Talk:Schizophrenia/Archive 12

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American or British English?

This article has a mixture of American and British English spelling, e.g., behavior vs. behaviour. There are not a lot of such differences, but it would help in the long term to post the standard notice at the top of the Talk page, e.g., {{American English}}, and on the article page, e.g, {{American English editnotice}}. I would do it but I can't recall the type of English used when the article began.   - Mark D Worthen PsyD (talk) (I am a man. The traditional male pronouns are fine.) 16:28, 6 September 2019 (UTC)

Toss a coin But seriously, we can look at an early revision Cas Liber (talk · contribs) 20:15, 6 September 2019 (UTC)

But for the coin toss should we use a dime or a shilling? ;^]   - Mark D Worthen PsyD (talk) (I am a man. The traditional male pronouns are fine.) 14:28, 8 September 2019 (UTC)

It was a mix in 2003 too. Maybe go with US English as DSM5 is American, and "disorganized schizophrenia" looks more natural to me than "disorganised schizophrenia".....Cas Liber (talk · contribs) 20:19, 6 September 2019 (UTC)

Disorganized looks pretty disorganised to me.--Literaturegeek | T@1k? 14:43, 8 September 2019 (UTC)

I'm a Yank but IMHO British pommy is more expressive. My mates will call me yampy, but I'll support the Queen's English if that's the consensus. (Seriously, either is fine with me.)   - Mark D Worthen PsyD (talk) (I am a man. The traditional male pronouns are fine.) 14:48, 8 September 2019 (UTC)

Is this sorted, so it can be archived? There's an American English template on the page, and when we set up Editnotices, this was not identified as British along with other FAs that were. Support American English here. SandyGeorgia (Talk) 17:54, 28 December 2019 (UTC)

As of 2019

In the lead - is this "As of 2019 there is no diagnostic test.." needed. If it were just stated that "there is no diagnostic test or biomarker" as covered in the Lancet 2016 ref (if a ref was needed for this) then one day when a test or biomarker becomes available this would undoubtedly be added at that time. --Iztwoz (talk) 17:46, 17 January 2020 (UTC)

agreed Cas Liber (talk · contribs) 20:08, 17 January 2020 (UTC)

Yup can be stated as fact and changed if another test every comes about.Doc James (talk · contribs · email) 22:45, 17 January 2020 (UTC)

Semi-protected edit request on 29 December 2019

Hello, I would like to change the following sentence: "Evidence for metacognitive training is mixed with some reviews finding benefit and another not" as follows: "Metacognitive training (MCT) has been entered into the treatment guidelines for schizophrenia of the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN; [161]) following two positive meta-analyses in 2018 [162] and 2019 [163]."

citations: [161] = https://www.springer.com/de/book/9783662593790 [162] = https://www.ncbi.nlm.nih.gov/pubmed/29489070 [163] = https://www.ncbi.nlm.nih.gov/pubmed/30456821

explanation: The latest (and largest) meta-analyses on metacognitive training were positive. Even the meta-analysis by van Oostehout et al. (2016) had significant effects in favor of metacognitive training when new data was entered (for full text see here: https://search.proquest.com/openview/80a62add2ad5d1219d2d41f6a8861c87/1?pq-origsite=gscholar&cbl=35753) Wiki psych21 (talk) 23:44, 29 December 2019 (UTC)

Sorry, no. Not part of general treatment and conflicting meta-analyses and letter to editor only. Cas Liber (talk · contribs) 21:16, 31 December 2019 (UTC)

Hello Caliber: I respectfully ask you to look at the issue again. First, Metacognitive Training (MCT) is now recommended by three different professional organisations (German Psychological Society (DGPs), German Psychiatric Society (DGPPN), Royal Australian and New Zealand College of Psychiatrists), which is worth mentioning itself - I can provide citations for that. Then, the last three (and largest) meta-analyses showed (significant) positive effects. Only one *earlier* meta-analysis (van Oousterhout et al., 2016) with fewer studies was negative (trend in favor of MCT), presumably due to power issues (if studies were added the effect was significant according to the authors (yes, they acknowledged this in a letter to the editor as they could not change the meta-analysis anymore). All latest meta-analyses were published as reguar articles in respected (peer-review) journals. I really think the current sentences needs to be updated --Wiki psych21 (talk) 17:34, 1 January 2020 (UTC)wiki psych21

Hello, I would like to add an apology for writing your name wrongly (Caliber - not Cas Liber), Wiki psych21 (talk) 09:46, 3 January 2020 (UTC)

Heh no problem on the name. I just tried looking for a source on the RANZCP and MCT in schizophrenia without success. A pointer would be good. Cas Liber (talk · contribs) 14:32, 3 January 2020 (UTC)

Hello Cas Liber, thanks a lot. Here is the full-text link for the citation: https://journals.sagepub.com/doi/pdf/10.1177/0004867416641195 - the recommendation is provided in the table on page 443 (EBR = evidence-based recommendation), training and evidence is summarized on page 442. If you want, I can also provide the texts and quotes for the German guidelines (incl. translation using deepl.com), yours Wiki psych21 (talk) 16:10, 3 January 2020 (UTC)

Okay good. I have updated the article accordingly Cas Liber (talk · contribs) 08:10, 4 January 2020 (UTC)

Dear Cas Liber. Thanks a lot. I would be grateful if you could link the entry "metacognitive training" to this site: https://en.wikipedia.org/wiki/Metacognitive_training - that would be all. Thanks again, Wiki psych21 (talk) 13:16, 4 January 2020 (UTC)

Wiki psych21, I have done that here. Please stop reactivating the edit request. Edit requests are designed to bring admin attention to a talk page. Once you already have that attention, and know that people are responding, it is not necessary to use edit request. By adding edit request, you put this page into a category that asks all admins to look in here-- this is no longer necessary. People are responding to your requests. This page is actively followed and editors have engaged with you, so it's not necessary to add an edit request. Thanks for the good info, BTW, and welcome! SandyGeorgia (Talk) 13:20, 4 January 2020 (UTC)

Brain stimulation

Have trimmed MDPI as it is potentially predatory. Dove Press is not a great publisher. Have moved this to the research section. Added a Cochrane review to provide some balance. Doc James (talk · contribs · email) 05:43, 1 January 2020 (UTC)

Split personality

The sources support the associate occurred within the popular imagination per "the idea of the 'split personality' became explicitly linked in the popular imagination with that of schizophrenia", not that the term officially implied a split personality. Doc James (talk · contribs · email) 09:16, 7 January 2020 (UTC)

This was changed as sentence as is, implies a current misconception - feel that this is very outdated and not now a usual association.--Iztwoz (talk) 10:11, 7 January 2020 (UTC)

Funny how this was such a thing 20 years ago and I think has almost faded from the public consciousness. Tempted to leave out of lead Cas Liber (talk · contribs) 10:19, 7 January 2020 (UTC)

Yah with User:Casliber on this. Do not think it needs to be in the lead. No one thinks this anymore. We also need to make sure that it was only the general public who historically made the association per "They learned that schizophrenia was commonly misinterpreted by the public as a ‘split personality’ and that ‘the schizophrenic does not suffer from split personality’"[1] Doc James (talk · contribs · email) 11:34, 7 January 2020 (UTC)

Ordering of sections

IMO it is reasonable to keep the standard ordering (as mentioned in WP:MEDMOS) to maintain some consistency within the layout of our articles. Doc James (talk · contribs · email) 09:17, 7 January 2020 (UTC)

WP:MEDMOS does not have a "standard ordering" it has "suggested headings", and the flow of the narrative is more important than a forced order. Not all articles lend themselves to the same order. Please do not make major changes to a Featured article without first discussing to achieve consensus. SandyGeorgia (Talk) 09:21, 7 January 2020 (UTC)

I have restored it to the ordering it had when it passed FA its last FA review in 2011.[2] Doc James (talk · contribs · email) 09:24, 7 January 2020 (UTC)

YOu are edit warring again; whatever reason you want to give, a pattern of edit warring is a problem.[3] SandyGeorgia (Talk) 09:28, 7 January 2020 (UTC)

It has been in this order for 9 years. Doc James (talk · contribs · email) 09:32, 7 January 2020 (UTC)

Self-revert and discuss. MEDMOS does not determine the order of the narrative, and "how it passed FAR" is irrelevant without discussion. There is no deadline. SandyGeorgia (Talk) 09:44, 7 January 2020 (UTC)

It has been in this order as I mentioned for more than 9 years. I agree there is no deadline. While ask for further opinions. Doc James (talk · contribs · email) 09:50, 7 January 2020 (UTC)

Yes, you will post to WT:MED; this pattern needs to stop, and you need to engage in collaborative discussion to achieve consensus. The ANI shone a light on the "Me, too" !voting pattern at WPMED, so I suggest you engage the discussion. And self-revert as a show of good faith. SandyGeorgia (Talk) 10:03, 7 January 2020 (UTC)

The order the headings are on MEDMOS (at Wikipedia:Manual_of_Style/Medicine-related_articles#Diseases_or_disorders_or_syndromes) is not proscriptive. There is nothing in that section that says they have to be in that order. In fact the initial author said as much. Doc James do you agree or disagree that symptoms/signs and diagnosis (i.e. based on symptoms) have alot in common and that hence it makes sense that the second follows the first? Also, it makes sense to place epidemiology before causes? But given we're after consensus, let's ask a wider field. Pinging @WhatamIdoing, Bluerasberry, Colin, and Jfdwolff: as editors who have discussed ordering of sections in the medmos guideline archives. And placing a note on the med page. Cas Liber (talk · contribs) 10:08, 7 January 2020 (UTC)

Having a fairly consistent ordering of sections across articles on diseases / health conditions in my opinion helps our readers who us use extensively quickly find the content they are looking for. And it helps our editors rapidly determine were new additions to our articles should go and were information is missing. In my opinion that benefit outweighs the benefit of grouping them as you suggest. User:Ozzie10aaaa has for example done a lot of working in putting our nearly 10,000 articles on health conditions in a somewhat consistent layout. Doc James (talk · contribs · email) 10:45, 7 January 2020 (UTC)

It is unfortunate that you have mentioned that Ozzie10aaaa is also editing to install personal preferences against policy or guideline. Ozzie10aaaa I suggest you might want to re-read the ANI, and not go down that road any longer.

James we have heard that you believe in your personal preference, even though no guideline or policy supports it. You still have not given us a reason, other than ILIKEIT. SandyGeorgia (Talk) 10:56, 7 January 2020 (UTC)

I have provide a reason. You disagree with my reason. That is different than me not having a reason. Doc James (talk · contribs · email) 11:28, 7 January 2020 (UTC)

Choice of ordering of sections

So folks. All those in favour of this order (by Doc James) , comment here.

1. Polling is not a substitute for discussion, and that needs to stop right here, right now. SandyGeorgia (Talk) 10:37, 7 January 2020 (UTC)
2. I support this order. I has been in use since 2011 without issue. Having some consistency between articles is useful in helping both our readers digest our content and our editors maintain our content. Doc James (talk · contribs · email) 10:39, 7 January 2020 (UTC)

   "Consisteny between articles" is not a requirement of any policy or guideline or WP:WIAFA for this article; consistency in order is a personal preference. James, we need to hear from you on this article why you think your preference provides a preferred narrative for the benefit of our readers. This is not a !vote; on Wikipedia, we actually discuss to come to consensus. If you cannot provide a reason for preferring this narrative, for this article, you have no valid reason to have installed a personal preference, via edit warring. SandyGeorgia (Talk) 10:46, 7 January 2020 (UTC)

   This is an editorial judgement call. Yes there are positive and negative. I believe the benefits of consistency to our readers outweighs the benefits of the claimed improved flow and the negatives of having these discussions one by one over our 10,000 disease related articles. I have provided a reason, you appear to simple not accept it as a valid one. Meh. Doc James (talk · contribs · email) 10:49, 7 January 2020 (UTC)

I would agree w/ Doc James rationale--Ozzie10aaaa (talk) 10:55, 7 January 2020 (UTC)

Ozzie10aaaa I'm shocked!! I can't count the number of times I've seen you type those words, with no discussion, no explanation, no rational. SandyGeorgia (Talk) 10:58, 7 January 2020 (UTC)

if one has the same opinion, there is no need for a wall of text IMO--Ozzie10aaaa (talk) 11:03, 7 January 2020 (UTC)

Ozzie10aaaa If you are willing to have your opinion discounted, that works. SandyGeorgia (Talk) 11:10, 7 January 2020 (UTC)

and all those preferring this order (by Cas Liber), comment below here

1. Cas Liber (talk · contribs) 10:08, 7 January 2020 (UTC)
2. Polling is not a substitute for discussion, and that needs to stop right here, right now.

Anyone else is welcome to post a dfferent order and explain why. Cas Liber (talk · contribs) 10:08, 7 January 2020 (UTC)

Cas, this "me, too" voting trend that has plagued WT:MED for several years now needs to stop. We need to hear from BOTH OF YOU why the narrative works better one way or another. MEDMOS is guideline, not a policy, and it does not require a certain order. James cannot use MEDMOS to install his preferred order. You both need to explain the benefits; I know you, Cas, thought about the order when you re-ordered it. James has made no effort to discuss, so we should hear from him before !voting.

And I strongly suggest that anyone showing up here from WT:MED consider the ANI thread that discussed this very problem, and remember that discretionary sanctions are in place right now for WP:MEDMOS. SandyGeorgia (Talk) 10:39, 7 January 2020 (UTC)

Okay, canning this

Okay, my thinking is to can this as I do agree that consistent order is a Good Thing. However I have just been looking over various medical articles and I don;t see any that would not benefit from haivng symptoms and diagnosis next to each other so will raise this over there. Cas Liber (talk · contribs) 13:19, 7 January 2020 (UTC)

Cas, the idea that we have any set order is faulty. We have recommended headings. Discuss before !voting. SandyGeorgia (Talk) 16:53, 7 January 2020 (UTC)

A one-size-fits-all order is a bad idea. However, a suggestion that mostly works for most is feasible.

The problem with putting symptoms next to diagnosis is where do you put causes? "Symptoms: Runny nose; Cause: Virus; Diagnosis: Run test to see if the virus is present" makes sense. "Symptoms: Strange behavior; Cause: Something about the brain and some other stuff, but honestly we don't really know; Diagnosis: Psychiatrist's evaluation" does not make sense. WhatamIdoing (talk) 19:20, 7 January 2020 (UTC)

@WhatamIdoing: - this is exactly how almost all psychiatric conditions are diagnosed if you look up DSM 5 - entirely on signs and symptoms, and dicussion on causation is mostly speculative and linked to epidemiology Cas Liber (talk · contribs) 23:32, 15 January 2020 (UTC)

Yes. This forced order is giving me fits at Tourette syndrome; it doesn't flow right. SandyGeorgia (Talk) 23:43, 15 January 2020 (UTC)

Didn't we have causes first once upon a time, and then moved symptoms up, because we thought people cared more about those? (I can't be bothered to look it up.) Anyway, I think that the mental model I had back in the day had a lot more to do with infectious diseases than psychiatric conditions, and what works for the one probably doesn't work for the other. When the causes are really speculative, I can see a WP:DUE problem with putting them high in the article. But that's a discussion for another month. Wikipedia:There is no deadline for getting the order settled. WhatamIdoing (talk) 02:07, 16 January 2020 (UTC)

I suspect we're going to find that the disease model won't work out for neuropsychiatric conditions, and we need to stop seeing an enforced order. SandyGeorgia (Talk) 02:41, 16 January 2020 (UTC)

This discussion has now moved to MEDMOS. SandyGeorgia (Talk) 19:32, 7 January 2020 (UTC)

I will respond there. JFW | T@lk 20:46, 9 January 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)

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)

Cause

This "Genetic vulnerability and environmental factors are involved in the development of schizophrenia."

was just changed to "Genetic, environmental, and vulnerability factors are involved in the development of schizophrenia."

User:Iztwoz what reference comments on "vulnerability factors"? I have never heard of these. Doc James (talk · contribs · email) 06:18, 4 May 2020 (UTC)

Doc James, this is addressed in the later ref which I have now added to the first sentence. As far as I can see this is a later inclusion to what used to be called the 'two-hit' theory. There is a lot of much later material that is more related to the neurodevelopmental model which also is more inclusive of the many other 'models' proposed for consideration, that mostly contribute to the neurodevelopmental changes. Even the dopamine and other neurotransmission disorders are seen in papers to result from changes in the neural connections development. It seeems commonsense to consider vulnerability factors as separate for example childhood adverse experiences would be better considered as a vulnerability factor (as per ref) rather than an environmental factor. There is so much later material available and I'm finding it hard to separate out the material included in Causes and Mechanisms - there seems to be a lot of overlap. ? Thanks --Iztwoz (talk) 06:45, 4 May 2020 (UTC)

Okay yes supported by " It is likely that these genetic risks, environmental risks and vulnerability factors are cumulative and interactive with each other and with critical periods of neurodevelopmental vulnerability." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876729/ Doc James (talk · contribs · email) 07:02, 4 May 2020 (UTC)

Adding text and a relevant Cochrane reference concerning antipsychotic combinations in "medications"

I would like to add a sentence or two of descriptive text and a citation to the following Cochrane review under the medication heading. Any comments from a more experienced editor? BDD user (talk) 17:47, 12 May 2020 (UTC)

References

HI, BDD user, best I can tell, no one answered you, and the text has not been added. Thanks for asking since this is a Featured article. I see no problem with the source, but because this is an FA, you should respect the WP:CITEVAR existing citation style, and cite it thusly:

• Ortiz-Orendain J, Castiello-de Obeso S, Colunga-Lozano LE, et al. (June 2017). "Antipsychotic combinations for schizophrenia". Cochrane Database Syst Rev (Review). 6: CD009005. doi:10.1002/14651858.CD009005.pub2. PMC 6481822. PMID 28658515.

Thanks for taking on board the advice I gave you a while back ... your work is looking good! SandyGeorgia (Talk) 23:35, 3 July 2020 (UTC)

"Skunk"

please alter this section to remove the term "skunk" in reference to high potency (high THC content) cannabis. This is immature and unprofessional. Its use here is pejorative to many and beneath community standards.

Its use is well documented see refs used. --Iztwoz (talk) 08:33, 18 May 2020 (UTC)

Skunk is a slang term for marijuana not an indication of potency and does not denote any particular "form" or refer to anything specifically. In California they say "fire" or "bomb" instead of "skunk" and they all mean the same thing... good weed. Additionally the word "potency" may address multiple characteristics of marijuana primarily THC and CBD levels. A specific strain may be potent in one, both or neither. An argument is not being made that increased potency in either THC or CBD may increase risk. The argument is that the slang term "skunk" is not qualifiable and in this context the word maybe be substituted with "fire" or "strong" without any loss of meaning other than what is implied. For the statement to have any value at all it would need to refer to the THC and CBD levels in a particular strain as a measurement of potency, not a slang term.

The word is linked; the word has specific meaning; the word is used widely see any google search. Sorry if its use offends you.--Iztwoz (talk) 05:13, 26 June 2020 (UTC)

However, I agree that THC needed mentioning and have since edited.--Iztwoz (talk) 08:52, 4 July 2020 (UTC)

The term is used quite regularly in UK publications and televised news debate. See for example: https://www.theguardian.com/society/2015/feb/16/skunk-cannabis-triples-risk-psychotic-episodes-study. Given this, it's use is neither immature nor unprofessional. However, I agree that it might be *inexact* and that knowing the actually potency of various chemical might be useful. --Talpedia (talk) 23:03, 3 July 2020 (UTC)

Thanks for your comments Talpedia have mentioned the THC which is more helpful. Best --Iztwoz (talk) 08:52, 4 July 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)

Thanks for this info, hopefully it can be incorporated when hopefully the sections on Cause and Mechanism are updated. It may be able to be entered in a subheading of Subgroups. --Iztwoz (talk) 08:56, 4 July 2020 (UTC)

Daughter articles

This article has daughter articles to try and improve the structure of the (massive) amount of material published (even restricting to secondary sources). We need to be mindful of Wikipedia:Summary style. So we have:

• Basic symptoms of schizophrenia
• Visual processing abnormalities in schizophrenia
• Childhood schizophrenia
• Causes of schizophrenia
• Early intervention in psychosis
• Mechanisms of schizophrenia
• Salience_(neuroscience)#Aberrant_salience_hypothesis_of_schizophrenia
• Comparison of bipolar disorder and schizophrenia
• Management of schizophrenia
• Prognosis of schizophrenia
• Epidemiology of schizophrenia
• History of schizophrenia
• Social construction of schizophrenia
• Religion and schizophrenia

not to mention articles on antipsychotics, clozapine etc. There is information in the main article that is in less detail or absent in many of these articles. The article is huge. I am thinking maybe we need an editnotice or something to stop the loading of the main article as it is oversized as is. Cas Liber (talk · contribs) 22:04, 5 July 2020 (UTC)

YES! This is 9,000 words of prose; a size around 7,000 is much more readable, and maintainable. Too Much Detail! I suggest Management is the best place to cut and better emply summary style, followed by Mechanisms, and then bits and pieces everywhere else. SandyGeorgia (Talk) 22:16, 5 July 2020 (UTC)

The problem has been that much of the whole page was outdated with old refs - and many of the daughter articles were likewise outdated or in need of work (in my view). Clearly a lot of the newer material can be summarised and moved to the daughter articles when the daughter articles are more up to date. As said there are many articles and they are in need of work. Both daughter articles on causes and mechanisms are really dated - it probably would be a good move for these ones to be worked on first to warrant the main article hatnotes and then resummarised on main page. ? --Iztwoz (talk) 22:35, 5 July 2020 (UTC)

But you can still move text there now, even if those articles need more tune up later. They aren't featured, this article is, and this article needs to meet FA criteria. If this article is mostly updated now (it is certainly MUCH better than it was when I said it needed to go to [[WP:FAR), focus could shift to updating the sub-articles, and only summarizing back to here what is key and has mention in the highest quality most recent reviews. This article is beginning to sprawl, we want it to be a readable encyclopedic summary, and needs to be an overview, making better use of summary style. The article has more than doubled in readable prose since its last FA review. SandyGeorgia (Talk) 22:45, 5 July 2020 (UTC)

Agree. clarify what needs moving first and then get to daughter articles. Feel free to update daughter articles as we go.....Cas Liber (talk · contribs) 22:50, 5 July 2020 (UTC)

Must admit to a general ignorance of overview style of main page. (Few articles have so many daughters).--Iztwoz (talk) 22:56, 5 July 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)

Thanks for this info, hopefully it can be incorporated when hopefully the sections on Cause and Mechanism are updated. It may be able to be entered in a subheading of Subgroups. --Iztwoz (talk) 08:56, 4 July 2020 (UTC)

Daughter articles

This article has daughter articles to try and improve the structure of the (massive) amount of material published (even restricting to secondary sources). We need to be mindful of Wikipedia:Summary style. So we have:

• Basic symptoms of schizophrenia
• Visual processing abnormalities in schizophrenia
• Childhood schizophrenia
• Causes of schizophrenia
• Early intervention in psychosis
• Mechanisms of schizophrenia
• Salience_(neuroscience)#Aberrant_salience_hypothesis_of_schizophrenia
• Comparison of bipolar disorder and schizophrenia
• Management of schizophrenia
• Prognosis of schizophrenia
• Epidemiology of schizophrenia
• History of schizophrenia
• Social construction of schizophrenia
• Religion and schizophrenia

not to mention articles on antipsychotics, clozapine etc. There is information in the main article that is in less detail or absent in many of these articles. The article is huge. I am thinking maybe we need an editnotice or something to stop the loading of the main article as it is oversized as is. Cas Liber (talk · contribs) 22:04, 5 July 2020 (UTC)

YES! This is 9,000 words of prose; a size around 7,000 is much more readable, and maintainable. Too Much Detail! I suggest Management is the best place to cut and better emply summary style, followed by Mechanisms, and then bits and pieces everywhere else. SandyGeorgia (Talk) 22:16, 5 July 2020 (UTC)

The problem has been that much of the whole page was outdated with old refs - and many of the daughter articles were likewise outdated or in need of work (in my view). Clearly a lot of the newer material can be summarised and moved to the daughter articles when the daughter articles are more up to date. As said there are many articles and they are in need of work. Both daughter articles on causes and mechanisms are really dated - it probably would be a good move for these ones to be worked on first to warrant the main article hatnotes and then resummarised on main page. ? --Iztwoz (talk) 22:35, 5 July 2020 (UTC)

But you can still move text there now, even if those articles need more tune up later. They aren't featured, this article is, and this article needs to meet FA criteria. If this article is mostly updated now (it is certainly MUCH better than it was when I said it needed to go to [[WP:FAR), focus could shift to updating the sub-articles, and only summarizing back to here what is key and has mention in the highest quality most recent reviews. This article is beginning to sprawl, we want it to be a readable encyclopedic summary, and needs to be an overview, making better use of summary style. The article has more than doubled in readable prose since its last FA review. SandyGeorgia (Talk) 22:45, 5 July 2020 (UTC)

Agree. clarify what needs moving first and then get to daughter articles. Feel free to update daughter articles as we go.....Cas Liber (talk · contribs) 22:50, 5 July 2020 (UTC)

Must admit to a general ignorance of overview style of main page. (Few articles have so many daughters).--Iztwoz (talk) 22:56, 5 July 2020 (UTC)

Silica gel+H2O as a cure for "(paranoid) Schizophrenia"

The DDR (socialist part of Germany up to 1989) used silica gel(+H2O ?) for people with psychosis. Nobel-laureate Julius Wagner-Jauregg from Austria treated hospitalized people bathing in horsetail-brew, coming to the conclusion that they were in a state where hospitalization wasn't necessary anymore. It was an easy step for me to find out the biological agent of the horsetail was silica-compounds. Note that healing earth, silicon dioxide (chert) or homeopathy is not meant. The both first aren't water-soluble. What's more, I know some people reacting like this - being healed - from e.g. hallucinations. However, amalgam-allergy induced dementia does exist asmuch as gluten-sensitivity up to coeliac disease. These might also cause - according to the diagnostician - schizophrenia. I want to remark here that typing with the angloamerican speakers is MUCH more fun than doing it in wikipedia.de (where you get kicked/deleted when you write some words). Lutz Fehling 89.15.239.182 (talk) 00:32, 6 November 2020 (UTC)

Copying within Wikipedia

Remember WP:CWW— we must attribute. SandyGeorgia (Talk) 00:14, 6 July 2020 (UTC)

There's info in Mechanisms that is not sourced to a review and could move to the sub-article. SandyGeorgia (Talk) 00:42, 6 July 2020 (UTC)

Remember to include a link! [4] If you do not link to the article in edit summary, then someone later has to go back and add copying within templates to article talk, and we end up with a mess like Talk:Dyslexia. SandyGeorgia (Talk) 23:00, 6 July 2020 (UTC)

Looking for citations for claim I made

On Open Dialogue (a psychological intervention or psychosis that is being trialed in several countries). I wrote, regarding its pyschological model that delusions in schizophrenia have metaphorical meaniing

"This understanding differs radically from common psychiatric models of psychosis that view it as being caused by a biological process in the brain, such as the dopamine hypothesis of schizophrenia."

I didn't think to add a citation (being quite familiar with the literature on the topic, and this sentence effectively being a sign post to say, "hey don't use this for a complete understand of psyschosis - you should know a bunch of people disagree". I had difficulty actually citing this however (I spent half an hour or so looking for citations. It seems quite difficult to actually get research in academic papers that represents the view of academics themselves.

I thought that someone here might immediately have a reference to hand, be able to advise me on how to cite this sort of claim (e.g. would a textbook work for the "accepted understanding", this feels like it's getting into WP:OR territory because this citation is startng to get a little "logic" to it), or have dealt with this sort of issue before.

Thanks for any help.

Edit: If anyone wishes to provide any assitance please reply to this message of Talk:Open Dialogue as (see below) this conversation is likely to be viewed as off topic.

--Talpedia (talk) 12:01, 10 July 2020 (UTC)

@Talpedia: Hi, it seems like you are asking for assistance with another page. May I suggest posting this to the talk page of the subject, or to WP:MED's talk page instead? This page is really for discussion regarding the Schizophrenia page, per Talk page guidelines.―Biochemistry🙴❤ 19:59, 10 July 2020 (UTC)

Hmm, I'll post on WP:MED. Don't think posting on the page itself will work very well, I wrote that page fairly recently and the information I want is related to the theoretical model of psychois / schizophrenia. My reasoning that that this other page is very much related to this page, and this was the most related place to post. I could probably validly verbatim include the contents Open Dialogue in this page (if that page were not to exist)v. I've just read the talk page guidelines. I'm not actually sure discussion of related page *is* off-topic as per the rules. It's not specifically addressed, and we have the sentence "Often, there are a number of related pages that would benefit from one single talk page for discussions". --Talpedia (talk) 21:30, 10 July 2020 (UTC)

@Talpedia: Thank you. Regarding the talk page guidelines, WP:TALK#TOPIC states:

"Stay on topic: Talk pages are for discussing the article, not for general conversation about the article's subject (much less other subjects). Keep discussions focused on how to improve the article."

Despite the subject similarity, the talk page of the article in question (± the talk page of an interested WikiProject) is usually the best place for such conversations—not the article of a related subject. For instance, although aspirin is used to prevent heart attacks—thereby relating the two subjects—improving or inquiring about references for the Aspirin page should not be done on the talk page of Heart attack. If you would like to discuss adding content from Open Dialogue to Schizophrenia, then I would be happy to participate here. I apologize if I misconstrued your intent.―Biochemistry🙴❤ 22:20, 10 July 2020 (UTC)

The purpose of the request is quite clear. I'm looking for a reference showing that the main understanding of psychois / schizophrenia amongst psychiatrists is a biological model for another article. I fully appreciate the usual situation and have explained why this doesn't apply - the article is a new stub article, and the claim is specifically one about schizoprhenia / psychosis. If someone were looking for a reference for "Most doctors think high blood pressure is correlate with heart disease" then the heart disease page might be the correct page to ask for help sourcing citation for this claim. I'm clearly discussing the improvement for *an* article, in a very targetted fashion, which would seem to be what your quote is about. *Anyway*, this is a boring technical argument which I doubt will be productive and risks preventing anyone who would provide me with assistance f rom doing so, particularly given you are ignoring points I consider relevant, and fiddling with the level of generality to make your argument correct. Anyway, I have updated the original post to refer to the the open dialogue talk page, and will move any reply here that address the subject matter (rather than continuing on this technical policy discussion) to that page alerting the user to the fact on their user page. This will prevent any further discussion here, which suits your purposes, while also allowing any interested party to reply there (though to be honest the original post was a bit of a long-shot anyway!). The argument that the body of the discussion should happen there seems quite reasonable. I will consider your arguments when requesting help going forward (but again to be honest, I don't expect a similar situation to arise). --Talpedia (talk) 00:24, 11 July 2020 (UTC)

History

This is a vague, unhelpful, and poor statement for a featured article ... and neither does history of schizophrenia explain the changes from DSM4 to 5 ...

• DSM-5 was published in 2013 and introduced changes to DSM IV.

SandyGeorgia (Talk) 07:02, 10 August 2020 (UTC)

Avatar Therapy?

I work to add reasonably recent Cochrane reviews to relevant Wikipedia pages. I have this one (below) related to a treatment called Avatar Therapy. I have not found a reference to it anywhere on Wikpedia but I have found a lot on the Internet in general, it would appear relevant and important. Any comments or feedback from a more senior editor on this on adding a description and citation of this in Section 6.3 of the article? Here's the citation:

References

This article is more of a broad topic overview, using summary style; I see that particular review as more relevant at management of schizophrenia. If it is summarized vback to here, at most a clause will do. SandyGeorgia (Talk) 18:52, 15 August 2020 (UTC)

Over-generalization with Co-Morbidities

I think that this sentence could be improved as it is an over-generalization "Many people with schizophrenia have other mental disorders that often includes an anxiety disorder such as panic disorder, an obsessive–compulsive disorder, or a substance use disorder." I just didn't know if I should change anything. My suggestion is to state: People with schizophrenia can have co-occuring mental disorders. I wouldn't even expand on that, but if you have to, maybe say: Examples of some disorders that occur alongside schizophrenia are anxiety, obsessive-compulsive, and/or substance use disorders. I don't think the examples are needed, because there can be any number of co-occuring disorders and there aren't any that are specifically related to schizophrenia. There can also be no co-occuring disorders. While it is important to note that there can be other disorders present, I think ascribing other disorders without solid evidence is not a good idea. --Kristinbell (talk) 08:59, 31 October 2020 (UTC)

Comorbidity is common. And these are more commonly occurring comorbid conditions. Which is why they are highlighted Cas Liber (talk · contribs) 12:44, 31 October 2020 (UTC)

I made some copy edits to the first four sentences of the paragraph (diff). As written, the comorbidities section is sparse. For example, more could be written about substance use disorders, similar to what is written about sleep disorders (in terms of length); and comorbid depression—absent in the current version—deserves coverage as well. Mark D Worthen PsyD (talk) [he/his/him] 02:06, 3 November 2020 (UTC)

If the comorbidities section becomes too long (not a problem currently, but I'm being optimistic :-), we could create a separate article on the topic. Mark D Worthen PsyD (talk) [he/his/him] 17:09, 12 November 2020 (UTC)

Semi-protected edit request on 19 February 2021

This ¨disease¨ is merely hypothetical:

"You have to tell the truth to the patient about how the medication works and what you know about it. And it seems that in co-operation with the pharmaceutical industry, they've told people things that are not completely correct about how medications work and what the risks are. For instance, there is a myth that there is some kind of chemical imbalance in the brains of people with serious mental problems [and] there is actually no research that really supports this."

A quote from https://www.bbc.com/news/stories-56097028

*And common sence: [as the old priests during the time of the Egyptian
  rules spread their ´religion so do psychiatrists these days;]. Wanwu09 (talk) 19:29, 19 February 2021 (UTC)

That isn't a requested edit. Also the sourcing on it is pretty solid so you're unlikely to find anyone who will change it to a "hypothetical disease". ScottishFinnishRadish (talk) 19:51, 19 February 2021 (UTC)

Types of schizophernia

There are many types of schizophrenia why doesn't this article list them. CycoMa (talk) 22:45, 29 March 2021 (UTC)

Subtypes of schizophrenia were removed in the DSM-V, IIRC. Urve (talk) 00:04, 30 March 2021 (UTC)

I get that but, so were we're Asperger's and PDD-NOS but, the Wikipedia article on Autism Spectrum still mentions the former conditions.

And the current article on Asperger syndromestill exists. I'm merely saying the article should mention different forms of schizophrenia as a way to link all the schizophernia articles together. CycoMa (talk) 02:15, 30 March 2021 (UTC)

There is some mention of the subtypes in the article at Schizophrenia#Changes made. Do you want them to be listed out? I'm not sure it's particularly helpful for a reader, though there is a mention of catatonic schizophrenia so it may be worth adding. Urve (talk) 03:57, 30 March 2021 (UTC)

Question

I have some problems with this edit by ARMILLARIA.9, [5]. As a featured article, we're required to use "high-quality reliable sources" per the criteria.

• About 0.3% to 0.7% of people are diagnosed with schizophrenia during their lifetime.
  • This was changed from "affected by" schizophrenia. The source uses the term "affected by" in relation to prevalence, not "diagnosed". Why the change?
• From the 1960s until 1989, psychiatrists in the USSR and Eastern Bloc diagnosed thousands of people with sluggish schizophrenia, based on "the assumption that symptoms would later appear," because the removal of legal rights from disabled people made it a convenient way to confine political dissidents. The sluggish schizophrenia diagnosis has been discredited and internationally condemned.
  • The ICD source does not support the statement. What makes GeoHistory a high-quality reliable source? Its site seems to suggest it is written by teachers and students.
• Prior to the 1960s, doctors in America primarily diagnosed nonviolent petty criminals and women with schizophrenia, categorizing the later as ill for not performing their duties within patriarchy as wives and mothers. Official descriptions emphasized the "calm" nature of such persons. However, in the mid-to-late 1960s, psychiatrists began diagnosing black men as schizophrenic at much higher rates, often citing their civil rights and Black Power activism as delusions, and categorizing them as "hostile and aggressive."
  • What makes a Psychology Today interview a high-quality reliable source? How does it support the claims that doctors saw Black Power as "delusions" or "hostile and aggressive" in general, or even at Ionia State Hospital?
• In 2015, an estimated 17,000 deaths were linked to schizophrenia.
  • This was changed from "caused by". Does the source support the change?

Thoughts?

References

Urve (talk) 02:36, 6 April 2021 (UTC)

Hello, 1. We know that those are the numbers of people diagnosed with schizophrenia, so that is neutral language to use. We don't know how many people with similar experiences go un-diagnosed, nor how many people experience these things in different cultural contexts that might complicate schizophrenia as the explanation. 2. The paragraph about the sluggish schizophrenia diagnoses simply repeats claims that were already written in the wikipedia article "sluggish schizophrenia," and well-sourced. I will go back and make sure I'm thoroughly copying over the correct citations from that article to this one. Thanks. 3. Dr. Jonathan Metzl is a psychiatrist who did an extensive historical study on the history of the schizophrenia diagnosis, and these were his findings in his book The Protest Psychosis, which is also cited alongside the Psychology Today interview. What do you feel makes Psychology Today *not* a usable source? 4. These are numbers of people with schizophrenia who died. It would take more substantiation to show that schizophrenia *caused* their deaths. I changed the wording in the interests of neutral language. - ARMILLARIA.9 (talk) 02:46, 6 April 2021 (UTC)

Regarding 1, makes sense! Regarding 2, sounds good -- it seems like appropriate and useful information for the article, so I'll be sure to watch what you do.

For 3, interviews don't have the kind of fact-checking that academic books do, so even if it is a reliable source for historical information, that's a lower bar: it is not of the caliber required by the featured article criteria, namely that it is "high-quality". To be sure, it is an expert talking about his area of expertise, but at the same time, it's not subject to peer review or editorial oversight that would suggest it is of sufficient quality. I am out of touch with sourcing policies, but interviews may also not be independent of the interviewee, so that could be another problem. But even if the interview is high-quality (I don't think so), it doesn't support the text here based on what I can see... The book is a better reference, for sure, and I wouldn't oppose the wording you've added if that's the source used, but that requires pages to verify the information. WP:V says: "The cited source must clearly support the material as presented in the article. Cite the source clearly, ideally giving page number(s) – though sometimes a section, chapter, or other division may be appropriate instead", so I suppose that's where my problem lies.

For 4, that's why I ask. If the source does say they died from schizophrenia (I have no access so I can't check), that's not the same thing as being "linked" to schizophrenia. But if you think that saying they died from schizophrenia is an exceptional claim that requires much more evidence than a single reference, I would not only agree with you, but I would be happy to remove the claim until there's either verification or more evidence. LMK what you think!

I appreciate your quick response. Urve (talk) 03:02, 6 April 2021 (UTC)

Semi-protected edit request on 12 April 2021

There's a typo in the "Negative symptoms" section: "blunt effect" should be "blunt affect". 2A01:C22:C867:CD00:E80E:91B3:7F92:2373 (talk) 23:47, 12 April 2021 (UTC)

Done, thanks Urve (talk) 23:50, 12 April 2021 (UTC)

Recreational Drugs section

Seems to me there are several claims with sources that say nothing. Especially on the bottom. Kenhick (talk) 04:22, 23 June 2021 (UTC)

Can you give specific examples?--Megaman en m (talk) 18:16, 23 June 2021 (UTC)

recent edit

Hi Bear420 I get what you're going for, but without a survey / poll of popular belief, maybe it's best to just cite the facts and not say 'contrary to popular belief'? Like the difference between saying "many disabled people have graduated from college" vs saying "contrary to common belief, many disabled people have graduated from college" - one puts the emphasis on facts about the actions of the people in question, the other shifts the emphasis to the biases or misconceptions of abled people. Thoughts? - ARMILLARIA.9 (talk) 01:22, 17 July 2021 (UTC)

Agreed, this is a clear case of editorialization.--Megaman en m (talk) 10:42, 17 July 2021 (UTC)

I don't know that it's editorialization per se, and if Bear420 wants to share a source / survey of popular belief, I'd be ok with keeping some mention of it. - ARMILLARIA.9 (talk) 13:33, 17 July 2021 (UTC)

I think (but am not too sure) that even if it's true, the claim is synthetic to make without explicit linkage between public opinion and college graduation in the source. Urve (talk) 13:53, 17 July 2021 (UTC)

Risk factors: Substance use possibly unintentionally misleading

I make no claims to being an expert on the subject of cannabis or schizophrenia. However, I felt it bears pointing out that for decades the U.S. government made so many official false claims about the dire effects of marijuana in its efforts to conduct its global drug war that now people all over the world are understandably skeptical about any reports of marijuana's potentially negative effects. Considering the debilitating effect a diagnosis of schizophrenia is apt to have on a patient's life, if sufficient reliable evidence to list marijuana as a contributing factor exists, special care must be taken to differentiate it from Reagan-era "just say no" bullshit [REJSNB]; otherwise, readers who might otherwise be helped by the information will surely ignore it.

The whole last paragraph of the section reads as though it might be suspect. But most egregious is: "One of these strains is well known as skunk"—a statement with all the hallmarks of REJSNB. Skunk weed isn't a strain of marijuana in the sense that, say, C. sativa is. It simply refers to an old, pre-legalization belief that the potency of any garden-variety marijuana can be judged by how it smells. Weed that emits a sharp, skunk-like odor when burnt was thought to be particularly potent.

Any habitual smoker will take one look at that and burst out laughing. Granted, they're probably giggling already, but I suggest the entire sentence can be elided unless the point of including it is to make a dubious claim that brand-name strains of marijuana are psychologically healthier than skunk weed. It seems unlikely that any such baldfaced attempt at monetization is being made here. If it were, however, such an attempt might be improved by finding a brand-name weed distribution company to sponsor this page. --Saltcub (talk) 21:45, 24 March 2021 (UTC)

I tend to agree that the paragraph is badly sourced, and the reserch cited in the citations used for the claim abbout 'skunk' being the coulpritt actualy does not say the same as what is written on the Wikipedia page. The relevant source for the potency claim mentions the chemical Delta 9-THC. Whilst it does mention 'skunk' i do not realy see the relevance of pointing out a certain strain when the findings point to the chemical and not the strain itsself. As a side note reserch on the effects of mrijuana on mental helath is especialy complicated as it is a plant. Therefore different strains may contain differnt levels of chemichals, and different chemicals, making the singelinng out of a particualar strain problematic at best, and pottentialy untruthfull at worst. However the basic raserch behind the linking of canabissmoking and schizophrenia seems to be sound, however it should not be a masive cause for concern as in the overall picture the ellimination of consumtion would only resoult in a poppulation wide derease in the prevalence of schitzofrenia of 8 %, if there is a causal relationship between the two. EirikRS (talk) 11:59, 8 December 2021 (UTC)

References

The sourcing is sound, and neither the NHS nor the Royal College of Psychiatrists are “Reagan-esque era” sources. SandyGeorgia (Talk) 15:03, 8 December 2021 (UTC)

They may be good sources, but thhey do not give good suport for what is stated in the wikipedia article, especially the mention of the strain 'skunk'. In my opinon the paragraph would be improved by simply removing themention of skunk. This would also increase the emphasis on the importatnt risk factor (THC concentration) and away from the focus on a single strain (skunk). EirikRS (talk) 10:24, 9 December 2021 (UTC)

Skunk

Incorrect usage of the word 'skunk' in the article:Italic text Hi, the use of the word skunk in the article is not factual and not backed up by the sources linked. As a Brit, I know exactly where this misconception has arisen. During the 2000s, the British government started calling any 'stronger' strains of cannabis,'skunk'. There is no strain actually just called 'skunk'. There is skunk no1' but no such strain as just skunk. Like i said, this was catch all phrase for the UK government for any stronger cannabis strains.

So basically the skunk sentence in article is wrong in two ways 1.the source provided does not back up the claim 2.No such strain exists and is a result of blanket phrasing by the British government/nhs. 3. The government/NHS was referring to any high thc content strain. — Preceding unsigned comment added by Systema2000 (talk • contribs) 20:18, 5 January 2022 (UTC)

See the discussion at (above on this page). The text in the article now reflects high quality sources. If you have better sources, please provide them. SandyGeorgia (Talk) 20:57, 5 January 2022 (UTC)

I severely question the quality of these sources in proving the use of the word skunk as factual. The Causal association between cannabis and psychosis: examination of the evidence source has no use of the word skunk that i can find.

The 'High-potency cannabis and the risk of psychosis' source does use it, but its in brackets used as a colloquial term next to the word sensimilia. It makes no reference to a strain called skunk. Like i said before, its using the word as a blanket colloquial term, and the only reason they include it is due to their(uk gov, nhs, medical establishmenet etc) past errors in basically nicknaming all high strength weed as some special strain called skunk.

What specifically do i need to provide? Im questioning the validity of the sources used as they dont support what the article says. You want me to provide a source proving that those sources are wrong? Because thats going to be impossible because no one is going to bother to write a scientific article on how the uk government and the nhs/uk medical establishments use of the word skunk is wrong.

I dont feel i need to anyway, as the sources pretty much define it as i was saying, using it colloquially.

Heres a recent source that makes the effort to not directly call all high strength cannabis 'skunk', instead they refer to it as 'skunk-like'. https://www.thelancet.com/pb/assets/raw/Lancet/pdfs/14TLP0454_Di%20Forti.pdf

Hopefully this enforces my point more. They would not drop the term skunk like that without good reason. The reason is, skunk is just a colloquial term. Skunkno1 is just one particular mix of land race cannabis strains. In the years since skunkno1 was bred, breeders and seed companies have collected and bred together different combinations of land race cannabis strains, many of which are much higher potency than skunkno1.

So all the other high strength strains that dont derive from skunkno1 are being labelled as skunk, incorrectly. Even with the older strains Eg White widow,a cross between a Brazilian sativa landrace and a resin-heavy South Indian indica. It has no skunk genetics. Yet its 18% thc. High strength cannabis. Skunk no1 is a hybrid of Afghani, Acapulco Gold, and Colombian Gold.

Different genetics entirely. the two most popular strains the uk at the moment are amnesia haze and stardawg. Amnesia haze has no skunk no1 genetics at all. Chemdawg has a complicated origin but is also considered not to have skunk no1 genetics.

— Preceding unsigned comment added by Systema2000 (talk • contribs) 16:02, 8 January 2022 (UTC) 

Can you find a secondary source that addresses the same issue that is more specific about "skunk" versus "high potency strains of cannabis"? Is "better" than the current source? Wikipedia tries to do as little "interpretation" as possible so getting a better source that addresses the same issue is a good approach. Unfortunately well-reasoned arguments will tend to lose to "this source says such and such". The role of knowledge and understanding is to know when a better source is likely to be found. Sometimes no suitable source exists. Talpedia (talk) 17:29, 8 January 2022 (UTC)

---

Yes i agree sometimes there isnt a better source available, but if we know some parts of the source to be incorrect, why do we need to relay that onto the wiki page? Seems a bit backwards, to provide something factually incorrect on a wiki page just because there isnt a more recent source with correct terminology.

Also, the sources all make reference to 'high strength cannabis' in some way, and detail the percentages of thc too. Now why would they put that if the word skunk was fine? Because they didnt have a clue about the strains their users were actually using, and they knew that the term skunk wasnt proper. One source, when using the word skunk, always puts it in apostrophes, indicating they arent using it as an offical term per se. Surely this enough to prove its being used an a slang phrase?

Usually if a source can be proven to be incorrect in its terminology, wouldnt that source be considered not acceptable/antiquated? 

The only solution i can think of is getting a written clarification from one of the authors of the sources , which I can imagine is going to be very hard.

I only briefly read the sources, but it seems to me they were going off user subject submitted data. Eg, the people being studied were just giving the researchers info about their cannabis usage. Now unless those users grew it themselves, they wouldnt even be able to tell if its skunk no1 genetics or not. So to then put 'skunk' on the wiki page just seems crazy.

I mean to me its super obvious the sources are using it as a blanket term , using it next to terms such as high potency cannabis.

I just think the level of proof thats required from me isnt the same as that source required when written, yet we are all going off those sources. All the source required was the user telling them they smoke high strength weed, then that gets made into 'they smoke skunk'by the authors of the source, without any details of strains being given to the researchers.

But because its published, its just considered fact by wiki? And now I have to provide superior evidence than the source did, in order to get that section of the wiki removed/altered into preferable terms? Eg instead of using the word skunk and mentioning the strain, just put 'high potency cannabis', a term used by multiple sources in place or alongside the word skunk already.

Its an incorrect addition to the wiki article, its really frustrating.

What abut providing details/sources about other high potency non skunk related strains? Surely thats enough to disprove the usage alone? — Preceding unsigned comment added by Systema2000 (talk • contribs) 18:05, 8 January 2022 (UTC)

I'm tempted to delete this sentence

One of these strains is well known as skunk.

since we already talk about high potency strains and some sources don't mention it. Perhaps we could add a link to cannibis strains article. Do we object? Talpedia (talk) 12:28, 11 January 2022 (UTC)

Hmm, I was about to make this edit, but then I searched for "skunk thc content", because I felt like adding this information to the page on strains. And I found a whole bunch of releatively recent newspaper articles talking about "skunk's" THC content. [This page https://www.kcl.ac.uk/archive/news/ioppn/records/2018/february/uk-cannabis-market-dominated-by-high-potency-%27skunk%27] looks interesting as it's a paper looking at THC content. Talpedia (talk) 20:25, 17 January 2022 (UTC)

Its nothing to do with 'skunk'. Theres countless other super high strength strains that have no skunk genetics. The issue is because in the uk the term skunk was used for any high strength weed. Then they started behaving like all high strength weed was a single strain called skunk. Including in the medical field. Systema2000 (talk) 13:11, 7 May 2022 (UTC)

even in your own link the write it like this : high-potency 'skunk'. Why you think the air quotes are there? Researchers analysed almost a thousand police seizures of cannabis from London, Kent, Derbyshire, Merseyside and Sussex. The same areas were last sampled in 2005 and 2008. In 2016, 94% of police seizures were high-potency sinsemilla, also known as ‘skunk’, compared to 85% in 2008 and 51% in 2005.

Again, they dont say skkunk no1. They are using the term in the colloquial sense. Its the equivalent of the words dro/high grade/chronic.

Nothing to do with the actual strains. Its simply referring to high potency cannabis and at the same time disparaging an actual specific strain with all the bad press because they keep using an old term from the 90s/early 2000s.

No one uses the term skunk colloquially anymore. That shows how out of date the usage of this term is and how messed up the usage has become. Systema2000 (talk) 13:21, 7 May 2022 (UTC)

Semi-protected edit request on 19 March 2022

Comma should be added after 'EAAT2' 123.208.227.204 (talk) 08:31, 19 March 2022 (UTC)

 Done Thanks for spotting, have a nice day --Ferien (talk) 09:12, 19 March 2022 (UTC)

Semi-protected edit request on 5 May 2022

The link for the source (The ICD-10 Classification...) of citation #13 is broken.

Drs; Sartorius N, Henderson AS, Strotzka H, et al. "The ICD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines" (PDF). World Health Organization. bluebook.doc. p. 76. Retrieved 23 June 2021.

it currently is https://www.who.int/classifications/icd/en/bluebook.pdf

it should be changed to https://apps.who.int/iris/handle/10665/37958 Reed12341234 (talk) 18:42, 5 May 2022 (UTC)

 Done Darcyisverycute (talk) 20:04, 5 May 2022 (UTC)

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)

Saving August 18, 2022 pre-cleanup version. SandyGeorgia (Talk) 13:14, 22 August 2022 (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,[6] 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)

Continued at #History (still) SandyGeorgia (Talk) 12:43, 22 August 2022 (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 [7] [8], [9] [10] update needed throughout. SandyGeorgia (Talk) 16:04, 24 January 2020 (UTC)

Minocycline

Update needed: [11] [12] SandyGeorgia (Talk) 16:26, 24 January 2020 (UTC)

Management section a wreck, Featured article review needed

Since July 2022, edits have deteriorated the Management section. I don't have time to clean up all of it. Unless others start helping in the maintenance of this article, which is WAY too long, it should go to WP:FAR. SandyGeorgia (Talk) 14:09, 18 August 2022 (UTC)

@Casliber, Graham Beards, Colin, Spicy, and Ajpolino: I am listing this at WP:FARGIVEN, and along with Major depressive disorder, Lung cancer, and all the other medical FAs that are no longer being maintained to FA standards, will start sending them to FAR. THIS article is WP:MEDs most highly viewed FA and important, and WP:MED simply no longer has editors interested in maintaining it (or any of the older FAs); I am one person only, and am sick and tired of trying to hold the finger in that dike. The article has quite seriously deteriorated and is constantly hit with advocacy editing, and I simply cannot clean all of it up myself, and I'm tired of the demoralizing effect of seeing WP:MED abandon its highly viewed FAs. SandyGeorgia (Talk) 14:20, 18 August 2022 (UTC)

The Management section has content of dubious weight that does not belong in Management at all, and uses lay sources. SandyGeorgia (Talk) 14:27, 18 August 2022 (UTC)

Length

This article is way too long and does not use summary style adequately. Advocacy content is being added that, if kept at all, belongs in sub-articles. SandyGeorgia (Talk) 14:24, 18 August 2022 (UTC)

Damn. I wonder when I last looked looked at this one....ok...to the history then....Cas Liber (talk · contribs) 21:19, 20 August 2022 (UTC)

To what "daughter article" are you moving these sections? It looks like you're just deleting tons of sourced material unilaterally. ARMILLARIA.9 (talk) 02:58, 21 August 2022 (UTC)

See WP:SS; at the top of many sections you will see which is the sub-article. I have not yet had even a moment to check whether Cas removed the content you placed in the wrong section (Management), with the wrong citation formats, with non-WP:MEDRS and advocacy sources, and that belonged in a sub-article, but please take greater care when editing a featured article. Also, the mixed citation formats you added made me wonder if you had copied the content from elsewhere, without following WP:CWW; if so, that too, jeopardizes the featured status of this article. SandyGeorgia (Talk) 03:10, 21 August 2022 (UTC)

The sources were not advocacy sources. They were: 1. a report of the Office of the High Commissioner for Human Rights, 2., two peer-reviewed articles from the National Library of Medicine, 3. a BBC article, and 4. a report on a lawsuit from the Council of Canadians with Disabilities. If the Medication section should not contain mention of international policy and the U.N. reports, by the same standard nor should it talk about U.S. court decisions, but only about how the medications work. ARMILLARIA.9 (talk) 08:50, 21 August 2022 (UTC)

Agree with @SandyGeorgia. If someone is here to push the POV that schizophrenia treatment is in general a violation of human rights, that would be advocacy and is not consistent with collegial editing on wikipedia. We portray the consensus of relevant experts. — Shibbolethink ^{(♔ ♕)} 15:10, 21 August 2022 (UTC)

Nothing is being "pushed," you're using loaded and biased language, and nor are U.S. judges "relevant experts." ARMILLARIA.9 (talk) — Preceding undated comment added 15:48, 21 August 2022 (UTC)

I don't believe I ever said that US judges were relevant experts. — Shibbolethink ^{(♔ ♕)} 16:19, 21 August 2022 (UTC)

Hey, can I get a diff of the material removed so I can form an informed opinion, I'm having difficulty finding it. All coercive treatment of sz will be a violation of human rights under most systems, just one that is justifiable based on other rights. It's not very controversial to say that violations of human rights occur in psychiatric treatment, what with the continuous flow tribunal cases and the case law it tends to generate. Talpedia (talk) 15:55, 21 August 2022 (UTC)

Agree, but the context is important, as is WP:DUE. Here are several diffs which (in part) run afoul of WP:NPOV: [13] [14] [15] [16] [17] (e.g. removal of "evidence-based" or "reason-based" from descriptors, introduction of WP:WEASEL wording such as "X, Y, Z person argues ____" or "Doctors believe X" when it is the consensus of experts, citations to Mad in America which insert the opinion of the UN special rapporteur on torture (which does not mention the word "schizophrenia" at all), insertion of unrelated text passages (e.g. "Numerous people diagnosed with schizophrenia have found it necessary to organize confidential groups with each other where they can discuss their experiences without clinicians present") into sections where it is not applicable.

The issue being that this user is combining helpful edits with ones which are problematic. We all do this on occasion, but just saying, that's why no clear BOLD-revert-discuss cycle exists for this dispute. — Shibbolethink ^{(♔ ♕)} 16:07, 21 August 2022 (UTC)

I imagine they are all helpful according to OP :D. Editors can often distinguish edits that are likely to be contentious and introduce them separately to help discussion, thought.

I think of "argue" as directly saying, "this is not consensus but a viewpoint" (WP:VOICE). My normal rule is if it comes from a systematic review which is quite clear I use WP:VOICE.

Thanks for the links. I agree that some of the edits should have been reverted.

I have a little sympathy for 9. I think the section talking about insight should be expanded to talk about non-adherence in general to give due weight to the literature. As it stands it sort of implies that insight is the only reason people don't take meds. I found some newer reviews talking about insight that mentioned that it varied over time and didn't necessary correlate with adherence (people with poor insight took meds, while those with good insight didn't).

10 can sort of be interpreted as "citation needed" for an implication in the text that psychotic behaviour is meaningless (rather than metaphoric). There are probably sources on this.

11 has some good "omit needless words" edits. There is also a point that LAI pose risks of side effects, so people need to be trialed orally first, or at least that's what I seem to remember.

I've got some sympathy for 12 with it's "are diagnosed" language given how people shift between different diagnoses and the whole FEP + episodic thing + substance induced + self-medication + behavioural diagnosis. But I can see the other side and would expect people to disagree.

I sort of agree with "call a spade a spade" when it comes to "stay" vs "commitment"... but note that voluntary (albeit under threat of involuntary) commitment is a thing, so it'd be wrong to call it commitment. Talpedia (talk) 16:37, 21 August 2022 (UTC)

Yes I mean @ARMILLARIA.9 is definitely improving the article in some ways, but also not improving it in others. I would ask them to please split their edits up more to allow us all to have consensus on each change, because many of their changes are good! It is the minority which are not good.

agree with your comments on insight, that could be improved with more modern sources, though likely will be plagued by issues in the field-specific sources for a long time, due to prejudices that exist among many psychiatrists that we cannot fix and indeed, to try and fix would be righting great wrongs. But it can be improved.

11 is an issue of DUE, we talk about those things elsewhere in the article IIRC, we don't necessarily need to mention it every time it is brought up. see also WP:HOWEVER

Re: commitment, I think the confusion here is about the multiple definitions of the term. The applicable one here is an engagement or obligation that restricts freedom of action [18] e.g. a "prior business commitment" which prevents one from attending their niece's birthday party. That can be voluntary or involuntary. The term of art is "commitment" because a "stay", in term, doesn't necessarily restrict one from leaving. A hotel "stay". — Shibbolethink ^{(♔ ♕)} 16:45, 21 August 2022 (UTC)

On commitment vs stay. My thought was that the language in the paper could be using a euphemism. Rather than acknowleding that they are detaining people (Involuntary commitment) they might be referring to a "hospital stay" to imply consent that does not exist. If so, it'd be clearer and more honest to talk about commitment (thought WP:JARGON) . But then I thought the stay could be voluntary so the term commitment was unclear. But thinking about it now, the term voluntary commitment gets used sometimes for voluntary stays in in-patient psychiatric facilities. Perhaps it could be a "detention" but that sounds a bit odd Talpedia

Regarding LAI i was mostly steelmanning. Risk of editorializing is noted, though it might just be WP:DUE, because if you accept an LAI with too high a dose you might have a very unenjoyable month which is not good for your health! (talk) 19:50, 21 August 2022 (UTC)

Without having to read a wall of text, the simplest solution here is for A.9 to read WP:FAOWN, and gain consensus on talk for edits. That will save everyone a lot of cleanup time going forward. The article was too long already: WP:SS is the style used: the WP:CITEVAR is maintained per WP:WIAFA by using the Diberri/BogHog template filler; Mad in America is the very definition of an advocacy website; and content about support groups forming to promote same belongs in the Society and culture section, not in Medication sourced to the laypress (see WP:MEDRS). The "loaded and biased" language being introduced in some edits here was using words never used by the sources, breaching source-to-text integrity; let's focus going forward, rather than backwards. Please gain consensus for controversial edits. SandyGeorgia (Talk) 19:58, 21 August 2022 (UTC)

Any responsible/sensible psychiatrist will have (hopefully) figured out a tolerable dose of medication orally before giving an LAI. So hopefully bad 4-week spells are very rare....Cas Liber (talk · contribs) 03:30, 22 August 2022 (UTC)

History (still)

As I stated eons ago (2019) above at #History, the sectoin needs some very serious trimming; the four sub-heads are the first indication, there is a sub-article, and it is a COATRACK magnet. SandyGeorgia (Talk) 22:09, 21 August 2022 (UTC)

I added the sections today because the paragraphs were turning into a bit of a random collection of stuff and I wanted to link to the others article - partly to stop more "stuff" getting added. We an probably summarize the stuff on the history of the diagnosis quite aggressively... and I broadly agree with this. We might be able to turn the other sections into short paragraphs that link to the relevant page in their first paragraph sentence. I do think mentioning how schizophrenia itself was used as a "catch all" diagnosis including for political purposes is pretty important, mentioning the historic development of the diagnosis is interesting and useful for understanding - but not necessarily important. WP:DUE. Talpedia (talk) 22:30, 21 August 2022 (UTC)

Re turn the other sections into short paragraphs that link to the relevant page in their first paragraph, yes. I appreciate the help here, as I run out of time. Have you had a chance to read this entire #FA issues section? I am wondering if Casliber wants some time to work unimpeded by edit conflicts from the rest of us, or if he prefers that others dive in right away to help trim and update? SandyGeorgia (Talk) 22:49, 21 August 2022 (UTC)

I think I'm going to call it a night soon and probably won't be back until next weekend... so it might be moot from me. Though there are other editors around. Talpedia (talk) 22:53, 21 August 2022 (UTC)

Am ducking in and out. Editing is all great so far. All going in right direction. Had a brief look at history and was pondering what to do with it. Will have a think...Cas Liber (talk · contribs) 03:24, 22 August 2022 (UTC)

I had a new look at the four section-idea, and while I appreciate Talpedia's motivation (to provide hatnotes so editors would be redirected to the sub-articles), we should not have to compromise writing to accommodate bad editing. The links mostly are repeats to the History sub-article. We should have one hatnote, one section, and chrono order. SandyGeorgia (Talk) 11:13, 22 August 2022 (UTC)

In theory the editors who want to add material are related to people wanting to *find* material. I do sort of feel political abuse and the history of invasive surgical interventions deserve not to be buried in a chronological order. Perhaps once we've started summarizing the section on the conceptual development the whole section will become short and manageable. Talpedia (talk) 11:31, 22 August 2022 (UTC)

I didn't work on the Conceptual section yet, but just in the five paragraphs in the other three sections, I found failed verification, uncited text, missing citation information, and over 50 words of repetitive and redundant prose. [19] I then put it all back in chrono order, removing the sub-sections; I didn't like it on preview (we go from too many short stubby sections, to one section that is too big), so I didn't save that edit. Will work on conceptual later (off for the morning), but this article (after years of neglect) is nowhere near Featured status, and will require serious attention. SandyGeorgia (Talk) 12:39, 22 August 2022 (UTC)

I am done with basic cleanup in this section, if anyone wants to have a look. There are sourcing and citation issues. SandyGeorgia (Talk) 15:32, 22 August 2022 (UTC)

PS, similar for Research directions and Society and culture. SandyGeorgia (Talk) 15:32, 22 August 2022 (UTC)

Adverse effects

@Casliber:. Hey

• I think we technically need a better source for "all commercially available AP cause EPS". That sources says all second-generation cause EPS; I think we need another that says all first-generation cause EPS... and also something else that says all AP are first-generation or second generation (aripiprazole is sometimes advertised as third generation - but it's mentioned in that source)... and even then it might count as WP:OR. It depends how pedantic we are going to be about sourcing, because I'm pretty sure it's true.
• The reason I included Tardive psychosis from the other article was that although it's rare or perhaps theoretical, there is a risk that you take AP for something else, e.g. tourettes, eating disorders, PTSD, sexual side effects of anti-depressant, then stop and get psychotic symptoms and then get diagnosed with schizophrenia. This felt important because although it's rare, the impacts - misdiagnosis of schizophrenia and lifelong AP - are extreme. Obviously it's a consensus matter as to whether it should be included, but those were my reasons.

Talpedia (talk) 21:25, 21 August 2022 (UTC)

Agree a better source for point 1. I was just going through first up and relegating material and reorganising. BTW kudos for removing all pro "atypical" guff - biggest annoyance in my job is pharma-led pushing of typical/atypical distinction. Drives me nuts. Big topic and needs discussing in daughter articles definitely. Cas Liber (talk · contribs) 03:28, 22 August 2022 (UTC)

Hmmm. I initially ditched it as extremely rare. In fact in 30 years of treating people with schizophrenia I couldn't say that I've seen a single case (as opposed to pro-psychotic symptoms with aripiprazole, which I definitely have seen a few of). You make a good case for leaving it in actually so happy to reinsert. Cas Liber (talk · contribs) 03:28, 22 August 2022 (UTC)

Research directions

Check for datedness needed. SandyGeorgia (Talk) 13:27, 22 August 2022 (UTC)

Symptoms

Paranoia is in the lead and in the infobox, but not in the body of the article. SandyGeorgia (Talk) 03:53, 23 August 2022 (UTC)

I find no mention of paranoia in the ICD, DSM as I can see online only, NIH, or WHO webpages linked, or the 2016 Lancet review; I have removed it. If it's worked backed in, some description in symptoms is needed--in particular, where did it go when subtypes were lost and why ? SandyGeorgia (Talk) 15:25, 23 August 2022 (UTC)

U.S. policy and international policy

Since the medication section is already discussing matters of legal policy (court-ordered medication) and U.S. judges are not greater or more neutral experts than international policymakers, it is also appropriate to cite international decisions (Convention on the Rights of Persons with Disabilities, and decisions stemming from it.) Wikipedia is not a U.S. exclusive resource and it's myopic and nationalistic to only state U.S. policy as the standard, when there are clear, relevant policies put forth by the U.N. The Office of the High Commissioner for Human Rights is not an "advocacy source." I told User:Praxidicae that they were edit-warring, which they promptly deleted. If we can't reach consensus here I will go to arbitration. ARMILLARIA.9 (talk)

Rp and quotes

I've got no strong opinions about citations styles. I tend to like to make it as easy as possible for others to check my working, so like to cite individual sentences and include page numbers. I basically just use Rp to avoid duplicate references. I discovered the "quote" property on Rp that shows a quotation on hover, which I thought was quite cool, and makes it even easier for people to check my work and find the relevant part of the paper. Also I think allowing people to check my work avoids needless work and drama. I seem to remember there was quote property in the reference... but it made the references long.

• What should we do in this artcile when we reference the same source twice with different pages for different claims?
• Do we think the quotes here are useful? I don't know of a pretty way of getting them other than using Rp.

Talpedia (talk) 09:44, 22 August 2022 (UTC)

We have a mess of citation styles; I would prefer to hear first from Casliber re which is easier for maintenance. I hate Rp with a passion because it's so disruptive to read, but switching the entire article to sfn would be quite time-consuming, when there is so much other work to be done. On the other hand, it's not at all clear to me how this article can retain Featured status, unless quite a serious push is made to address issues that include sloppy prose, sourcing, citing, datedness and inattention to MOS. Unless several editors are all in for restoring featured status here, the citation variety doesn't really matter. SandyGeorgia (Talk) 12:35, 22 August 2022 (UTC)

PS, Talpedia have a look at the citations at dementia with Lewy bodies and Buruli ulcer ... both more recent FAs, both use sfns. The short footnote (sfn) allows one to cite a section of an article or a page number. It's what we should be doing, and I can do the convert, but am not interested in doing that amount of work unless a) Cas wants it, and b) this article is actually going to be brought back to FA standard. I don't mind you putting in the page nos for now in rp format, as that makes sfn conversion easier. I don't think adding quotes is a good idea, except in rare occasions where text may be challenged, because ... imagine if we had to quote every bit of inaccessible text ... the article would explode and also become impossible to edit ... and we'd have to worry about breaching copyright on articles that are used extensively. SandyGeorgia (Talk) 12:54, 22 August 2022 (UTC)

Yeah, I've used sfn's before when I was being a bit paranoid about disagreement, they aren't as "tidied away" as Rp stuff, but it is how e.g. print history texts seem to work. It just feels a bit of a waste having people find the relevant section of a text and not noting it down... but those are relevant points. I hadn't thought about the editing implications. I'm using the visual editor so for me its just a box with numbers. I think the main reason I don't use markup for editing is that I find long references make proof reading text as you write difficult - so for me adding quotes is just adding moredata to an already unreadable piece of markup - but others might have superior powers of markup reading. I wonder how long references are already - I could imagine use of quotes doubling the length of references. Talpedia (talk) 14:35, 22 August 2022 (UTC)

I'd still like to hear from Cas on a preferred citation method, but as I work through cleaning up citations, I'm finding the huge majority of sources are used only once ... so we could opt for a modified/hybrid approach, whereby any source used only once is not converted to sfn, and the quote and page no are given within the citation template; and only sources used multiple times are converted to sfn. Many FAs do that; it is acceptable. SandyGeorgia (Talk) 15:30, 22 August 2022 (UTC)

PS, forgot to say, if we are to believe the WMF, most people these days access Wikipedia on mobile devices where the hover doesn't work anyway. SandyGeorgia (Talk) 19:39, 22 August 2022 (UTC)

Yeah... the same applies to navboxes which I find a little depressing. I console myself regarding navboxes by imagining that "deeper" reading takes place on desktops. Just looking now mobile seems to be two thirds and desktop one third. Interestingly the ratio seems different for different pages. If the clickstream had mobile-vs-desktop data (whiuch it appears not to at the moment) you might be able to work out how long people are staying on pages on mobile versus browser :/ Talpedia (talk) 11:12, 23 August 2022 (UTC)

I like sfn for books with individual page numbers used in different parts (but only for those - not for all the refs. Cas Liber (talk · contribs) 23:08, 27 August 2022 (UTC)

"Fail to" vs "do not"

I've restored the original wording regarding "fail to" recognize vs. "do not" as it seems far more neutral and I would ask that it's discussed here before being reverted or restored again. See this edit. PICKLEDICAE🥒 22:42, 24 August 2022 (UTC)

Personally... I'm with "do not" since "fail to" implies that you should be taking medication. For example: "Why have you failed to eat your peas?", "I do not like peas, so I failed to eat them". Fail to has a default assumption that adherence is the correct thing... which it often, but not also is. On the other hand... this may well be the language the source uses... so it might be an editorial decision, but you could maybe construct an argument out of misleading the reader about their legal rights and person-centred language. However.... I think this section should be replaced with a larger one on adherence with newer sources on insight. — Preceding unsigned comment added by Talpedia (talk • contribs) 22:58, 24 August 2022 (UTC)

I support "do not" but I think the remainder of the changes in that edit should not be accepted for reasons detailed above, I think they insert POV. — Shibbolethink ^{(♔ ♕)} 23:00, 24 August 2022 (UTC)

No objection to that. PICKLEDICAE🥒 23:01, 24 August 2022 (UTC)

done — Shibbolethink ^{(♔ ♕)} 23:07, 24 August 2022 (UTC)

Who made the unsigned comment? I explained above why U.S. policy isn't more objective and worthy of being treated as "the exclusive standard" than international policy. ARMILLARIA.9 (talk) — Preceding undated comment added 23:04, 24 August 2022 (UTC)

I slightly lean to "fail to" as it is common usage in medicine. But not enough to argue over if the consensus is the other way. The segment on "United Nations Special Rapporteur on Torture has classified forcing people to take these medications without consent as a human rights violation" is misrepresenting the source by implying that all long-acting injectables are wrong rather than situations where the diagnosis and management is abusive. The material is more about the politcal use of medical diagnosis specifically so not relevant enough to be here but somewhere on a daughter article can be discussed at length and in a more nuanced fashion. Cas Liber (talk · contribs) 23:12, 27 August 2022 (UTC)

Political abuse of psychiatry is probably a good place to include this. Which we link to in the history section. I think it's enough to have a few high level sentences here that mention that the diagnosis of sz has been used abusively and cover the body of the material there.

As above I'm for do not since patients are often not compelled to take medication and actively choose not to take medication and are under no obligation to do so, or tell anyone that they have stopped. I do think there might be something to be said about patients deceiving healthcare workers around this though.

I suspect there could be some "non-political" misuse of LAI, for example to force compliance without sufficient oversight (that is hopefully provided by CTOs). Talpedia (talk) 14:02, 28 August 2022 (UTC)

Semi-protected edit request on 19 December 2022

I would like to add a thumb image of File:SchizophreniaBrain.jpg to Symptoms>cognitive entitled Map of deficits in neural tissue throughout the human brain in a patient with schizophrenia. Thank you 45.53.152.94 (talk) 17:00, 19 December 2022 (UTC)

 Done casualdejekyll 17:52, 19 December 2022 (UTC)

Neurodevelopmental hypothesis

Under risk factors it is explicitly stated that schizophrenia is described as a neurodevelopmental disorder. As far as I can tell this is a popular hypothesis with some good evidence behind it, but in textbooks it is considered alongside other hypotheses and not presented as fact. The New Oxford Textbook of Psychiatry (2020) states: "[s]everal lines of evidence have supported speculation that schizophrenia is a neurodevelopmental disorder resulting from brain injury occurring early in life." Under risk factors it's also said that prenatal brain development is altered, citing a 2010 Finnish source which in turn cites a 2005 Nature paper reviewing the neurodevelopmental hypothesis. There's newer evidence for this from a few stem cell studies but I don't think there's secondary literature on it yet to the extent that it can be presented as fact. Also under mechanism the neurodevelopmental hypothesis is said to be the prevailing theory, but sourcing should be improved and according to this paper it's evolved into the "developmental risk factor model." PMID 28981842 I'll look into it a bit more but seems like a few easy tweaks. Feline negativity (talk) 22:27, 31 January 2023 (UTC)

Diagnosis controversy

The diagnosis of schizophrenia itself is the subject of some controversy, a fact not at all reflected in the article. Boyle (2002) very thoroughly critiqued the validity and reliability of the diagnosis. Critical psychiatrists are also skeptical of the label (Moncrieff & Middleton 2015). Read & Dillon (2013) have also collected a number of critical perspectives. Several leading researchers such as van Os (2016, Guloksuz & van Os 2018), Bentall (in Poland & Tekin 2017) and Murray (2017) have also proposed the retirement of the schizophrenia diagnosis in favor of a psychosis spectrum. Former NIMH director Insel (2010) also believes there will be a shift in our understanding of schizophrenia, which at present he views as a useful clinical construct but one of dubious neurobiological validity for research. Finally, some service users, such as those of the Hearing Voices Network(s), also contest the usefulness of the label in their lives. To some extent this variety of criticisms, from different perspectives and suggesting different solutions, should be incorporated into the article, possibly under its own heading or dispersed throughout. Eventually I hope to do so, but suggestions for further references or criticisms of the criticisms are very welcome. Feline negativity (talk) 10:56, 21 January 2023 (UTC)

The Diagnosis of schizophrenia page linked notes some of these criticisms, possibly some material from there can transferred or referenced, but it certainly warrants mention on the primary page. Feline negativity (talk) 11:16, 21 January 2023 (UTC)

Which is probably where they better belong, per summary style, as I indicated below (you posted this note after I responded). SandyGeorgia (Talk) 11:20, 21 January 2023 (UTC)

Feline negativity, see WP:MEDDATE; everything you've indicated above is fairly old. If you'd add PMIDs after each source above, we can more easily determine if those sources meet Wikipedia's guidelines for sourcing medical content, which for a featured article, means the most recent highest quality secondary reviews or textbooks. You can add PMIDs to talk page posts by using {{PMID}}. This is a bit old, but still gives a good overview of how to find and use sources for biomedical content on Wikipedia. Finally, I suggest you not add this content without further discussion and gaining consensus, as this is a featured article; see this message which appears in the edit window when you edit this article. Also, because this article is a broad overview that uses summary style, most sources used should be broad in nature rather than things like individual proposals, comments, etc. SandyGeorgia (Talk) 11:19, 21 January 2023 (UTC)

@SandyGeorgia Schizophrenia is a very old diagnosis and research into its neuropathology has not seen any recent breakthroughs that would invalidate the idea of it being highly heterogeneous, meaning that most of the criticisms in the above sources continue to hold up. I will look for systematic reviews on the subject and better, more recent sources, but this heterogeneity is by now well-recognized. The most recent edition of Charney & Nestler's Neurobiology of Mental Illness speaks instead of psychotic disorders as a general class and immediately notes the controversy regarding their boundaries. Even in a summary, the fact that some of the most prominent schizophrenia researchers believe the diagnosis is, to quote Bentall, "beyond its use-by date," is surely pertinent and worthy of at least a few lines. In any case as the last line suggests I was not planning on unilaterally making any edits anytime soon. PMIDs for those that have one: PMID 25710241, PMID 28689498, PMID 28003469, PMID 21068826. Of the remainder, three are books or edited volumes published by academic presses (Routledge, Routledge, and MIT Press, respectively) and one is a "personal view" piece in the BMJ. These were exemplary and what I had immediate access to; I am aware of the sourcing policy for the article itself. Feline negativity (talk) 12:43, 21 January 2023 (UTC)

See here for making the PMIDs more easily accessible. None of the PMIDs cited above are optimal; they are either old or not reviews (although one is 2018). My suggestion is to use the most recent (within five years) highest-quality secondary source and suggest a sentence or two based on it. We can't give weight here to 2010 opinions, advocacy networks or dated proposals, although dated secondary sources may have a place as a controversy at Diagnosis of schizophrenia. SandyGeorgia (Talk) 15:18, 21 January 2023 (UTC)

I've recently looked into it a bit more and found better sources, and it seems if anything even clearer that there is an ongoing shift in psychiatry and clinical psychology away from the schizophrenia concept and towards some sort of transdiagnostic dimensional conceptualization of psychosis. To be sure, debate remains, both over the concept and what might replace it (RDoC, HiTOP, etc.). However, the latest major textbook on psychotic disorders places real and extensive emphasis on the understanding that neuropathology, genetics, and symptoms all cut across diagnostic boundaries. A couple other textbooks I glanced at note this too (New Oxford, Psychopathology, aforementioned Charney & Nestler). Additionally, I found this 2017 consensus report from the British Psychological Society Division of Clinical Psychology. It is quite critical of the schizophrenia concept's clinical utility. I'm not sure where to insert something about all this, it doesn't clearly fall under the current sections and subsections. Maybe a "criticism/controversy" subsection under Diagnosis? This seems to be a fairly major evolution that's mostly occurred in the last 8 or so years (although I found papers in the early nineties with the similar positions, and the first systematic review on the psychosis continuum dates to 2008), some aspects of which should maybe be incorporated elsewhere in the article too. Possibly more of it belongs in diagnosis of schizophrenia but I think this summary should probably reflect the emerging scientific consensus, as it is now in textbooks. But given that schizophrenia remains very widely used in clinical practice I understand that the recent research probably shouldn't be overemphasized at this time. Feline negativity (talk) 12:31, 30 January 2023 (UTC)

Hello again ... I am going to be quite tied up with another Wiki issue for a couple of days, so can't look closely at this. But before proceeding anyway, it would be good to hear from Casliber, and just a note, that Criticism/controversy sections are discouraged ... it is better to weave that sort of content into the text in the appropriate section. I'll check back after Cas has had a look; thanxk Fn. SandyGeorgia (Talk) 12:49, 30 January 2023 (UTC)

So far neurobiological findings have almost zero impact on how schizophrenia is diagnosed and treated worldwide. Similarly with researchers who doubt the validity of the condition (a la Szasz and successors). Controversies from the misdiagnosis of people with complex trauma as schizophrenia belong in discussion of differential diagnosis or history. The article is huge and we had to be pretty strict with what remains in the parent article (this one) while shifting large amounts of material to the daughter articles. Cas Liber (talk · contribs) 18:45, 30 January 2023 (UTC)

@Casliber As I did note, you're right that schizophrenia isn't going anywhere anytime soon and the article should reflect that and not give undue influence (Although the BPS consensus report would suggest that practice has been changing for some). But parts of the article should probably reflect what is now taught in textbooks, i.e. that the risk factors and other elements of the illness are shared with other conditions and that its concept validity is now considered quite doubtful. As an example, newer textbooks note that there is significant overlap in the polygenic risk for schizophrenia and a number of other conditions, especially bipolar, but this isn't in the article. Major genetic findings are one of the particular reasons schizophrenia's validity has been questioned in favor of a transdiagnostic system.

It's nothing at all to do with Szasz or other fringe researcher views, or of misdiagnosis per se, it's a mainstream change that's happened regarding the way psychosis and other schizophrenia symptoms are now understood dimensionally. I'd really encourage you to take a look at the textbooks, particularly the first underscores the extent of this changed understanding. I think it would be strange for there to be discongruency between the article and modern textbooks and consensus statements. Length could be a problem but I'm sure something suitable could be found. Feline negativity (talk) 22:03, 30 January 2023 (UTC)

Fn, how about if you propose a sentence or two, appropriately cited, here on talk, and indicate into which section you would incorporate them? That could shorten the conversation (and Lord knows we're all pushed for time on Wikipedia <sigh> ... ) You can see a format I like to use at User:SandyGeorgia/sandbox5#Draft proposals. Using that format allows you to show side-by-side what the existing content is and how you would weave the new content in . SandyGeorgia (Talk) 22:10, 30 January 2023 (UTC)

You can just edit that section of my sandbox, to copy-paste the table template to your own sandbox, and work from there and then bring it here. SandyGeorgia (Talk) 22:11, 30 January 2023 (UTC)

Proposal

Here are two sentences, a bit more could certainly be put in but this is the bare bones. I'm not sure where it would fit in, however. Perhaps the first sentence could be revised a bit and stuck under mechanism, and the second revised and put under management?

Schizophrenia is now widely understood to be a construct grouping many different phenotypes, with varying etiologies, neuropathologies, and prognoses. Some researchers have therefore proposed disbanding the schizophrenia diagnosis to better identify and treat the different biological and psychological mechanisms which lead to psychotic experiences. Feline negativity (talk) 04:25, 1 February 2023 (UTC)

Gave it a little bit more thought and think splitting it is the way to go: a similar sentence or two under mechanism about how schizophrenia is not one categorical disease but many falling along a transdiagnostic continuum, and then somewhere under management something about the encouraged transition away from the schizophrenia concept in clinical practice. (Which is what the BPS report is mostly about, could also cite relevant material from Psychotic Disorders) Feline negativity (talk) 16:47, 1 February 2023 (UTC)

Anyone who works clinically in mental health sees various conditions (substance use, personality, bipolar) in people's family history so not specific to schizophrenia and not new. I suspect has alot to do with trauma as well some genetic loading. Agree with Sandy about popping a proposed addition here and discussing. Cas Liber (talk · contribs) 00:46, 31 January 2023 (UTC)

Might be worth noting here that this clinical understanding also shows up in some academic literature. I've read papers that trace ICD-10 codes over time. X% of substance induced psychosis is eventually diagnosed as bipolor, Y% as a schizophrenia. Another spanner in the work here is that I've also read some stuff looking at diagnoses of "schizophrenia" versus other forms of psychosis at FEP, and claiming the ability to predict relapse, along with the clinical (and legal) implications about medication... suggesting that "schizophrenia" may indeed be meaningful diagnosable separate from other forms of psychosis – pretty suspicious though. Also you controversial things like brief psychotic disorder and the concept of psychogenic psychosis, that might place trauma as a *cause* of psychosis rather than a differential diagnosis, though I guess they are differentiated from sz if not psychosis. Talpedia (talk) 17:01, 1 February 2023 (UTC)

@Talpedia I think the second is an argument for the clinical utility of scz as a label applied when worse outcomes are anticipated, but it doesn't say anything about concept validity. One of the arguments I've seen (in the BPS report for instance) is that psychotic experiences are quite common and the fact that scz is often diagnosed straightaway doesn't reflect that the prognosis isn't necessarily so poor. So it could well be that schizophrenia is just diagnosed less often and for more severe psychosis in the future, but lives on.

I don't think it's especially controversial anymore to say that trauma can be a cause of psychosis, current thinking seems to be that there needs to be some sort of genetic risk but that trauma can play a major role. There were two seminal meta-analyses on it, one on psychosis and one specifically on scz, published in 2012 which both found a fairly large effect. There's a chapter in Psychotic Disorders about early childhood adversity and another about the neural correlates of child trauma so it's definitely an active subject in scz research. Feline negativity (talk) 23:53, 1 February 2023 (UTC)

It feels like if something is predicting outcomes it has to be in some sense "real", though you could be detecting a range of concepts, or some other environmental factor that predict outcome. But yeah scz could just mean "bad", here. For what it's worth, this mentions the effect https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5608829/

As a causal factor or "trigger", sure. The literature seems to love this word "trigger" with the implication that there is an underlying factor without the need to explicitly state this. The controversial parts would circle around the need for medication (it's worth noting that a bunch of people are pushing for life-long medication following FEP, and some countries like AUS,NZ and Canada are using outpatient commitment to enforce compliance with medication) and the effectiveness of trauma-related talking therapies for a subgroup of psychosis. As far as I can tell, no one anywhere is suggesting any form of talking therapy for scz, outside of some fringe people pushing for Open Dialogue (with some success at obtaining trials), some patient groups, and fringe psychoanalytic types, so you have the spectre of the label scz effectively denying people access to treatments for trauma. Talpedia (talk) 00:19, 2 February 2023 (UTC)

@Talpedia Yes in this case it's likely that scz is a proxy for other factors which affect outcome. But I could look into the literature more on it as well.

Re talking therapy yes it seems to be fairly uncommon in the anglophone, but I think it's also something the tide is turning on. Psychotic Disorders has chapters on a number of psychotherapeutic approaches to psychosis, and the BPS consensus report also recommends them. Labelling all or most of FEP schizophrenia does imply a need for consistent medication which is something there's definitely been debate about, and the BPS report raises this as well. Feline negativity (talk) 00:38, 2 February 2023 (UTC)

I apologize for being completely exhausted by another long and difficult Wiki project, but several things ...

Schizophrenia is now widely understood to be a construct grouping many different phenotypes, with varying etiologies, neuropathologies, and prognoses.[1][2] Some researchers have therefore proposed disbanding the schizophrenia diagnosis to better identify and treat the different biological and psychological mechanisms which lead to psychotic experiences.[3][4][5]

1. There is a very long discussion above that is very short on the issues we need to determine content. Which is. A discussion of WP:DUE and all sources. I'll wait for Casliber to have time to read it, but it appears to be mostly opinion, and those sorts of long discussions don't help us decide content.
2. This is a Featured article, so WP:WIAFA. What is meant by now? (MOS:CURRENT). Since x date? In X century ?
3. What about that sentence is different from many conditions?
4. "Some researchers" ... have "proposed" ... by definition is not written in a way that belongs in Management ... sounds more like Research directions. And some researchers needs to be less vague.
5. WP:CITEVAR; please remember to use the vauthor format for author names, even on books. The citation templates also allow for veditors.

That's all I've got for now. SandyGeorgia (Talk) 00:54, 2 February 2023 (UTC)

1. Apologies, easy to get a little off-topic.

2. I can look into when it began to shift, the tipping point has come fairly recently I think but as mentioned there are papers going back at least to the early 90s proposing this. It only gained serious momentum in the 2010s.

3. Schizophrenia is widely believed by the public and many clinicians not working in research to be a categorical and discrete disease entity. Certainly there are other conditions, psychiatric and somatic, that are given one name but are probably actually several. However I imagine this is noted on their wiki pages as it's something obviously relevant. In Scz it's particularly relevant because there's encouragement to change or do away with the concept.

4. Not sure how to phrase it, perhaps you could advise. It did feel like an understatement to me. It is in the consensus statement of a major professional body and is also recommended in Psychotic Disorders, which seems to be the foremost textbook. It's the position of some of the most prominent researchers in psychosis, but there are certainly still others who argue that the concept, at least clinically, is useful. In translational and basic research it is widely agreed that schizophrenia shouldn't be used to guide research, although it often remains a necessity. (For grant funding, human subjects, lack of alternatives, etc.)

5. Will fix.

Regarding "dueness" I think it certainly is due. Again it's in the major textbooks and a consensus report. Clinical practice guidelines and the like do still speak of schizophrenia and probably will for the foreseeable future. However the featured article criteria say that all major facts and details should be included. The push towards a transdiagnostic understanding of psychosis is one of the most significant developments in schizophrenia research in the last couple decades, and is not a fringe but a mainstream position. Accordingly a few sentences are due. Feline negativity (talk) 01:42, 2 February 2023 (UTC)

Not thrilled about wording as it implies a heterogeneity that isn't there. Yes schizophrenia is a very broad diagnosis, but no-one has come up with zones of rarity that allow the demarcation of it into smaller entities - in fact, the old subcategories of disorganised, paranoid and catatonic have been largely done away with. FEP specifically isn't schizophrenia diagnosis depends on longitudinal path as much as phenomenology Cas Liber (talk · contribs) 02:51, 27 February 2023 (UTC)

@Casliber You're right about that, and I really am not sure how it should be worded either. But in textbooks are statements like these: "Although the significant heterogeneity of schizophrenia has always been recognized, with multiple etiological factors and pathophysiological processes, it has been treated as a singular entity. Now it is almost certain, however, that our construct of schizophrenia encompasses not one but several diseases." This sort of information and its implications don't seem to be in the article but do strike me as something relevant. Feline negativity (talk) 06:35, 27 February 2023 (UTC)

Agree - the idea just sort of "floats" along in discussion of schizophrenia, but never comes up in clinical practice. If I'm talking to a patient, I talk about good and poor prognostic indicators but that's about it. And they don't subdivide the condition, just point to possible outcomes. Cas Liber (talk · contribs) 19:09, 27 February 2023 (UTC)

References

Semi-protected edit request on 3 April 2023

I think there is a good deal lacking from the research directions section that should be included. I would like to add information regarding current human behavioral research to create better diagnostic tools, namely studies using tasks such as the AX-CPT to identify cognitive abnormalities that may be specific to schizophrenia. There have also been many recent publications looking at pharmacological manipulations to generate psychosis-like symptoms, and while that doesn't need to be addressed in depth here it would be useful to have a sentence or two with some hyperlinks. Last note is that the page directs to animal models of schizophrenia without providing any information about them on this page. I feel a brief description of some of the efforts in animal research could be useful here as well, but ultimately unnecessary. Knepx001 (talk) 02:12, 3 April 2023 (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. Tollens (talk) 02:21, 3 April 2023 (UTC)

Semi-protected edit request on 23 April 2023

Please change '"favoured" to "favored"' for dialect in the last sentence of Signs and Symptoms, Negative symptoms. Riixvø (talk) 14:49, 23 April 2023 (UTC)

 Not done: please read MOS:ENGVAR. M.Bitton (talk) 15:12, 23 April 2023 (UTC)

Lead poisoning

I have removed a series of primary studies related to lead poisoning, which is already given due weight cited to WP:MEDRS-compliant secondary reviews at risk factors of schizophrenia. Other than the somewhat older reviews used in the Risk factors article, I am unable to find any broad overview-- indeed any recent secondary source-- covering lead poisoning in schizophrenia, so its inclusion here seems UNDUE. If anyone has a WP:MEDDATE and WP:MEDRS-compliant secondary source, we could discuss mention here. SandyGeorgia (Talk) 11:40, 27 April 2023 (UTC)

Please see:

- Early-life lead exposure and neurodevelopmental disorders

- Beyond the looking glass: recent advances in understanding the impact of environmental exposures on neuropsychiatric disease (this study was supported in part by the NIH)

Thanks. Dustfreeworld (talk) 15:11, 3 May 2023 (UTC)

Any thoughts? :-) Dustfreeworld (talk) 03:38, 12 May 2023 (UTC)

Schizo + phren/phrenic

"The word schizophrenia—which translates roughly as "splitting of the mind" and comes from the Greek roots schizein (σχίζειν, "to split") and phrēn, phren- (φρήν, φρεν-, "mind")" isn't stricly true as φρήν 1 The midriff, stomach and lower chest or breast (which is retained as the phrenic nerve) 2 The seat of emotions, heart; seat of bodily appetites such as hunger 3 The seat of intellect, wits, mind" has 2-5 (if intellect & wit isn't the same as mind) prior possible meanings before mind is the connected meaning. So giving the greek word as directly associated with mind is misleading, there should be a discussion as to how this is possible. ClassisSIPadresse9ai8123Ge1Gia81V4a7iNd64i0i49i4f5anni123231IIIhorasIVminuta (talk) 16:55, 27 June 2023 (UTC)

I think you are referring to the material Schizophrenia#Conceputual_development. Do you think there are sources that discuss this distinction in the context of schizophrenia, given the tangential connection between sz and greek people will probably call WP:DUE or WP:OR unless a source specifically discusses the nuances of greek *andy sz at the same time. Talpedia 11:17, 28 June 2023 (UTC)

Semi-protected edit request on 2 July 2023

Submission for inclusion into your article "Schizophrenia" along with 10 (ten) reliable sources of doctors/medical professionals:

Psychiatry is fraud/pseudo-science & mental illness does NOT exist because it is NOT proveable by any biological medical tests, & pharmaceutical companies are just looking to profit off this fraud by selling poisons, article by Citizens Commission on Human Rights (website: www.cchr.org):

"Real Disease vs. Mental “Disorder”

Psychiatric disorders are not medical diseases. There are no lab tests, brain scans, X-rays or chemical imbalance tests that can verify any mental disorder is a physical condition.  This is not to say that people do not get depressed, or that people can’t experience emotional or mental duress, but psychiatry has repackaged these emotions and behaviors as “disease” in order to sell drugs. This is a brilliant marketing campaign, but it is not science. 

“…modern psychiatry has yet to convincingly prove the genetic/biologic cause of any single mental illness…Patients [have] been diagnosed with ‘chemical imbalances’ despite the fact that no test exists to support such a claim, and…there is no real conception of what a correct chemical balance would look like.” —Dr. David Kaiser, psychiatrist

“There’s no biological imbalance. When people come to me and they say, ‘I have a biochemical imbalance,’ I say, ‘Show me your lab tests.’ There are no lab tests. So what’s the biochemical imbalance?” —Dr. Ron Leifer, psychiatrist

“All psychiatrists have in common that when they are caught on camera or on microphone, they cower and admit that there are no such things as chemical imbalances/diseases, or examinations or tests for them. What they do in practice, lying in every instance, abrogating [revoking] the informed consent right of every patient and poisoning them in the name of ‘treatment’ is nothing short of criminal.” —Dr. Fred Baughman Jr., Pediatric Neurologist

“Psychiatry makes unproven claims that depression, bipolar illness, anxiety, alcoholism and a host of other disorders are in fact primarily biologic and probably genetic in origin…This kind of faith in science and progress is staggering, not to mention naïve and perhaps delusional.” —Dr. David Kaiser, psychiatrist

While “there has been no shortage of alleged biochemical explanations for psychiatric conditions…not one has been proven. Quite the contrary. In every instance where such an imbalance was thought to have been found, it was later proven false.” —Dr. Joseph Glenmullen, Harvard Medical School psychiatrist

“The theories are held on to not only because there is nothing else to take their place, but also because they are useful in promoting drug treatment.” —Dr. Elliott Valenstein Ph.D., author of Blaming the Brain

“There is no blood or other biological test to ascertain the presence or absence of a mental illness, as there is for most bodily diseases. If such a test were developed…then the condition would cease to be a mental illness and would be classified, instead, as a symptom of a bodily disease.” —Dr. Thomas Szasz, Professor Emeritus of Psychiatry, New York University Medical School, Syracuse

“I believe, until the public and psychiatry itself see that DSM labels are not only useless as medical ‘diagnoses’ but also have the potential to do great harm—particularly when they are used as means to deny individual freedoms, or as weapons by psychiatrists acting as hired guns for the legal system.” —Dr. Sydney Walker III, psychiatrist

“No biochemical, neurological, or genetic markers have been found for Attention Deficit Disorder, Oppositional Defiant Disorder, Depression, Schizophrenia, anxiety, compulsive alcohol and drug abuse, overeating, gambling or any other so-called mental illness, disease, or disorder.” —Bruce Levine, Ph.D., psychologist and author of Commonsense Rebellion

“Unlike medical diagnoses that convey a probable cause, appropriate treatment and likely prognosis, the disorders listed in DSM-IV are terms arrived at through peer consensus.” —Tana Dineen Ph.D., Canadian psychologist "

Source:

https://www.cchr.org/quick-facts/real-disease-vs-mental-disorder.html 2607:FB91:8C9E:4883:8D79:621F:1646:2047 (talk) 10:18, 2 July 2023 (UTC)

 Not done: requested edit is a copy/paste of the original source.

Views expressed are also WP:FRINGE and WP:UNDUE. Xan747 (talk) 14:34, 2 July 2023 (UTC)

I think care should be taken not to assess claims based on "truthiness" and it should be noted that true ideas are often mixed in with exaggeration (true of course meaning due and verifiable in wikipedia). It would be helpful if comments came quoting sources. I don't think it's that disputed that psychiatry uses behavioural diagnosis, does not have biomedical tests for conditions, nor proof about a chemical mechanism. Although... there is a bit of "no true scotsman" here because when mental conditions get biomedical explanations they tend to become neurology rather than psychiatry, and so by definition psychiatry deals with that which is not understood using biomedical science.

In fact, I think the majority of the statements here are entirely mainstream and would be accepted by most psychiatrists apart from the reasoning that just because we have no idea about the mechanism for conditions they don't exist and aren't treatable, and that there is a "fraud" involved. Though they might point at biomedical theories, neurological conditions, drug effects and brain scans as suggestive evidence.

I think it's entirely due to say that there aren't fully worked through biomedical mechanisms, and that behavioural diagnosis is hard, resulting in incorrect diagnosis at times or people moving between diagnoses. Talpedia 16:47, 2 July 2023 (UTC)

Violence, politics and mental health

Doesn't this lead to violence, as stated on many news outlets everytime there is a mass shooting incident, or is it a ploy for defense lawyers to use to help their clients escape punishment (often a death sentence), and can this be stated in any article, with sources? Right now, the mental health situation is in the news as a election issue for the 2024 Elections, and can that be used as well? My news outlets state that "X(person/suspect)" has this illness as police take him/her to either jail or the prison wing in a hospital after he/she has shot a lot of people. Thanks. Nuclear Sergeant (talk) 02:45, 14 July 2023 (UTC) 🥺🥰

As ever with causes of violence. It's complicated (see https://en.wikipedia.org/wiki/Involuntary_commitment#Containment_of_danger). SZ is correlated with violence, but it's also correlated with adverse childhood experiences, abuse and poverty which are in turn correlated with violence. The link above looked at twins and found a 1.8 times increase in risk in violence. I find much of the discourse on the topic rather misleading "more likely to experience violence than cause violence". I would say that there a bunch of common things that have a far larger effect on violence. I imagine there might be content of "violence and sz" that is WP:DUE and can be added here.

On insanity defences, it varies by country, but of an insanity defense will result in indefinite detention by the state while being made to take drugs. So it is my no means to be seen as a way of getting out of a prison sentence.

With mass shooters, I remember reading a paper on this which found that psychotic states of mind were over represented in mass shooters, but were far from the majority - the figure 18% comes to mind. You also have issues that people may diagnose strange fixed beliefs and psychosis when other cognitive faculties are unimpaied (i.e. this is not actually psychosis) so misdiagnosis is a risk. I imagine this would be better explored on the spree killing page. Although there might be an argument for a sentence here (once sourced) along the lines of "psychotic diagnoses make up x% of spree killers" Talpedia 08:56, 14 July 2023 (UTC)

Thanks. I'm currently in Missouri, and we had a really bad mass shooting incident in Columbia,MO. That got covered not only by the local media, this ended up in the National media as well. Can that, if sourced, be used? Thanks 😘🥰 Nuclear Sergeant (talk) 09:19, 14 July 2023 (UTC)

As a rule we'd prefer general sources that look at the topic. I think this was the paper I was looking at before that discusses psychosis and mass shootinghttps://psycnet.apa.org/record/2021-43325-001 . A particularly nasty mass shooting probably won't be considered WP:DUE here - unless other sources on the general topic often talk about it. You often get laws created directly in response to an event and then books will talk about it.

If you feel the need to sort of place this event within the context of violence related to mental health. I think the "wikipedia" way of doing it would be to create an article on the shooting itself and then link this article to a more general discussion on mass shooting, and mass shooting and mental health through links. In the other direction you might be able to find "lists of mass shootings due to psychosis" or create them. I am aware that this is all rather "technical" and organizational in comparison with the impact that local effects can have. Generally the closer the article is to the topic the more you can WP:DUE it is so there might be arguments for the addition to, say, the crime and safety section on missouri.

Outside of wikipedia, I remember there was a charity advocating for the prevention of violence due to mental illness - so if you want an impact less bounded by WP:DUE and less demanding of abstraction that might be a place to go as well. Talpedia 10:07, 14 July 2023 (UTC)

@Nuclear Sergeant Those extreme and violent cases are the ones that get visibility in the media, but just like any other thing, the extremes that make it to the news do not represent the majority. People with schizophrenia are more at risk of being exploited or the victim of violence than to be the perpetrator.

Saying people with schizophrenia are violent means that you also have to say that people without schizophrenia are extremely excessively violent. Kardoen (talk) 13:01, 16 July 2023 (UTC)

Well on average people with schizophrenia *are* more violent, just not by that much. I'm never quite sure what that "more at risk of violence" statistic really means. Talpedia 01:35, 17 July 2023 (UTC)

Here’s a good read:

https://www.rcpsych.ac.uk/mental-health/problems-disorders/schizophrenia

See the sections on causes and myths. --Dustfreeworld (talk) 09:25, 18 July 2023 (UTC)

Hmm, I think it's unsupported misleading advocacy designed to prevent stigmatization, get people to take the drugs, and apologise for family and society without any citatations. It's probably "trueish". Talpedia 14:44, 18 July 2023 (UTC)

Hmm … I’m not sure which sentence on that page that you’re referring to. Maybe I should have quoted it:

What causes schizophrenia? - A difficult childhood A few people with schizophrenia do become violent – they usually hurt themselves but sometimes hurt other people. This can be caused by feelings of persecution or voices telling them to do it – often a combination of the two. It is much more likely if the person has used drugs or alcohol.

Myths about schizophrenia - Doesn't schizophrenia make people dangerous? Usually not.  Any violence is usually sparked off by street drugs or alcohol - not unlike people who don’t suffer from schizophrenia. There is a higher risk of violent behaviour if you have schizophrenia, but it is very small compared to the effects of drugs and alcohol. People with schizophrenia are far more likely to be harmed by other people than other people are to be harmed by them.

I think that page has a balanced POV as it didn’t deny that people with SZ can become violent, while stating that it’s not always the case, and that it can be caused by feelings of persecution or voices telling them to do it.

And yes IMHO it’s important to prevent stigmatisation, because when we say, for example, “people with SZ are 4 times more likely to engage in violent behaviour than members of the general public”, it sounds like they’re really dangerous, “4 times more dangerous”. However, if we say, for example, for people without SZ one in a thousand will engage in violent behaviour, then it just means that four in a thousand will engage in violent behaviour for people with SZ. Then what about the 996 people left? They are just the “potential sufferers” of violence like everyone else. And of course it’s unfair to label them as “dangerous”.--Dustfreeworld (talk) 19:11, 18 July 2023 (UTC)

I suppose I just don't really trust that source because it's intended for the public rather than practictioners and the scientific community. I feel like the way you stop stigmatising is by being WP:DUE and citing the best sources. Any attempt to "spin" can come across as being lied to. Talpedia 22:52, 18 July 2023 (UTC)

Well, I don’t think there’s any attempt to “spin” here, neither from our editors nor the RCPSYCH.

A google search on “schizophrenia are not aggressive, and are more likely to be victims of violence rather than perpetrators” gives this, in which it wrote “Persons with schizophrenia are undoubtedly at increased risk of becoming victims of violence in the community setting, with risks up to 14 times the rate of being victimized compared with being arrested as a perpetrator.” with a reference to this. Regards,--Dustfreeworld (talk) 08:16, 20 July 2023 (UTC)

I suppose I don't even know what the comparison means. Do I become less violent if I move to a less safe area because I become more at risk of violence. For some form of violence maybe, because perhaps the area forces me to be violent, but mostly no. Talpedia 09:06, 20 July 2023 (UTC)

That said, in media directed at the public this "more victims than perpetrators" talking point does come up a lot. So while I think it's probably meaningless (without a whole bunch of related discussion) it may also be WP:DUE because people repeat it so much! Talpedia 10:41, 20 July 2023‎ (UTC)

Lighter colored areas

Maybe (almost certainly) I'm just stupid, but it's not clear to me which areas in the picture in the "Cognitive symptoms" section are "lighter colored". 93.72.49.123 (talk) 20:56, 29 July 2023 (UTC)

Agreed that "lighter" doesn't make sense here. By comparison with similar illustrations (e.g. [20]), I'm guessing the scale is supposed to go from blue to red and have updated the article accordingly. Jhvx (talk) 17:51, 6 August 2023 (UTC)

Autism comorbidity

Link to National Autistic Society Remote123457 (talk) 03:04, 26 October 2023 (UTC)

Wiki Education assignment: LLIB 1115 - Intro to Information Research

This article was the subject of a Wiki Education Foundation-supported course assignment, between 21 August 2023 and 8 December 2023. Further details are available on the course page. Student editor(s): GunnarBear0875 (article contribs).

— Assignment last updated by GunnarBear0875 (talk) 16:37, 8 November 2023 (UTC)

Hormones and schizophrenia

More research and inquiry into connections between hormones (primarily estrogen) and schizophrenia. Increase in post-menopausal women is an interesting place to track or study relationship between estrogen decline and schizophrenic symptoms. Perhaps consider its presence in ER+ breast cancer patients, whose estrogen is suppressed. Mokshafarmsanctuary (talk) 21:27, 10 November 2023 (UTC)

Is there a secondary review or source complaint with Wikipedia's sourcing guidelines you want incorporated into the article? Otherwise, it's unclear what you're asking or why you're posting. SandyGeorgia (Talk) 22:02, 10 November 2023 (UTC)