Talk:Schizophrenia

FA issues

Casliber, would you have time to work on this FA; it has issues. I haven't gone in depth beyond the lead, but if the number of problems in the lead are indicative of what we might find in the rest of the article, its FA status needs review. These are samples only from the lead.

• The lead is not in sync with the body. We find conflicting information between the lead and body about prognosis and epidemiology, even based on different dates. When we cite hard data, such as on prognosis and epidemiology, the data cited in the lead should be the same cited in the body.
• And those very numbers in the lead and body diverge from this, suggesting that other content might be outdated.
• There are numerous areas of prose in the lead that need clarification:
  • "strange speech", can strange be better explained? Mork had strange speech with Mindy, but didn't have schizophrenia.
  • During diagnosis, a person's culture must also be taken into account. I don't explicitly object to this sentence, but my query is a) whether this is true of most DSM conditions, and b) if it belongs in the lead, it is not adequately explained.
  • As of 2013, there is no objective test. This is probably still true in 2019. "no objective test" leaves a reader hanging ... not all readers will understand that means that diagnosis cannot be conferred based on any test. (Example: There are no specific tests for diagnosing Tourette's.)
  • All of this needs to be synced with the body and/or updated:
    • About 0.3% to 0.7% of people are affected by schizophrenia during their lifetimes.[9] In 2013, there were an estimated 23.6 million cases globally.[17] Males are more often affected and onset is on average earlier in age.[2] About 20% of people eventually do well, and a few recover completely.[6] About 50% have lifelong impairment.[18]
      • "do well" is vague.

It is not a long article; I am hoping you will find time to comb through it to identify and correct anything else. Best, SandyGeorgia (Talk) 17:18, 8 December 2019 (UTC)

Sigh....not again.....but yes. Time for some housekeeping I suspect. Cas Liber (talk · contribs) 07:47, 9 December 2019 (UTC)

Update the epidemiology.

With respect to "About 20% of people eventually do well, and a few recover completely." How do you want to summarize the source? Having the source present makes it much easier. Source is the DSM5 page 102 that says "The course appears to be favorable in about 20% of those with schizophrenia, and a small number of individuals are reported to recover completely."

With respect to "no objective test" how do you wish to convey this? Agree year is not really needed. Doc James (talk · contribs · email) 20:30, 9 December 2019 (UTC)

On "do well" unless the DSM specifies what they are referring to with the word "favorable", then we should use a source that does (do they mean these people do not require medication, do not require hospitalization, do not require social services ... what?) On "no objective test", I gave a sample from Tourette syndrome; if the source used does not give tighter wording, then another source could be used that does. SandyGeorgia (Talk) 21:09, 11 December 2019 (UTC)

We can use "favorable" if you wish. Just was being careful not to paraphrase to closely. Doc James (talk · contribs · email) 04:33, 13 December 2019 (UTC)

Changing one ill-defined phrase (do well) to another ill-defined word (favorable) does not solve the problem. The reader needs to know in what way these 20% "do well"; if the source does not explain it, a better source should be found. SandyGeorgia (Talk) 14:26, 14 December 2019 (UTC)

The ideal here is to change to something better-defined and more concrete such as no symptoms/minimal symptoms/return to work or study, which means going back to the literature, which means checking on latest Review Articles. This will require some time. Cas Liber (talk · contribs) 18:30, 16 December 2019 (UTC)

• Another: and a few recover completely. The source is not freely available, but it's probably not wrong to state that mention of the prognosis for "a few" is probably unwarranted in the lead. Also, the source is ten years old. What is meant by "a few", should this be in the lead, if so can the reason be pinpointed, and can this source on prognosis be updated? SandyGeorgia (Talk) 17:41, 27 December 2019 (UTC)

Is anyone planning to address each of the concerns I raised below, three weeks ago? SandyGeorgia (Talk) 08:00, 17 January 2020 (UTC)

....getting there.....Cas Liber (talk · contribs) 08:11, 17 January 2020 (UTC)

WP:OVERCITE in the lead

Additionally, the lead is overcited, which does not aid the reader, does not conform with guidelines, and (as indicated elsewhere) has only been done to facilitate a different, off-Wiki project. (While it is understandable that translators may find their task easier if citations glob up the lead, someone who isn't familiar with the entire topic, the body of the article, and the relevant MEDRS-compliant sources probably has no business translating articles to begin with.) Globbing up the lead with unnecessary citations should not be done in an FA, which must comply with policy and guideline.

I suggest the unnecessary citations on the following text be removed from the lead, which is intended to be a summary. Citation in the body for information not likely to be challenged will suffice; none of this is extraordinary, surprising, likely to be challenged, or involves data or quotes-- this is common info available anywhere:

• Schizophrenia is a mental illness characterized by abnormal behavior, disorganized speech, and being out of touch with reality.
• Other symptoms may include false beliefs, unclear or confused thinking, hearing voices that do not exist, reduced social engagement and emotional expression, and lack of motivation.
• Symptoms typically come on gradually, begin in young adulthood, and, in many cases, never resolve.
• Genetic factors include a variety of common and rare genetic variants.
• Diagnosis is based on observed behavior, the person's reported experiences and reports of others familiar with the person.
• Social problems, such as long-term unemployment, poverty, and homelessness, are common.

The versions that passed FAC and FAR did not include this unnecessary overcitation in the lead. Unless these issues are corrected, schizophrenia may need to go to FAR yet again. SandyGeorgia (Talk) 19:38, 9 December 2019 (UTC)

There is no policy or guideline which states leads should not contain citations. Citations make dealing with content disputes such as we see here way easier. So I for one strongly oppose removing them. Doc James (talk · contribs · email) 20:30, 9 December 2019 (UTC)

MOS:LEADCITE is the relevant guideline. (I never stated that "leads should not contain citations".) Featured articles must conform with MOS. There is not likely to ever be a dispute over any of the text I highlighted-- that is why the guideline is worded the way it is. And by forcing citations to each element of the lead, we prevent FAs from presenting compelling summary leads, and force them instead to be choppy prose, bogged down by unnecessary little numbers. SandyGeorgia (Talk) 20:38, 9 December 2019 (UTC)

I was simple commenting out citations for a while. But lots of people would not see the commented out citation and add little {{cn}} tags. The big issue is our readers more or less expect them. Doc James (talk · contribs · email) 21:29, 9 December 2019 (UTC)

Agree with Sandy Georgia on all points raised. The argument that a lot of 'cn's' would be generated could simply be dealt with by stating that the items are sourced in the body - it's clear that the lead is to be just a summary. And to state that it's what readers expect - comes from where? I have never seen a post on any page complaining of the lack of citations in its lead. Also there are many refs that are duplicated in the infobox.--Iztwoz (talk) 06:25, 10 December 2019 (UTC)

I agree with Iztwoz as to never seeing such a problem, but even if we did see this problem, what better place than an FA to explain to editors who lack basic knowledge of Wikipedia policy and guideline that leads are summaries and that citations are only required in certain instances. By breaching best practice on FAs, we are leaving the impression all over Wikipedia and medical content that fully cited leads are required.

Much worse, though, is that our medical articles no longer have the compelling lead summaries required for FAs, because we are forced to choppy prose that cites each little bit.

Commenting out citations does not address the fundamental problem, and indicates you may not understand what the problem is. It is not that we are citing unnecessarily; it is that we are writing leads in ways that forces each choppy little piece to be cited, rather than writing a compelling summary of text that may involved multiple sources. Leads should be written in a way that the reader gets a broad overview and enticed to continue reading-- not as a collection of independent, cited factoids (that are boring and tedious to read). SandyGeorgia (Talk) 21:47, 11 December 2019 (UTC)

I prefer a lead without citations too - the most obvious reason for adding a cite is a highly controversial fact. However, I don't think there are any that stand out here. Cas Liber (talk · contribs) 08:44, 10 December 2019 (UTC)

I prefer not having to search the body to find the support for the sentence in the lead. A lack of citations makes it more complicated to update or see how old the support for a statement is. We should be trying to write for the widest audience possible. To do that requires using shorter sentences. Doc James (talk · contribs · email)

The general and accepted rule for the lead is that it is a summary of the body of the article. All points raised in the lead will be covered in the body, and often in more detail together with citations. So that a reader will know that the contents of the lead are sourced; so where is the desire or need to search for validation in the lead itself? I would think the main aim of the lead is to provide a readable introduction and hopefully generate and hold the interest of the reader. This is not the outcome achieved by stilted sentences often over simplified, and an intrusive use of citations.--Iztwoz (talk) 08:05, 13 December 2019 (UTC)

Having lots of citations in the lead is something I would expect from C-class articles, not FA-class ones. It is the job of the editors to make sure that all of the information in the lead is sourced in the main body. If it is not, it should be removed.--Megaman en m (talk) 09:55, 13 December 2019 (UTC)

I have long come to the conclusion that the leads should be cited because a significantly large number of editors see non-cited text in the lead and simply remove it, or if you are lucky add citation need tag to text they dispute or query, assuming it is not cited. It also makes non-cited text more tempting for some editors to edit and change without referring to any reference because it is not immediately clear what reference refers to the lead text. The readers cannot quickly locate references to know how recent the sources are for the text in the lead. So yeah, I definitely favour citing the lead for verification purposes. It also makes it look professional and verified to our readers which we want as many people only read the leads and don’t trust Wikipedia text that is not cited.--Literaturegeek | T@1k? 03:29, 16 December 2019 (UTC)

Well in this article we have a WHO reference that is only used in the lead and not used in the body of the article at all. Andmuch of the lead has multiple citing. Cas Liber (talk · contribs) 18:25, 16 December 2019 (UTC)

This is a recurring problem throughout medical articles, as leads are being altered without keeping the body in sync. SandyGeorgia (Talk) 16:02, 18 December 2019 (UTC)

• Wikipedia:Manual of Style/Medicine-related articles/RFC on lead guideline for medicine-related articles SandyGeorgia (Talk) 22:28, 22 December 2019 (UTC)

CITEVAR

This article uses the vauthor format for cite journal, yet many recent additions are changing that style. I will put the article in use to correct the changes to citation style, but don't want to do that while the article is actively being edited. Who is doing this? FAs must have a consistent citation style. SandyGeorgia (Talk) 16:02, 18 December 2019 (UTC)

Putting article in use to clean up citations. SandyGeorgia (Talk) 16:14, 28 December 2019 (UTC)

All as vauthors now...but what happens with editors in that format...Cas Liber (talk · contribs) 08:19, 17 January 2020 (UTC)

Cas, because cite journal and cite book are not in sync with vauthor, I manually format books. SandyGeorgia (Talk) 15:36, 24 January 2020 (UTC)

AGAIN: citation consistency fixed. Vauthor on author names, more than six authors truncated to three et al. SandyGeorgia (Talk) 09:53, 16 February 2020 (UTC)

Causes

I do not have access to the full text. Should

• People with a family history of schizophrenia who have a transient psychosis have a 20–40% chance of being diagnosed one year later.

that "one year later" be "within one year of the transient episode"? SandyGeorgia (Talk) 16:58, 28 December 2019 (UTC)

References

Also, this section has stubby paragraphs. SandyGeorgia (Talk) 17:12, 28 December 2019 (UTC)

I fixed this myself,[1] but the source is extremely dated (2005). Tagged. SandyGeorgia (Talk) 15:42, 24 January 2020 (UTC)

Mechanisms

This section appears to be overcited; why is this happening? SandyGeorgia (Talk) 17:03, 28 December 2019 (UTC)

Also, the article uses summary style to summarize content to sub-articles, and Mechanisms of schizophrenia is a sub-article; can this section be trimmed to the summary article? SandyGeorgia (Talk) 17:11, 28 December 2019 (UTC)

Management

Can this be updated?

• As of 2015 it is unclear if transcranial magnetic stimulation (TMS) is useful for schizophrenia.

SandyGeorgia (Talk) 17:16, 28 December 2019 (UTC)

Experimental stuff like this has been moved to the eternal purgatory of Research directions .....Cas Liber (talk · contribs) 02:24, 18 January 2020 (UTC)

Prognosis

Also looks to be overcited, and if two almost 15-year-old sources is the best we can do, one wonders if the text belongs here or needs to be updated. Similar throughout this section. SandyGeorgia (Talk) 17:26, 28 December 2019 (UTC)

• Schizophrenia and smoking have shown a strong association in studies worldwide.

References

Can this be updated to a more recent review by the same author, Laursen 2014, PMID 24313570 which says "about 20 years"? I cannot access the full text of the 2014 paper; the statement is cited to Laursen 2012. SandyGeorgia (Talk) 15:45, 29 December 2019 (UTC)

• It results in a decreased life expectancy by 10–25 years.

History

Again, per WP:SS, cannot some of this be trimmed to History of schizophrenia? SandyGeorgia (Talk) 17:28, 28 December 2019 (UTC)

Epidemiology

The infobox says 17,000 deaths in 2015 (worldwide??), but the body of the article says 20,000 in 2010. The infobox needs to be synced throughout with the body of the article, and the article needs to be updated. SandyGeorgia (Talk) 17:36, 28 December 2019 (UTC)

Clozapine

See [2] [3], [4] [5] update needed throughout. SandyGeorgia (Talk) 16:04, 24 January 2020 (UTC)

Minocycline

Update needed: [6] [7] SandyGeorgia (Talk) 16:26, 24 January 2020 (UTC)

Updating sections to match modern terminology

Under the "Differential Diagnosis" section, the "AIDS dementia complex" link/term should be updated to reflect the page it links to, and the modern terminology, "HIV-associated neurocognitive disorders (HAND)". — Preceding unsigned comment added by Ethanbissbort (talk • contribs) 23:10, 6 February 2020 (UTC)

You are right but I'm not sure that its inclusion is relevant. [8] relates that a small percentage (16%) of a study were found to have an existing or preexisting psychotic disorder.--Iztwoz (talk) 08:48, 7 February 2020 (UTC)

Semi-protected edit request on 13 February 2020

there is supposed to be a high overlap of dissociative disorders and psychotic disorders, especially for the positive symptoms, and many dissociative people are misdiagnosed with schizophrenia - this should be included in the differential diagnosis section. sources are eg https://journals.lww.com/jonmd/Abstract/1995/04000/Positive_and_Negative_Symptoms_in_Dissociative.9.aspx SherianKrafa (talk) 11:44, 13 February 2020 (UTC)

 Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format and provide a reliable source if appropriate. DarthFlappy (talk) 00:10, 4 March 2020 (UTC)

Urban

The source says "First, the risk of schizophrenia and related categories increases linearly with the extent to which the environment in which children grow up is urbanised (odds ratio [OR] ~2).3"[9]

"There are also consistent reports of higher rates of schizophrenia in individuals born in late winter or early spring,58 in individuals born and/or raised in cities" [10] Doc James (talk · contribs · email) 00:17, 15 February 2020 (UTC)

The ref used in that ref makes constant urban referrals - many other refs use the tern urban areas over cities as urban can relate to the sprawling built up areas not readily associated with the narrower (in UK) view of a city. However, have made small change to add iving in - which is referred to in many sources - and more specific ref.--Iztwoz (talk) 11:02, 15 February 2020 (UTC)

The works of Bertram P. Karon and Silvano Arieti

Hello,

I would like to add more mentions/references to the work of Bertram P. Karon, who did intensive psychotherapy of schizophrenics up until his death in 2019, as well as to the work of Silvano Arieti, who wrote an extensive book on schizophrenia, and applied successful psychotherapy to his patients. I am a recovering schizophrenic myself, diagnosed in the prodrome of the disease at the time I recieved medication, and I have read all 700 pages of Interpretation of Schizophrenia, and I feel like some of Arieti's theories would deserve to be mentioned in this article; for example, his theory on hearing voices(The Listening Attitude, as he called it), as well as on some of the manifestations of psychotic distortions. Same for Bertram P. Karon's work.

I just feel that the work of these authors is seldom brought up online, despite the fact that both have applied successful psychotherapy to their schizophrenic patients(see the examples of Geraldine and Mark in Interpretation of Schizophrenia), and also despite the fact that works are to this day taught in the psychiatric profession, and psychiatrists/psychologists rely upon them to treat their patients.

Some articles by Bertram Karon: https://www.ncbi.nlm.nih.gov/pubmed/12722890 https://www.apa.org/pubs/videos/4310823

Please confirm if it is okay for me to make such changes. Theoverfloater (talk) 16:25, 26 March 2020 (UTC)

Hello Theoverfloater thanks for bringing this item up, and in view of the increasing length of the page I intend making an inclusion at some time.--Iztwoz (talk) 08:16, 28 March 2020 (UTC)

Please add the following information to the article

Research on brain samples shows that people with Schizophrenia have disrupted arginine metabolism in their brains.

They show significantly different arginine levels and arginase levels compared to the control group.

https://www.nature.com/articles/tp2016144

2600:1010:B16F:8081:F979:D85C:56CD:13B8 (talk) 01:07, 10 April 2020 (UTC)