Talk:Schizophrenia
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Contents
The First Sentence[edit]
May I suggest that characterizing schizophrenia as a "failure to understand reality" is unnecessarily stigmatic? The cited source says nothing about "failure" or "reality." I think the words "failure to understand reality" represent an unneccessary extrapolation on the part of the author(s) of this page. I'm not saying it is an inaccurate description, but I am saying that such an assertion is definitely not directly supported by the cited source. The source says that schizophrenia is characterized by "distortions in thinking, perception, emotions, language, sense of self and behaviour." I see no reason to characterize schizophrenia as a "failure" when there are much more precise ways to describe the disease (i.e., the disease constitutes a distortion, not a failure). Moreover, I fail to see any reason to extrapolate "failure" from a cluster of symptoms described on a WHO page. "Failure" connotes judgment. I suggest that someone in control of this article revise this wording. Even though it might seem trivial, when the very first sentence of the article describes schizophrenia as a "failure" it certainly contributes to the stigma surrounding the disease. I submit my comment very humbly, and without any intention to be inflammatory -- I'm just saying that if I were a schizophrenic I would feel bad if I went to Wikipedia to learn about my disease and found it characterized as a "failure." I would be further distressed if I went to the cited source and found the word "failure" did not appear anywhere in the source. Nor did the word "reality." Using words like these seem to lay bare the judgment of their author. Not very informative.
- You are correct. This is overly simplistic, stigmatizing and incorrect. It shouldn't be described in a simple way because this is a complex disorder that describes various clusters of psychomotor symptoms. Asterixf2 (talk) 10:06, 15 September 2018 (UTC)
- The sentence People with schizophrenia often have additional mental health problems... describes another disorder -- schizoaffective -- and is also incorrect. Asterixf2 (talk) 10:12, 15 September 2018 (UTC)
- People with schizophrenia often have additional mental health problems... is not correct. Look at comorbidity, and then perhaps compare the diagnostic criteria for schizophrenia and schizoaffective disorder.
- Schizophrenia is a chronic and severe mental condition that encompasses any of a group of psychomotor symptoms that vary widely among affected individuals. Psychomotor symptoms are a subset of psychotic symptoms, and do not encompass, for example, delusions, hallucinations or though disorder.
- Paresthesia is not a common manifestation of schizophrenia.Petergstrom (talk) 04:51, 16 September 2018 (UTC)
- Thank you for the clarification. My goal here is to improve the top paragraph by making it less stigmatizing and written in a more encyclopedic, informative style.
- Regarding #Paresthesia is not a common manifestation of schizophrenia. -- I may remove the wikilink to paresthesia, because what I meant are "sensory hallucinations" as noted in the WHO document as one of the core symptoms of schizophrenia. However I have found it useful to link "needles" to paresthesia as these are the most common afaik "bizarre physical sensations" (original WHO wording). Please take a look at page 4: http://www.who.int/mental_health/media/en/55.pdf among others. Furthermore, please note that according to WHO auditory hallucinations (voices) occur only in 70% of patients. I insist on improving the top paragraph, please help. Thank you for your valuable input.
- Do you find the following wording sufficiently tolerable?:
- Schizophrenia is a chronic and severe mental condition that encompasses any of a group of symptoms that vary widely among affected individuals. Some of the following disturbances can always be observed: delusions – firmly held false beliefs that usually include ideas of reference, control or persecution; hallucinations – hearing, seeing or feeling things that are not there like voices or needles; thought disorders – as evidenced by disorganized speech, illogical associations or sensations of thought insertion; altered motor activity – reduction of spontaneous movements, prolonged bizarre positions; abnormal affect – reduction in emotional intensity or variation, lack of motivation.[1][2][3] Symptoms typically begin in early adulthood.[4][5] About 45% of patients recover after one or more episodes and 35% show a mixed pattern with varying degrees of remission and exacerbations of different length. Schizophrenia is treatable. Risk of relapse during the first year following an acute episode in patients on antipsychotic medications is reduced to about 20%, in comparison with about 60% on placebo.[6] People with schizophrenia often have additional mental health problems such as anxiety, depressive, or substance-use disorders.[7]
- Asterixf2 (talk) 05:35, 16 September 2018 (UTC)
- Alternatively, I propose to change the first sentence into:
- Schizophrenia is a mental disorder characterized by abnormal behavior and disturbances in the perception of reality.[8]
- Asterixf2 (talk) 06:07, 16 September 2018 (UTC)
- Auditory hallucinations are by far the most common type of hallucination, although there is significant variability across time and cultures; in the end, its not worth specifying any sensory modality, as the intro is meant to be general. Furthermore, the current wording is not at all stigmatizing, and is fine the way it is. There is no reason to change that sentence, and the proposed edit just doesn't work - it doesn't flow well, is excessively convoluted, and doesn't provide a succinct overview. Lets get some other editor input on this.Petergstrom (talk) 06:07, 16 September 2018 (UTC)
- Ok. Please also take into consideration another alternative that I have proposed. Asterixf2 (talk) 06:11, 16 September 2018 (UTC)
- We are writing for a general audience, especially the leads.
- Agree with going with "abnormal behavior" as also used by WHO[1]
- The term "fixed, false beliefs" is basically "failure to understand reality" Doc James (talk · contribs · email) 17:27, 16 September 2018 (UTC)
- Strictly speaking, failure to understand reality is correct but may be misleading for general audience. It is stigmatizing because -- in a sense -- it denies people with schizophrenia the right to have legitimate views or ideas about reality and therefore the need to respect their opinions. It suggests total failure instead of partial and often very limited and specific kinds of failures. Disturbances and distortions are both used by WHO. Asterixf2 (talk) 19:28, 16 September 2018 (UTC) Not to mention the fact that schizophrenia is episodic afaik. Asterixf2 (talk) 19:34, 16 September 2018 (UTC)
- Ok. Please also take into consideration another alternative that I have proposed. Asterixf2 (talk) 06:11, 16 September 2018 (UTC)
- Auditory hallucinations are by far the most common type of hallucination, although there is significant variability across time and cultures; in the end, its not worth specifying any sensory modality, as the intro is meant to be general. Furthermore, the current wording is not at all stigmatizing, and is fine the way it is. There is no reason to change that sentence, and the proposed edit just doesn't work - it doesn't flow well, is excessively convoluted, and doesn't provide a succinct overview. Lets get some other editor input on this.Petergstrom (talk) 06:07, 16 September 2018 (UTC)
Please change the photo.[edit]
Hi. Please change the photo. Stop of discrimination of patients. — Preceding unsigned comment added by Artystka88 (talk • contribs) 16:32, 30 August 2018 (UTC)
- Can you clarify what you find offensive about the photo and how you feel it discriminates against people who have schizophrenia? TylerDurden8823 (talk) 18:25, 30 August 2018 (UTC)
- IMO, this is likely due to the Framing effect (psychology) from the first sentence of the article discussed above in another section of the talk page. The picture is merely negative, subjective and puts emphasis, perhaps undue, on the delusion ofl control. Asterixf2 (talk) 11:12, 16 September 2018 (UTC)
Changes to the "mechanism" section[edit]
I posted a potential rewrite of the mechanism section(which I don't think is up to date, and gives a bit too much weight to certain lines of research) in July, and it only got one response. I am reposting it here as it was archived, and would appreciate other editors inputs.
| Proposed "Mechanism" content |
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| The following discussion has been closed. Please do not modify it. |
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The mechanism of schizophrenia is unknown. Evidence implicate a number of possible mechanisms, such as abnormalities in dopaminergic signalling, glutaminergic neurotransmission, and neurodevelopment. Many frameworks have been hypothesized to link these biological abnormalities to symptoms, including psychological and computational mechanisms.[9] Abnormal dopamine signalling has been implicated in schizophrenia by the efficacy of D2 receptor antagonists, and the observation that dopamine synthesis and release, as measured by positron emission tomography, is elevated during acute psychosis.[10][11] Abnormalities in dopaminergic signalling have been hypothesized to underlie delusions via dysfunctional signalling of salience.[12][13][14] Dopaminergic predictions errors, which mediate learning when expectancies are violated, are abnormal in schizophrenia, and these abnormalities correlate with the severity of delusions. Furthermore, impaired learning, putatively reflecting the functionality of the dopaminergic system, is present in schizophrenia and correlates with delusion severity.[15] Dysfunctional prediction errors may be related to hyperactive input from the hippocampus, which has been observed to be metabolically overactive in schizophrenia.[12] Hypoactivation of D1 receptors in the prefrontal cortex may also be responsible for deficits in working memory.[16][17][18][19] Reduced NMDA receptor signalling is suggested by multiple lines of evidence. Post-mortem studies demonstrate reduced NMDA receptor expression and NMDA receptor antagonists mimic both schizophrenia symptoms and the electrophysiological abnormalities associated with schizophrenia (notably reduced mismatch negativity and P300).[20][21][22] This deficit in NMDA signalling may be related to the abnormalities observed in parvalbumin interneurons that express NMDA receptors.[23] Post-mortem studies consistently find that a subset of these neurons fail to express GAD67,[24] in addition to abnormalities in morphology. The subsets of interneurons that are abnormal in schizophrenia are responsible for the synchronizing of neural ensembles that is necessary during working memory tasks, a process that is electrophysiologically reflected in gamma frequency (30-80 Hz) oscillations. Both working memory tasks and gamma oscillations are impaired in schizophrenia, which may reflect abnormal interneuron functionality.[24][25][26][27] Multiple lines of evidence suggest that schizophrenia has a neurodevelopmental component. Schizophrenia is associated with premorbid impairments in cognition, social functioning, and motor skills.[28] Furthermore, prenatal insults such as maternal infection,[29][30] maternal malnutrition and obsteric complications all increase risk for schizophrenia.[31] Animal models of these insults demonstrate patterns of cellular and molecular abnormalities similar to those in schizophrenia, such as increased RELN methylation and abnormal GABAergic cell development.[32] Schizophrenia usually emerges symptomatically during late adolescence, 18-25, an age period that overlaps with certain stages of neurodevelopment that are implicated in schizophrenia.[33] Deficits in executive functions, such as planning, inhibition, and working memory, are pervasive in schizophrenia. Although these functions are dissociable, their dysfunction in schizophrenia may reflect an underlying deficit in the ability to represent goal related information in working memory, and to utilize this to direct cognition and behavior.[34][35]. These impairments have been linked to a number of neuroimaging and neuropathological abnormalities. For example, functional neuroimaging studies report evidence of reduced neural processing efficiency, whereby the dorsolateral prefrontal cortex is activated to a greater degree to achieve a certain level of performance relative to controls on working memory tasks. These abnormalities may be linked to the consistent post-mortem finding of reduced neuropil, evidenced by increased pyramidal cell density and reduced dentritic spin density. These cellular and functional abnormalities may also be reflected in structural neuroimaging studies that find reduced grey matter volume in association with deficits in working memory tasks.[36] Positive and negative symptoms have been linked to reduced cortical thickness in the superior temporal lobe,[37] and orbitofrontal cortex, respectively.[38] Anhedonia, traditionally defined as a reduced capacity to experience pleasure, is frequently reported in schizophrenia. However, a large body of evidence suggests that hedonic responses are intact in schizophrenia,[39] and that what is reported to be anhedonia is a reflection of dysfunction in other processes related to reward.[40] Overall, a failure of online maintence and reward associativity is thought to lead to impairment in the generation of cognition and behavior required to obtain rewards, despite normal hedonic responses.[41] Bayesian models of brain functioning have been utilized to link abnormalities in cellular functioning to symptoms.[42][43] Both hallucinations and delusions have been suggested to reflect improper encoding of prior expectations, thereby causing expectation to excessively influence sensory perception and the formation of beliefs. In canonical models of circuits that mediate predictive coding, hypoactive NMDA receptor activation, similar to that seen in schizophrenia, could theoretically result in classic symptoms of schizophrenia such as delusions and hallucinations.[44][15] References
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Petergstrom (talk) 21:49, 1 September 2018 (UTC)
- Overly complicated IMO and needs substantial simplification. Doc James (talk · contribs · email) 03:37, 2 September 2018 (UTC)
- An improvement over the current text IMO. I personally don't understand the following words in this context: "frameworks", "consistent observation" (... in PET of elevated dopamine synthesis. <-- what is consistent, the observation or the elevated synthesis?), "Dopaminergic predictions errors" (the ending -s in both words mess with me), "putatively" could possibly be switched with a synonym, "post mortem" could be hyphenated (as it is in 2nd mention), "associativty" seems to be missing a letter i. These changes would improve readability IMO. --Treetear (talk) 22:34, 13 September 2018 (UTC)
- I don't really think this needs very much simplification. This is pretty much as simple as it gets, and I think it actually simplifies a number of topics that are covered in the current mechanism section (in particular dopamine). As for what Treetear said, this does need a lot of copy editing. I went ahead and implemented corrections to errors found, but there are probably a few more that I am missing.Petergstrom (talk) 03:16, 19 September 2018 (UTC)
- An improvement over the current text IMO. I personally don't understand the following words in this context: "frameworks", "consistent observation" (... in PET of elevated dopamine synthesis. <-- what is consistent, the observation or the elevated synthesis?), "Dopaminergic predictions errors" (the ending -s in both words mess with me), "putatively" could possibly be switched with a synonym, "post mortem" could be hyphenated (as it is in 2nd mention), "associativty" seems to be missing a letter i. These changes would improve readability IMO. --Treetear (talk) 22:34, 13 September 2018 (UTC)
- Overly complicated IMO and needs substantial simplification. Doc James (talk · contribs · email) 03:37, 2 September 2018 (UTC)
"Culture"[edit]
The line in the introduction "During diagnosis a person's culture must also be taken into account." seems like an odd and unhelpful statement for an introduction. Why must it be taken into account? How does this information form part of an introduction to the topic?
I'm unsure where it could be reworked in, but I think it should be? Thoughts?
Nauseous Thot (talk) 11:29, 20 September 2018 (UTC)
- Yes a person's culture must be taken into account when symptoms are interpreted. Doc James (talk · contribs · email) 03:26, 22 September 2018 (UTC)
- I agree that a person’s culture must be taken into account before labelling a sign or symptom as related to schizophrenia. Perhaps an example could be added (if the source gives one) such as local or tribal superstitions or unusual religious belief.--Literaturegeek | T@1k? 12:47, 22 September 2018 (UTC)
- Yes a person's culture must be taken into account when symptoms are interpreted. Doc James (talk · contribs · email) 03:26, 22 September 2018 (UTC)
Comorbidity[edit]
I've removed a sourced edit based on two studies, which gave undue weight to comorbidity of schizophrenia and gender identity disorder, as no other condition was mentioned, and g.i.d. isn't close to the major conditions which should be mentioned when discussing the subject. It could be added back, in proper context, and with proper weight, which I suspect will be very low. Mathglot (talk) 04:41, 9 November 2018 (UTC)
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