Talk:Schizophrenia

Edit request from Kd3qc, 2 September 2010

{{editsemiprotected}}

Cannabis

Newer review from the authors of the 2007 Lancet article: http://bjp.rcpsych.org/cgi/content/full/193/5/357 (2008); this one is about outcomes. Robin Murray seems to think the danger of causing psychosis is greater (see his bio); I'm not sure if that's wroth mentioning here though. Also a 2010 meta-analysis http://schizophreniabulletin.oxfordjournals.org/content/36/6/1115.abstract finds that 1/4 of the schizophrenia patients could be diagnosed with CUD (cannabis use disorder). Also a 2010 10-year longitudinal study http://ajp.psychiatryonline.org/cgi/content/abstract/167/8/987 (not a review though) found that cannabis worsens the outcomes. That seems to agree with a 2009 study on long-term outcomes of discontinuing cannabis after a first episode http://schizophreniabulletin.oxfordjournals.org/content/early/2009/11/13/schbul.sbp126.full Tijfo098 (talk) 10:57, 25 October 2010 (UTC)

Article issues

I think that this is a little shaky in the FA department. Here are some concerns I found:

• First paragraph of "signs and symptoms" is entirely unsourced.
• "Research suggests" weasel-wording in "positive and negative symptoms" section.
• [Citation needed] under Diagnosis header.
• "In a recent study" under Substance Abuse header — how recent? Don't use recent.
• Medication header has a couple one sentence paragraphs and another unqualified "recent."
• Second paragraph of "iconic cultural depictions" is unsourced.
• Many references are lacking page numbers and/or have broken DOIs.

Ten Pound Hammer, his otters and a clue-bat • ^{(Otters want attention)} 22:42, 6 November 2010 (UTC)

Thanks for mentioning this. I'll take a look. -- WeijiBaikeBianji (talk, how I edit) 00:41, 7 November 2010 (UTC)

Good points...and should be straighforward to fix. Casliber (talk · contribs) 02:30, 8 November 2010 (UTC)

Encephalitis lethargica

Regarding this edit: The NEJM review of that book specifically questioned that assertion: "How can he be so certain that persons with Kraepelin's schizophrenia in fact suffered from encephalitis lethargica and that therefore today the outcome of the disease is seen in an unnecessarily gloomy light?". You may want to read the rest: . Tijfo098 (talk) 02:16, 8 November 2010 (UTC)

Susan has also pointed out that the same (or similar) information is covered here which is a good start. Now what would be better is the same information from the PMID article was covered elsewhere in one or more Review Articles - the sheer enormity of material published on schizophrenia means we have to limit the page to material which has gained broad acceptance. Casliber (talk · contribs) 02:23, 8 November 2010 (UTC)

PS: It does get cited in 19 articles, with some interesting places to look. Casliber (talk · contribs) 02:26, 8 November 2010 (UTC)

Yes, certainly I agree about the need to limit this page. I thought it was interesting enough to try out (Google gives at least 12,000 hits for "encephalitis lethargica schizophrenia" and over a million if you drop the "lethargica"). Regarding the review and comments from Tijfo098, I have about four days to go on a DYK. Thank you. -SusanLesch (talk) 02:30, 8 November 2010 (UTC)

To Casliber: hopefully in a better known journal (need not be a psychiatric one) than J Hist Behav Sci., which seems rather obscure [1]; impact factor not much better than Psychological Reports. [2] Tijfo098 (talk) 02:56, 8 November 2010 (UTC)

I've looked at some of the articles citing Boyle. Insofar I did not ones in mainstream sources, but there's no shortage of articles like which cite him. Not very reassuring. Tijfo098 (talk) 03:21, 8 November 2010 (UTC)

I wouldn't expect you to be reassured. M Boyle is Mary Boyle, author of "Schizophrenia: A Scientific Delusion?". -SusanLesch (talk) 03:26, 8 November 2010 (UTC)

She seems entirely committed to the notion that schizophrenia is nothing but a social construction: "Just as ideological biological psychiatrists reduce all explanations to neurochemistry, Boyle seems unwilling to entertain anything other than a social explanation for madness." Hardly a reliable source for examining the historical record. Tijfo098 (talk) 03:36, 8 November 2010 (UTC)

I'm happy to see you've upgraded her to a female this time. But I don't like your source mentalhelp.net ("Ask a Psychiatrist" we have "12 online" right now). Pardon me if I return to my project. -SusanLesch (talk) 04:15, 8 November 2010 (UTC)

Metapsychology online reviews is a reasonably good source of book reviews in my experience. There's probably a review in PsycCRITIQUES as well, but I did not check. And MOR is free to access, so they have Google ads. I normally have them blocked, so I don't normally see what you say they advertise, and on a spot check, I don't get the one you say you see, but you can probably get one like that on occasion. Google probably doesn't think I need a psychiatrist. :-D Tijfo098 (talk) 04:24, 8 November 2010 (UTC)

Oh dear. My fault entirely for not noticing that that was an ad. Sorry. -SusanLesch (talk) 05:45, 8 November 2010 (UTC)

There are more reviews on Talk:Mary Boyle. One even said "But we like to remind that biology is not a right-wing plot." Tijfo098 (talk) 06:02, 8 November 2010 (UTC)

Side note

E. Fuller Torrey's hypothesis on Toxoplasma gondii is not mentioned in this article either, and there's a good reason for that too: it's not mainstream. Ironically, Boyle and Torrey are at opposite ideological poles on mental illness causes, and particularly treatment. Tijfo098 (talk) 04:08, 8 November 2010 (UTC)

By the way

Searching for citations of Boyle's book, I found this 2010 BJP paper of some relevance here: . Boyle was cited in one of the five letters to the editor this paper triggered: [3]. Tijfo098 (talk) 06:12, 8 November 2010 (UTC)

Journalism about schizophrenia

Perhaps that topic deserves a few sentences by itself: [4] [5] Tijfo098 (talk) 07:09, 8 November 2010 (UTC)

Also, I see we cover [6], but not the other two papers from the fabled press release (all in the same issue of Nature), so we're doing slightly worse journalism. ;-) The best write-up seems this one (but, hey it came a day later, so it doesn't count.) Tijfo098 (talk) 07:29, 8 November 2010 (UTC)

Edit regarding poor use of words

The sentence under 'Postive and Negative Symptoms': "Negative symptoms are things that are not present in schizophrenic persons but are normally found in healthy persons, that is, symptoms that reflect the loss or absence of normal traits or abilities." can be written better to avoid use of "things" . I would suggest "Negative symptoms are a result of traits or abilities that are not present in schizophrenic persons, but are normally found in healthy persons." 76.175.239.170 (talk) 21:35, 28 November 2010 (UTC)

I take your point, but the article needs to say what negative symptoms are, not what they are the result of. Looie496 (talk) 17:47, 29 November 2010 (UTC)

I have to somewhat agree on the comments of the unnamed poster. I might only be in the process of getting my Masters in Psychology, and thus not a true 'expert', but the section on 'Positive and Negative Symptoms' just seems off. The way negative symptoms are portrayed (i.e. only called that because they are difficult to treat, as opposed to positive symptoms, which according to the article are easier and more responsive to treatment and thus called 'positive') is inaccurate - it has more to do with the LACK of symptoms that are usually expected, such as an inexpressive face. I would like to have a discussion on this section, and a forum of ideas and sources, otherwise I feel this section needs to be reviewed by someone higher in the science/medical field. People use Wiki as an important source of information, and if we are giving them something inaccurate, we need to discuss ways to fix it, because mis-information is worse than no information at all. Thank you! Barbiegurl676 (talk) 10:13, 21 December 2010 (UTC)

Other research

Zuardi et al., 2006, Cannabidiol, a Cannabis sativa constituent, as an antipsychotic drug, Brazilian Journal of Medical and Biological Research (2006) 39: 421-429 http://www.scielo.br/pdf/bjmbr/v39n4/6164.pdf

A snip from the abstract says it all but the paper is worth a read. "In addition, open case reports of schizophrenic patients treated with CBD and a preliminary report of a controlled clinical trial comparing CBD with an atypical antipsychotic drug have confirmed that this cannabinoid can be a safe and well-tolerated alternative treatment for schizophrenia."

I am unaware of the psychiatric research into the levels of THC versus CBD in street cannabis. It is noteworthy that the drug does induce something that looks psychosis-like, i.e. it scores on PANSS and other scales of psychosis as looking like psychosis in lab conditions however if users are sat in front of a TV watching Cheech and Chong it is clearly a pleasant experience whereas pathological psychosis for many is an intensely distressing experience.

Cannabis in one of many entheogen and can be used for purposes other than recreational highs. There are non-pathological interpretations of psychosis and schizophrenia advocated by organisations such as Intervoice and the Hearing Voices Network which seek to apply meaning to the experiences pathologised by psychiatry as schizophrenia. Rufus May is an advocate of an approach to deal with voice hearing, delusions and hallucinations as real

Morethanhuman (talk) 10:42, 5 December 2010 (UTC)

Concerning this article, that paper would count as a primary source per WP:MEDRS and therefore not really suitable. In any case the paper is clearly not favorable to giving cannabis itself to people with schizophrenia, which would be a remarkably bad idea. Looie496 (talk) 18:07, 5 December 2010 (UTC)

Contradiction about lifetime prevalence

There is a contradiction in the article about the lifetime prevalence: in the introduction it is given as "a global lifetime prevalence of around 1.5%", in the section Epidemiology it is given as "The lifetime prevalence of schizophreni [...] is commonly given at 1%. However, a 2002 systematic review of many studies found a lifetime prevalence of 0.55%." 87.212.160.173 (talk) 14:59, 8 December 2010 (UTC)

probably time to update with another more recent review and also time to challenge the myth that incidence is fixed . Earlypsychosis (talk) 20:37, 8 December 2010 (UTC)

Heh -- that came out citing an article with title Magnus Bareleg's Journey to the West. I fixed the cite pmid template. Looie496 (talk) 22:53, 8 December 2010 (UTC)

A spelling bug

It's in "These symptoms gererally respond well to medication." Replace "gererally" with "generally". Good article, by the way. Alexander.gotmanov (talk) 11:42, 20 December 2010 (UTC)

Iconic cultural depictions

Add reference to the movie Clean Shaven http://en.wikipedia.org/wiki/Clean,_Shaven which tries to objectively view schizophrenia and those who are affected by it. Linuxsims (talk) 14:41, 22 December 2010 (UTC)

Neuroanatomical and neurophysiological pathologies

Schizophrenia is a neurological disorder and after reading the very meager section on the neuroanatomical and neurophysiological pathologies I have a few papers to suggest for expanding this section and for making it much more inclusive of the data. The following are PMIDs:

• 11343862 A review of MRI findings in schizophrenia.
• 20954428 Structural neuroimaging in schizophrenia: from methods to insights to treatments.
• 20237131 Diffusion tensor tractography findings in schizophrenia across the adult lifespan.

Until this section is vastly improved I really don't see how it can continue to be an FA. It's just missing lots of very important information. Basket of Puppies 00:21, 24 December 2010 (UTC)

That's a very biological viewpoint. Thankyou for restricting the results to review articles- ultimately, these have very little impact on how the condition is treated and managed. Yes some aspect of neuroimaging should be included. I'll have a read though. Casliber (talk · contribs) 02:10, 24 December 2010 (UTC)

Can you please explain what you mean by a very biological viewpoint? I ask as I am confused as to what else schizophrenia might be. It's a brain disease that effects every aspect of a person's life. The review articles are valid secondary sources, especially Shenton's MRI review article, which is the authoritative paper as to MRI findings of the schizophrenic brain. Still, I cannot see how this article can continue to be a Featured Article when it is lacking in extremely basic information as to the underlying pathologies. Basket of Puppies 03:45, 24 December 2010 (UTC)

It means that we have what we call very clear-cut neurological disorders such as epilepsy, parkinsons' disease, multiple sclerosis etc. Then we have several psychotic disorders such as schizophrenia, bipolar disorder and some forms of depression, where the hard evidence is not so clear cut. There is a huge range on how people view these latter disorders, from very biological psychiatrists - who focus on investigations, genetics, subtypes etc. all the way through to the other extreme of folks in the antipsychiatry and similar who see them as sociological constructs. Consensus I'd take an educated guess (working in the field) as lying about a third the way along from the former to the latter. There are other odd discrepancies, such as the fact that the concordance is somewhere between 40 and 50% for monozygotic twins (biologically focussed investigators tout this as firm evidence for the biological nature of the illness...but in which case why is this not much higher?) and several others.

Anyway, I digress a little - in medicine we generally reserve the term "neurological" for the more medical bunch of conditions I outlined initially - the second bunch are still generally called "psychiatric", "functional" (older term now) etc. There is a nuance here in common parlance that veers from what one would concretely expect. I will read the Reviews sometime soon as I am juggling a bit. Getting fulltext should be pretty straightforward. Casliber (talk · contribs) 03:59, 24 December 2010 (UTC)

I have in front of me (PDF form) "Adams and Victors Principles of Neurology 8th Ed" which lists schizophrenia and goes into depth of the CT and MRI findings and labels it a genetic problem in at least 80% of the cases. Thus I am very confused how you can declare schizophrenia not to be neurological. Basket of Puppies 04:11, 24 December 2010 (UTC)

As I said, it is in the nuance. Of course it is neurological, but there are some funny ways that doctors use words....anyway, I am actually busy wrapping presents ATM - BoP, I don't own this article, you are more than welcome to summarise and add the three review articles. I am up to my armpits in wrapping paper and have a few other priorities on-wiki as well. If you can't get fulltext let me know and I will try to ferret some. Casliber (talk · contribs) 13:19, 24 December 2010 (UTC)

You very much act like you own this article. Basket of Puppies 18:24, 24 December 2010 (UTC)

(undent) Classically, "neurological" disorders pertains to disorders that can be linked to pathologies of specific regions of the nervous system. For example, Gerstmann syndrome is considered a neurological disorder because it can be linked with pathologies in left parietal cortex, as is dyscalculia. Conversely, disorders that are due to widespread differences in neurotransmitters or brain communication are considered "psychiatric" or "mental", and generally linked to disorders of overall thought or emotion (depression, OCD, schizophrenia, etc). This is the point that Casliber has been arguing (correctly in my opinion). The problem here is that mental disorder, which the psychiatric disorder page redirects to, seems to carry the implication that it's just "all in your head", while it is indeed clear that there is a genetic and biological basis for schizophrenia, as Basket of Puppies rightly argues. So, "neurological" doesn't apply in this case, since sz is not linked to just one brain region, but "mental" alone also feels inappropriate. Simply insisting on adding neurological also doesn't address the deeper issues, but neither does leaving "mental" alone. Perhaps "neuropsychiatric" in parallel with neuropsychiatry would be more appropriate than purely "neurological" or "mental." Edhubbard (talk) 21:37, 24 December 2010 (UTC)

neuropsychiatry has its own connotation too, which I'll dig up. Big problem is, wikipedia has to reflect current usage, even if idiosyncratic :/ Casliber (talk · contribs) 22:16, 24 December 2010 (UTC)

For instance, the WHO distinguishes neurological and mental health disorders, reserving the former for epilepsy and MS, and discussing schizophrenia separately. Casliber (talk · contribs) 00:28, 25 December 2010 (UTC)

I never suggested even for a minute that mental disorders be removed from the lead of this article but rather have twice tried to add neurological disorders. Each time this has been reverted with an edit summary of "see talk". I am here seeing talk but I do not see the rationale for removing neurological. I am only suggesting that each point be presented. So why constantly remove valid, sourced information? You say you do not WP:OWN the article but it sure seems like you do. Basket of Puppies 22:50, 25 December 2010 (UTC)

BoP - (1) I didn't revert you the second time. (2) find me a summary where it is called a neurological disorder. (3) I hope your intentions are to improve the article rather than just the lead. Casliber (talk · contribs) 00:31, 26 December 2010 (UTC)

Casliber, 1)I know, your tag-team buddy did, 2) I cited it above in the neurology textbook, 3) I hope you've read the FAR. Basket of Puppies 15:43, 26 December 2010 (UTC)

I have nominated Schizophrenia for a featured article review here. Please join the discussion on whether this article meets featured article criteria. Articles are typically reviewed for two weeks. If substantial concerns are not addressed during the review period, the article will be moved to the Featured Article Removal Candidates list for a further period, where editors may declare "Keep" or "Delist" the article's featured status. The instructions for the review process are here. Basket of Puppies 23:35, 25 December 2010 (UTC)

Neurological disorder

Really? We would need a review article for this. I somehow do not think my colleges in neurology would be impressed if I called them for someone I had diagnosed with schizophrenia.Doc James (talk · contribs · email) 04:57, 26 December 2010 (UTC)

This 2010 Nature article is interested:

How will we view schizophrenia in 2030? Schizophrenia today is a chronic, frequently disabling mental disorder that affects about one per cent of the world's population. After a century of studying schizophrenia, the cause of the disorder remains unknown. Treatments, especially pharmacological treatments, have been in wide use for nearly half a century, yet there is little evidence that these treatments have substantially improved outcomes for most people with schizophrenia. These current unsatisfactory outcomes may change as we approach schizophrenia as a neurodevelopmental disorder with psychosis as a late, potentially preventable stage of the illness. This 'rethinking' of schizophrenia as a neurodevelopmental disorder, which is profoundly different from the way we have seen this illness for the past century, yields new hope for prevention and cure over the next two decades.

Insel TR (2010). "Rethinking schizophrenia". Nature. 468 (7321): 187–93. doi:10.1038/nature09552. PMID 21068826. {{cite journal}}: Unknown parameter |month= ignored (help)

It is suggesting we think of it as a neurological disorder by is currently a mental disorder. The cause is unknown. Doc James (talk · contribs · email) 05:02, 26 December 2010 (UTC)

I completely agree with the article. Schizophrenia must be viewed as a neurological disorder, not a mental health disorder. Basket of Puppies 06:49, 26 December 2010 (UTC)

Nothing new here. Ignores the fact that there has been alot of focus on receptors and psychopharmacology. It is an opinion piece. Find me a consensus statement that says "neurological" BoP. Casliber (talk · contribs) 09:20, 26 December 2010 (UTC)

This refs say today schizophrenia is viewed as a mental disorder. We think it should be view as a neurodevelopmental disorder. So one could add to the body of the text that some wish schizophrenia where viewed as a neurodevelopmental disorder but it currently is not. Second just because someone is affiliated with the NIH does not mean they speak on behalf of the NIH.Doc James (talk · contribs · email) 10:34, 26 December 2010 (UTC)