antipsychotic medication is still a bit unclear. e.g.: "Although the newer, atypical antipsychotics have also been associated with NMS in published case reports, the relative risk of NMS with these new drugs compared to the typical antipsychotics remains uncertain" from here.
Article text changed to:
"The newer atypical antipsychotic medication (such as olanzapine, risperidone and clozapine) is preferred over older typical antipsychotic medication (such as chlorpromazine and haloperidol), as the atypicals have fewer side effects, such the development of extrapyramidal side-effects. However, it is still unclear whether newer drugs reduce the chances of developing the rare but potentially life threatening neuroleptic malignant syndrome."
...pending further information. Thanks Alex, well spotted ! Vaughan 15:40 28 Jul 2003 (UTC)

Ive speculatively added a chunk on the User-based approaches that have been emerging in recent years with a link to the 'hearing voices movement'. The balance isnt right, and it could probably go under other sections -either alternative approaches or controversies.

Also the Treatment sect looks a little thin. There is a mass of evidence now about the value of psychological treatments -particularily CBT. The B.P.S. (2000), conclude that there is convincing evidence, now,’.... that psychological interventions are effective for many people in reducing psychotic experiences and the distress and disability they cause’. The recent developments in Cognitive Behavioural Psychotherapy (CBT) have been well documented in the literature demonstrating a broad range of clinical benefits across a range of client groups (such as the young, newly diagnosed; people with long-term, drug-resistant problems, through hospital and community settings). Indeed the most recent findings are extremely promising as acknowledged by a recent Cochrane review of the literature. “....a variety of CBT methods are associated with substantially reduced risk of relapse” CBT provides a range of interventions that can enable people who hear voices to empower themselves. Can anyone update?

Hi there,
The material you added is valuable and should certainly have a place in wikipedia, although I think it perhaps deserves an article of its own (perhaps Hearing Voices Network, which can include new philosophies and approaches to voice hearing outlined in Accepting Voices - ISBN 1874690138). It might be worth summarising the material you added in a sentence or two, and then linking to a fuller article on the HVN with much of the new material. I'll aim to do this in the next couple of weeks if it hasn't been done already. I also agree CBT should be highlighted. Comments, suggestions on this welcome as always - Vaughan 12:20, 14 Oct 2004 (UTC)
Great, thats perfect. The bit I included has got pulled for copyvio despite being a selection from an original article (and me as the author!). Not too sure why I keep attracting these. But thanks for your responseJinko 13:24, 14 Oct 2004 (UTC)
Jinko, I almost pulled the section as a copyvio except I couldn't find it on the internet so I accepted on good faith that it was not. (It was too good and came in one insert so take it as a compliment.) If I had found it on the internet then I would have pulled it. Firstly, great stuff but I tend to agree with Vaughan that it deserves it's own area. The schizophrenia article is too big already. What about putting it in Hallucinations and then leaving a one sentence reference to this in the schizophrenia article. Alternatively, it's own article with references in the relevant articles such as schizophrenia and hallucination. Secondly, it is really worth putting a brief paragraph in the talk page with a new heading to say you have added your own info that you have written when you put in a big chunk like this. That way any copy editor can check the talk page and see that it is NOT a copyvio. Thirdly, if you put an article in with references, please also put in the references in the same format as the rest of the article. "Baker (2000) in OpenMind ..." does not really allow the reader to access what Baker said in full. All picky points but the bottom line is, thanks for the great contribution. --CloudSurfer 18:58, 14 Oct 2004 (UTC)
Yes Understood -all the points you make -make sense. Lots to learn aboutfor me here. The work is from articles I have published so a bit sad you didnt find on the internet! I will try and follow these directions when I have a little time. If any one else wants to help or have a go, please do! Jinko 23:27, 14 Oct 2004 (UTC)

Changes to Prevalence and Incidence section

Added info from recent studies.

-- Vaughan


Changes to Prognosis section

Referenced 'thirds' recovery figure and added information about suicide risk . -- Vaughan

I thought the prognosis was more on the order of 1/5 have full recovery, a bit less than 1/5 have very poor prognosis and most people are somewhere in between ... Alex.tan 18:35 26 Jul 2003 (UTC)


Misc Changes

I brought back an incorrectly deleted reference which was not cited inline using superscripts but was nonetheless (in the style of an encyclopedia) correctly referencing a source. In addition some of the information that was pruned from that source was deleted. I merged it back into the article. I am not sure why it was removed.

-- Ram-Man 00:27 23 Jul 2003 (UTC)

Minor changes and discussion

Hi Mandark,

I've moved the new information on genetic linkage out of the summary to keep it lay-person friendly. It's now in the 'Causes' section.

I'd like to tone down the sentence "overwhelming evidence (including causative gene findings) argue for a genetic cause modified by enviromental stressors in the etiopathogenesis of schizophrenia" as its impossible to seperate genetic and environmental influences in a cause of a disorder.

My version would be:

While the reliability of the schizophrenia diagnosis introduces difficulties in measuring the relative effect of genes and environment (for example, symptoms overlap to some extent with severe bipolar disorder or major depression), there is evidence to suggest that genetic vulnerability modified by enviromental stressors can act in combination to cause schizophrenia.


Great information on the COMT linkage (good ref here) but perhaps a little selective ? A recent review paper (I've uploaded the full version here for those that are interested) identified 7 gene candidates. Certainly COMT seems the only gene with a obvious functional linkage in terms of dopamine function, but perhaps it is either worth discussing this or briefly mentioning the other candidates. Also, I would argue over-emotional mothers do seem to be an environmental influence on schizophrenia (see ref 8) but perhaps it is worth mentioning that it is not mothers in particular but any people with high levels of 'expressed emotion'. Would you mind if I rejigged it a little in light of this ?

Please reply if you think otherwise or would rather do your own rejigging !

-- Vaughan

FWIW, I think your rewording sounds better. -- Ram-Man 22:56 24 Jul 2003 (UTC)

Changes to 'Alternative Approaches' section

Rewrote part of it because of distortion of message (i.e.. 'anti-psychiatry says schizophrenia doesn't exist'). Added Tim Crow theory. Moved info about higher rates of schizophrenia minority communities to causes section.


Vaughan 11:12 25 Jul 2003 (UTC)


Changes to 'Causes' section

Reworded new info on genetics for flow and to take the academic edge off it. Added ref to COMT study. Took out sentence which mention family stress and drugs / alcohol as it's handled by existing sections.

Vaughan 16:05 25 Jul 2003 (UTC)

Genetic causation

Recent edits related to genetic causation in schizophrenia are weak and might stem from a failure to keep current with the literature. There is NO debate regarding the heritability of schizophrenia and the hesitancy to clearly state this reminds one of past unwillingness of the psychiatric community to view mental illnesses as biological in origin. What purpose does it serve the lay reader to suggest that this issue is under debate? As for specifics of COMT, there have been no other papers to demonstrate a functional link between any gene and this illness. This is not a selective discussion, but simply a paucity (at the time of this writing) of findings. There will be published reports on at least two other genes in the upcoming year (dysbindin and disc-1) to add to the list.

Mandark 14:53 14 Aug 2003 (UTC)


Hi Mandark, From looking at the text as it is, I don't think it leaves any doubt that inheritance plays an important role in the development of schizophrenia. It is the amount of hereditory influence in general, and role of specific genes in particular, which seem to be the subject of debate among researchers.
I'm not sure what you mean about 'no debate' but recent exchanges in The Lancet after Harrison and Owen's recent review of 'Genes for Schizophrenia' seemed to show quite a strident debate, with Tim Crow going as far as to say that there is "little firm evidence of genetic linkage to psychosis" (I've put the whole exchange here and here for those without access to The Lancet). Whilst you may not agree with him (and few people do) I think it's important to communicate that there is an ongoing debate to be make the article fully NPOV.
On a related note I was interested to read a recent paper again suggesting that epigenetic factors may be important, but I'm not a geneticist (although I try and keep up with the literature as best I can). Could you (or anyone else) comment on how important this is and whether it's worth a mention in the article ?
Also, I notice we got listed on the Wikipedia:Brilliant_prose_candidates page. Excellent work all round I think, although I'm sure as Mandark mentions, there's probably still work to be done !
Vaughan 07:44, 15 Aug 2003 (UTC)
Hi Vaughn

Pretty weak retort. Tim Crow is a famous for biased and selective reviews the literature and never provides data of this own or of others to back up his point (as in the Lancet exchange you cite). Funny, I'm not surprised you see his response as support for your points. Please see American Journal of Human Genetics Sept. 2003 for a series of meta-analyses that answer Dr. Crow's suggestion that heritability is not high. As for epigenetics, in our lab we too feel this is important and are investigating alternate splicing, methylation, etc. But, until more is known about the transmission of these modifications, much will remain conjectural. I have re-read the schizophrenia section and notice a number of "controversies" that are no longer seriously considered valid, yet are of historic importance and appear to be cited (as you have done with Tim Crow) with little critical evaluation, but rather in deference to the notoriety of the author(s). I guess this does liven things up and interested readers are provided with numerous links to outside reading.

Mandark 14:00, 25 Sept 2003 (UTC)
Hi Mandark,
I don't cite Crow's suggestion as support for any point except that there is a debate about the role of genetic factors in schizophrenia (and mental illness in general). As it happens both you and I are of the same opinion that genetic factors are important in schizophrenia, but this is not a universally held view. For example, the recent book The Gene Illusion by Jay Joseph (ISBN 1898059470) is extremely critical of genetic research in psychiatry and this is not an isolated example. Hence I think both sides of the debate should be reflected in the article to be fully NPOV, rather than purely our (or anyone else's) opinions on the matter, no matter how well supported we feel them to be.
I'd be interested to hear which controversies you no longer feel are valid, as I'm keen to keep the article up-to-date. However, I have tried to draw most points from ongoing debates I encounter from current books, articles and conference so a few pointers would be handy. Thanks - Vaughan 17:24, 26 Sep 2003 (UTC)

Saying "Famous people afflicted with schizophrenia" is POV. --Daniel C. Boyer 21:38, 18 Dec 2003 (UTC)

Actually says "Famous people affected by schizophrenia" - Vaughan 12:12, 21 Dec 2003 (UTC)

Symptom prevalence

Removed the following. Useful information, but I think 1973 is a little out of date for a survery of symptoms. Any chance of finding a more up-to-date report on this ?

The World Health Organization in 1973 characterized these symptoms as most common in schizophrenia:

- Vaughan 23:02, 8 Jan 2004 (UTC)

I couldn't find anything analogous to the list above but the 2001 WHO report on mental illness might provide some starting points. This seemed the most useful chapter. Mazzy 17:38, 14 Jul 2004 (UTC)

http://www.who.int/whr2001/2001/main/en/chapter2/index.htm

I can't see any reason to delete this useful list just because it is 30 years old. With the same justification you could ignore Schneider. Until there is a more up to date reference why not keep it in? Are you really suggesting that schizophrenia has changed so much in the last 30 years that this is no longer valid? I doubt it.

Hi there
I would argue that an out-of-date list is not worth including as symptom prevalence may be affected by factors such as, population demographics, social environment and diagnostic standards, all of which have changed to varying degrees since 1973. For example, delusions have been found to vary with country, gender and social class, culture and exposure to urban environment and in the same vein, diagnostic standards are being increasingly challenged (e.g. recent Appelbaum study).
Schneiderian first rank symptoms are still relevant because they are still used as diagnostic criteria (see Sims, 2004 - ISBN 0702026271), although the article mentions problems as to their reliability, so they are not presented without criticism. - Vaughan 09:31, 8 Sep 2004 (UTC)
I agree with your reasons but perhaps a compromise until better data were available would be to reinsert the list with these caveats. As a psychiatrist I very much appreciate your reasons but I do feel that the many non psychiatrists who read this article would better understand schizophrenia with this list reinstated. By the way, apologies as a newbie for not signing my initial comment. CloudSurfer 09:39, 9 Sep 2004 (UTC)
Hi CloudSurfer
Fair point, but perhaps we can look for some more up-to-date information. This article supposedly has WHO symptom prevalence data from 1986. I have not read the article in full yet, but I shall do so and keep looking for more recent information. If you come up a pointer to anything more recent please post it here. If none of our leads look useful after a brief investigation (perhaps we can give it a week or two), I think we have a good case for including the 1973 data. - Vaughan 10:10, 9 Sep 2004 (UTC)

This is my first time posting to a Wikipedia section, so bear with me with any mistakes I may have made while adding this post. :) Okay what I have to say is: Why isn't there any mention of "Memoirs of My Nervous Illness" by Daniel Paul Schreber? I would think this would be recommended reading! Thanks for reading this feedback note.

Sincerely,

The Puzzle Fish Who Is A Real Fish! But At The Same Time A Snack Good For Parties.


I think that Schreber needs an article of his own really, as he's a pivotal psychiatric case, especially since James Tilly Matthews is already written up. Definitely one for the 'to do' list. I'll see if I can make a start shortly, then perhaps we can link it in with the schizophrenia page. - Vaughan 21:20, 16 Feb 2004 (UTC)

Schizophrenia vs. D.I.D

Shouldn't there be a paragraph explaining the common misconception that Schizophrenia is Multiple Personality Disorder (aka Dissociative Identity Disorder)? I can't count the number of times I've heard people confuse the 2.

See the second to last paragraph in the History section. - Vaughan 17:03, 14 Jul 2004 (UTC)
Although a quick review of this paragraph suggests that it needs a bit of work for clarity. To be completed shortly. - Vaughan 17:15, 14 Jul 2004 (UTC)

Removed image

Hi there,

I've removed the image 'SchizophreniaBrain.jpg' from the schizophrenia page, as it's from a copyrighted source, as far as I know. Unfortunately, it comes from the following article:

Paul M. Thompson, Christine Vidal, Jay N. Giedd, Peter Gochman, Jonathan Blumenthal, Robert Nicolson, Arthur W. Toga, and Judith L. Rapoport. (2001) From the Cover: Mapping adolescent brain change reveals dynamic wave of accelerated gray matter loss in very early-onset schizophrenia. Proceedings of the National Academy of Sciences, 98, 11650-11655.

See this link for online version.

- Vaughan 12:33, 16 Jul 2004 (UTC)

Image ideas

Barring good (meaningful) images of schizophrenic brains, what other images could this article utilize? A common example in psychology books is the degeneration of Louis Wain's artwork in the 1930s (link) as he apparently suffered from schizophrenia and some think it was responsible for his shift away from realism (some don't think it had much to do with it, though). It's from the 1930s at the very latest which, I think, makes it copyright a-ok, but I don't know. Other ideas? This topic is lacking in visual stimulation, so to speak... --Fastfission 17:13, 16 Jul 2004 (UTC)

Gene Ray

With reference to Gene Ray been listed in the 'Famous people affected by...' section, he mentions he has been diagnosed with schizophrenia on his webpage timecube.com. Someone kindly pointed this out to me on my talk page, so I thought I better reiterate it here. - Vaughan 12:41, 11 Oct 2004 (UTC)

I've removed a couple of books from the recommended reading list. They're both excellent books but very academic, and perphaps not suitable for the general reader as the others are.

Anyway, they're listed here so as to not remove them entirely as they're certainly worth tackling if you're interested in the neuropsychology of schizophrenia and psychosis:

  • Green, K. J. (1998). Schizophrenia from a Neurocognitive Perspective. Boston, Ally and Bacon
  • David, A. S., et. al. Eds. (1997). The Neuropsychology of Schizophrenia. Brain Damage, behaviour, and cognition Series. East Sussex, UK, Psychology Press.

Objects, comments etc welcome. - Vaughan 15:42, 27 Oct 2004 (UTC)

Congratulations

Congratulations are in order for anyone who has worked on this article - it's fantastic! zaius 15:19, 14 Feb 2005 (UTC)

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