Talk:Schizophrenia/Archive 3

Citation

Where's the citation for this? Which "studies show"? "...though studies suggest that genetics, neurobiology and social environment are important contributing factors"

152.42.142.1Daniel

Virtually all of them. - Vaughan 06:42, 16 October 2006 (UTC)

Violence section deletion

Mihai, please stop deleting the violence section. This has already been discussed here, and you have already taken the fact that you disagree with its presence to mediation before pulling out of the process. The research presented in this section is from peer-reviewed scientific journals, if you can provide updated or contradictory evidence from similarly respected sources, it's inclusion would be much appreciated. Simply deleting the section is not acceptable, however.

- Vaughan 13:23, 28 June 2006 (UTC)

Wikipedia articles on other health disorders don't have violence sections, and there is no rational reason for schizophrenia to be singled out like that. --Mihai cartoaje 04:59, 29 June 2006 (UTC)

The reason schizophrenia has a violence section is because there are common misconceptions about violence and schizophrenia, and there is a huge amount of research and discussion on the issue. - Vaughan 07:03, 29 June 2006 (UTC)

Mihai, I have now referred this to mediation. - Vaughan 12:36, 29 June 2006 (UTC)

If he's already pulled out of a mediation, I don't think another one is going to help. You could try to appeal to a broader community for consensus by asking at the Village pump, posting a Wikiquette alert, or filing a Request for Comment. Ideogram 15:28, 29 June 2006 (UTC)

The issue is currently listed as requiring a new mediator, and I would be willing to do so on this case. I have a bit non-professional experience with mental health issues. - MSTCrow 00:04, 30 June 2006 (UTC)

Please avoid edit-warring during the mediation. That goes for all sides; if someone else makes an edit do not respond in kind. Ideogram 13:19, 30 June 2006 (UTC)

Wikipedia's rules about removing obvious vandalism are clear. This is the disputed section:

Schizophrenia and violence

Violence perpetrated by people with schizophrenia

Although schizophrenia is sometimes associated with violence in the media, only a small minority of people with schizophrenia become violent^[3], and only a minority of people who commit criminal violence have been diagnosed with schizophrenia^{[4] [5]}.

Research has suggested that schizophrenia is associated with a slight increase in risk of violence, although this risk is largely due to a small sub-group of individuals for whom violence is associated with concurrent substance abuse and ceasing psychiatric drugs^[6]. For the most serious acts of violence, long-term independent studies of convicted murderers in both New Zealand^[7] and Sweden^[8] found that 3.7%–8.9% had been given a previous diagnosis of schizophrenia.

There is some evidence to suggest that in some people, the drugs used to treat schizophrenia may produce an increased risk for violence, largely due to agitation induced by akathisia, a side effect sometimes associated with antipsychotic medication.^[9] Similarly, abuse experienced in childhood may contribute both to a slight increase in risk for violence in adulthood, as well as the development of schizophrenia.^[10]

Violence against people with schizophrenia

Research has shown that a person diagnosed with schizophrenia is more likely to be a victim of violence (4.3% in a one month period) than the perpetrator^[11].

Mihai

Your first edit to the Schizophrenia page was on 09:49, 24 January 2006 when the text in question was already in existence, so replacing it after you've deleted it is hardly vandalism.

- Vaughan 06:47, 1 July 2006 (UTC)

This is very clearly not vandalism, just a content dispute. Ideogram 12:17, 1 July 2006 (UTC)

Vaughan and Mihai, do you agree to mediation by myself? - MSTCrow 03:12, 2 July 2006 (UTC)

Sounds good to me - Vaughan 07:54, 2 July 2006 (UTC)

Yes. --Mihai cartoaje 13:16, 2 July 2006 (UTC)

Ok, I'll start with Mihai. Mihai, do you disagree with Vaughan's assertion that many people perceive a high level of assocation between schizophrenics and violence, and that this assocation is a fallacy? - MSTCrow 15:39, 3 July 2006 (UTC)

I was not aware of any association between schizophrenia and violence before reading wikipedia's article. Websites on the internet that try to make readers think that people with schizophrenia are violent have something to gain by doing it. schizophrenia.com is a forced-drugging advocacy group which, according to our article, is pharmaceutical-sponsored. For example, if we click on their advocacy section, we get directed to tac. schizophrenia.com says that delusions cause violence; however, Vaughan presented a study in the archives in which the authors tried and failed to find a correlation between delusions and violence.

May I interject for a moment? I have had no involvement with this article in the past, but generally when violence and a mental disorder are mentioned together, I take heed. I have found from my personal experience that a lot of people assume that things like being tagged with diagnoses like schizophrenia and bipolar disorder automatically mean violent tendencies in a person. You're right, this is a misleading probability - but I saw nothing in the disputed section to make one think that schizophrenics are violent - to the contrary, the section did well to dispell that myth. In my humble opinion, I think that if just one person reads this article and become aware that schizophrenics aren't generally violent (as at least the US media would make you think), I think the article serves the interest of those folks who have the disorder. I'll crawl back into my hole now. CQJ 03:31, 5 July 2006 (UTC)

Mihai, If you can quote studies to back up your assertions it would aide the discussion. You are right about drug-induced mental health issues being responsible for many of the cases of violence in people with schizophrenia, as was noted in the original text. Delusions do have a small association with violence, however, as also noted in a recent review article on the topic.

As shown by surveys from mental health charities (e.g. this one from Mind), there is significant public misconception about the link between violence and mental illness. The original text in the article aims to dispell those myths by presenting the evidence from peer-reviewed scientific studies.

Therefore, schizophrenia.com's opinions on this matter are neither here not there as they are not quoted or used as a source.

- Vaughan 09:02, 5 July 2006 (UTC)

Mihai, what do you mean by a forced-drugging group? Do you disagree that it would be reasonable for a pharma company to be most likely to be knowledgeable about the mental illness in question, as they seek to produce treatments for the illness? - MSTCrow 13:52, 6 July 2006 (UTC)

If I may say so, MSTCrow, this is a distraction from the issue at hand. The issue is Mihai's reasons for wanting the violence section deleted (he has given none so far except alluding to the idea that people may think people with schizophrenia are violent if they read the actual research in this area - which in my opinion, dispells this myth), not whether he thinks drug companies are most knowledgeable about mental illness.

- Vaughan 16:08, 9 July 2006 (UTC)

pharmaceutical companies don't always know everything, as shown by this experiment [12]. --Mihai cartoaje 09:39, 10 July 2006 (UTC)

Mihai, I'm having difficulty understanding why you believe the violence section should be deleted. Is it something related to the perceived connection between schizophrenia and violence, or because a link that states there is a misperception between violence and schizophrenia originated from a pharmaceutical company? - MSTCrow 03:26, 11 July 2006 (UTC)

Mihai, are you intending to continue with mediation? - Vaughan 06:02, 14 July 2006 (UTC)

Wikipedia articles on other health disorders don't have violence sections, and there is no rational reason for schizophrenia to be singled out like that. --Mihai cartoaje 05:13, 15 July 2006 (UTC)

That is not a reason to delete the violence section on schizophrenia. Schizophrenia has a violence section because a) there is a lot of public misconception about the link (i.e. the media singles out schizophrenia - which the section aims to address with the actual statistics) b) there is a huge amount of research into violence and schizophrenia, which doesn't exist to the same degree (although there is some) for other disorders.

This is just going round in circles. Mihai has produced exactly the same reasons for deleting the section again and again, despite the fact that it is proportional to the scientific concern over the subject, is proportional to the public concern over the issue, and it represents the research accurately. I really don't think it is acceptable that one person can remove large parts of an article on a whim and then have other people have to defend its reinclusion. MSTCrow, your input would be appreciated. - Vaughan 09:03, 15 July 2006 (UTC)

Deleting a section repeatedly is a form of blanking, which is considered a form of vandalism on Wikipedia. Mihai, the reason that other mental health disorders do not have a violence section is because none of them that I am aware of have a wide public misperception that those with the mental illness are significantly more prone to acts of violence than the general population. - MSTCrow 08:11, 18 July 2006 (UTC)

So, the violence section has now been removed for over a month. I would very much like to replace it, as in my view it is accurate and appropriate, and was only removed on the behest of one person. What is the best way of going about this? Do I call for a vote on the Village Pump page or ask for consensus here? - Vaughan 19:53, 23 July 2006 (UTC)

I've contacted Mihai on the talk page, asking if they have withdrawn from the mediation, and/or have decided the section is appropriate for inclusion. If they don't get back to me by the end of the week, I suppose they must have abandoned any concern with it. If they still believe that the section should not be included, I don't think mediation will work. In which case, I suggest referring to Resolving Disputes. - MSTCrow 16:30, 29 July 2006 (UTC) (forgot to add the tag)

I have not been asked any more questions. --Mihai cartoaje 09:31, 27 July 2006 (UTC)

Mihai, it's a discussion not an interview. There are points above which you have not answered. This all sounds like delaying tactics to me. - Vaughan 08:19, 28 July 2006 (UTC)

Place the data into the article. If Mihai removes it, then you must seek more formal means of resolution. It is my belief that the data should be in the article, and I don't understand at this point why Mihai is against the data being included. There is a fundemental difference of perspectives here that I do not believe can be mediated. As such, I am removing the case from mediation, and hope that it can be worked out via other avenues. - MSTCrow 23:38, 1 August 2006 (UTC)

I looked at the disputed section and decided to throw in my two cents as a neutral third party - I don't see anything inherently wrong with the section, and if violence is sometimes associated with Schizophrenia, the section seems to have a place here. It is properly sourced and is verifiable, and there doesn't appear to be much reason to removing the section. I don't believe the reasoning that other articles don't have similar sections is one that has much backing, as people could always add one should there be misconceptions about them. I don't think the section violates anything on WP:NOT, so it could indeed have a place on this article. Cowman109^Talk 00:04, 2 August 2006 (UTC)

Thank you both for your comments. I've restored the section on violence. - Vaughan 06:54, 2 August 2006 (UTC)

Mihai has just deleted the violence section again after a number of people have expressed their views that it is accurate, balanced and should stay. I'll look for other avenue's for getting this addressed as mention above. - Vaughan 15:28, 2 August 2006 (UTC)

I have re-added the section, as there does not appear to be any policy-related reasoning for removing it. It is verifiable and does clear up a common misconception. There appears to be a growing consensus to keep the section, but just to make sure, I will leave a note on the village pump to see if I can get another opinion or two. Cowman109^Talk 16:18, 2 August 2006 (UTC)

From an outside perspective (having never edited the article before), I would keep the section. I don't see amy arguments here which would motivate me to think the presence of the section is intrinsically pov or such. It seems well referenced, and the references go a long way to establishing notability. Lack of similar sections in other articles is not a good motivation to remove it in my mind. In short, I think the section should be kept. --The preceding unsigned comment was added by TeaDrinker (talk * contribs) .

• I would agree, as this is an issue much discussed in the popular press as well as in the professional literature. NothingMuch 10:52, 31 August 2006 (UTC)

We all know(?) that schizophrenics are more likely to be poor, and that poor people are more likely to be both schizophrenic and violent. But do we know whether schizophrenics are any more or less violent than other poor people? --londheart 15:17, 31 August 2006 (UTC)

Schizophrenia does not make people violent. You can read about it here: [13]. --Mihai cartoaje 15:42, 26 September 2006 (UTC)

Zelda Fitzgerald

Isn't it misleading to call her a "painter"? If some activity other than being Scott Fitzgerald's wife is called for "writer" would be more accurate--she published a novel and helped Scott with his writing. ⅔

Cannabis association

"Nevertheless, some previous research in this area has been criticised as it has often not been clear whether cannabis use is a cause or effect of schizophrenia."

Could someone please explain to me how cannabis use is an effect of schizophrenia? Is this saying people with schizophrenia are more prone to use cannabis? If so, I think there should be a linked study. At the very least this sentence should be rephrased.

Hi there,

People with mental illness are many times more likely to use drugs and alcohol, partly in an attempt to relieve the distressing symptoms and experiences.

If you read the reference 48 paper, it deals with exactly these issues.

- Vaughan 15:21, 9 July 2006 (UTC)

Also, patients are more likely to be long-term unemployed, and therefore less likely to behave in ways unconducive to job retention, which would include admitting to technically illicit recreations. --londheart 08:02, 24 August 2006 (UTC)

'Viral cause' section

Someone has added to the article viral claims which come from a dubious source and have not been independently replicated. If you look through my edit history, you would see that everything I have added to Wikipedia has been independently replicated. --Mihai cartoaje 03:21, 6 July 2006 (UTC)

The claims do not come from a dubious source. They are published in a peer-review scientific journal. However, I agree with your general point. The section is derived from a single study which actually shows no clear causal link, so I've removed the section and have included it below.

personal attack removed

- Vaughan 08:15, 6 July 2006 (UTC)

A 2001 study by Johns Hopkins University Children's Center found the moloecular "footprint" of a retrovirus in the cerebrospinal fluid of 30 percent of people with accute schizophrenia and about 7 percent of those with chronic schizophrenia. The "footprint" was created by retroviral RNA by active expression of an endogenous retrovirus known as HERV-W.^[14] Researchers at Johns Hopkins have also found associations between a high level of maternal Herpes Simplex Type 2 antibodies and onset of adult psychosis in offspring. Researchers have also found a 508 percent increase in the risk of developing schizophrenia if born in the winter or early spring when indections deseases are more rampant.^[15]

^ Karlsson,H.; Bachmann, S.; Schröder, J.; McArthur, J; Torry, E.F.; Yolken, R.H. (2001)Retroviral RNA identified in the cerebrospinal fluids and brains of individuals with schizophrenia. PNAS, 98(8), 4634-4639.

^ Yolken, R.H. (2004)Viruses and Schizophrenia: A Focus on the Herpes Simplex Virus

Why not just add some kind of note explaining that the study has not been verified by other sources since then and that the result is preliminary because it is only based on a single study? It might still be useful information. Since the source is apparently legitimate, why not include the information? Ram-Man 11:34, 6 July 2006 (UTC)

Because hundreds of studies are published on schizophrenia every month. Including every single finding would make a mess of the article. Hence, the article should really represent the most significant knowledge about the condition, and not just list individual research findings.

- Vaughan 11:52, 6 July 2006 (UTC)

I've given this some more thought and I wanted to point out that the section under "Prognosis" that talks about the "World Health Organization" taking couple of "long-term" studies. In that case, the information suggested that there is some link to developed nations and schizophrenia. Yet, nothing more is said about the link or whether it was proven or disproven. Yet we consider the source to be reliable. Most likely that same standard would eliminate large chunks of this article. There is no precedent for not including data simply because we don't personally think it is legitimate. Information that is early or speculative but authoritative should be included, but with a proper explanation. If it turns out the viral link was wrong, well then it is an interesting historical fact. If it turns out that the link is something, well we don't want to miss out on that either. The same could be said about the studies I mentioned at the start of this post. For all we know it is just errors in methodology, but maybe not. Ram-Man 11:57, 6 July 2006 (UTC)

Schizophrenia patients having better long-term recovery without neuroleptics has been independently replicated. The NIMH pitted chlorpromazine (Thorazine), fluphenazine (Prolixin), thioridazine (Mellaril) and a wonder drug named Placebo(TM) and the winner was Placebo(TM) [16].--Mihai cartoaje 17:09, 6 July 2006 (UTC)

Mihai,

You are citing a single 1967 paper to back up your point. You need to consider the research as a whole to fully back up an argument. There are many more research studies which do not support this result. I encourage you to look them up on PubMed.

- Vaughan 15:24, 9 July 2006 (UTC)

Given I just read your post as I was typing the above, I will say this: Why is the World Health Organization study still included then? Ram-Man 11:57, 6 July 2006 (UTC)

Your point is well taken that single studies (or multiple studies by a single group) are suspect and highly speculative in nature, because they have not been repeated by others in the field. But perhaps in this case that can be overridden. We are not asked to make a choice between good information and speculative information. We are making a choice between no information (not letting the article contain information on a potential viral cause) and some early information. Of course if at any time there is clearer information available, then we should use that instead. Ram-Man 12:00, 6 July 2006 (UTC)

Actually, if you read the study, you'll find that it is not a study by a single organization, but a study co-published by many different organizations around the world. (Including Johns Hopkins, the University of Heidelberg, and a NAMI institute). The article saw print 5 years ago, and, according to PubMED, there is extensive research being done on the the retrovirus itself and its effects on human DNA. In the four years that I have been studying schizophrenia, I have not found any research that claims this study to be false, and it's only a five-year-old study, which could explain why it has yet to be replicated (that I know of, at least.) Dlmccaslin 22:39, 6 July 2006 (UTC)

Upon thinking, I tried some more searching, and found a study conducted in Germany published by the Journal of Virology (American Society of Microbiology) that found HERVs overrepresented in the spinal fluids of pateirts with schizophrenia and bipolar disorder [17]. Dlmccaslin 23:10, 6 July 2006 (UTC)

It's the University of Heildelberg again. --Mihai cartoaje 20:38, 10 July 2006 (UTC)

Might I suggest using this source: Seasonality of births in schizophrenia and bipolar disorder: a review of the literature, Schizophr Res. 1997 Nov 7;28(1):1-38 rather than this source: A systematic review and meta-analysis of Northern Hemisphere season of birth studies in schizophrenia, Schizophr Bull. 2003;29(3):587-93 for the seasonality citation? It's from several years earlier, but it reviews over 250 studies rather than 8, and also covers both hemispheres -- Josh 05:08, 16 July 2006 (UTC)

I don't see why cutting edge research should be included here. There have been many false starts over the years: transmethylated tryptamines, adrenochrome, megavitamin therapy. Such detail would be warranted in a seperate srticle (causation).172.162.67.144 15:20, 17 December 2006 (UTC)

"third trimester (4-6 months)"

This should either read "second trimester (4-6 months)" or "third trimester (7-9 months)" - I am presuming the latter? 81.100.56.174 22:29, 4 February 2007 (UTC)

508 percent increase

Researchers have also found a 508 percent increase in the risk of developing schizophrenia if born in the winter or early spring when indections deseases are more rampant.^[18]

Is this legitimate? We have another reference in the article to this where it states a "small" increase. If we have another source that is claiming a major influence, we should be taking that into consideration. Ram-Man 12:03, 6 July 2006 (UTC)

Hi Ram-Man,

The point of not including the viral stuff into the article is an essentially editorial decision. Studies shouldn't simply be included because they've been published, but because of the quality of the study, and the significant of the study.

The quality of the study can be judged by understanding its methodology. For example, a single study well-conducted study that has a methodology that allows a causal inference and has significant power to draw strong enough conclusions is worth many more correlational studies.

The significance of a study is based on a wider theoretical understanding of the field. A study (particularly of the high quality type mentioned above) might be particularly influential, and hence worth of note in an encyclopaedia article.

Simply listing study results does not make for a good article. As far as I know, there have been no studies on schizophrenia that have demonstrated a causal role for viruses in schizophrenia. As a consequence, it is rarely discussed in textbooks, lectures or research papers.

Hence, I would argue that devoting a whole paragraph to it as a 'cause' is both misleading (there is only circumstantial evidence for any causal role) and overstating its importance in the field.

Perhaps, it could be added to the 'alternative approaches to schizophrenia' section, though? As this section has the more speculative stuff in it.

As for the 508% result, it sounds highly suspect to me, and I have never heard it stated elsewhere, although I've not read the paper which was linked to.

- Vaughan 15:18, 9 July 2006 (UTC)

Hello, I believe the 508% is a error on the website. If you check the pdf document at http://www.ihmf.org/journal/download/11Yolken(83A)sup283A.pdf is is clear that they indicate between 5 and 8% increase (5-8%). This may have been incorectly read/rendered for the website, resulting in the 508. It appears that the 5-8% is valid and verifiable.

Pubmed also shows 5-8% http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15319094&dopt=Citation—Preceding unsigned comment added by 129.215.37.129 (talk • contribs)

Proposed pre-pulse inhibition merge

I don't see any reason to merge this article with schizophrenia as it is an experimental method that is not specific to schizophrenia. Although it has been used widely in schizophrenia research, it has also been used to investigate anxiety, depression and panic disorder to name but a few.

Unfortunately, the prepulse inhibition article is so badly written as to suggest that it is purely a model of schizophrenia.

So, if there are no objections, I'll remove the merge tag at the top of the article.

- Vaughan 15:48, 11 July 2006 (UTC)

Etymology

Regarding "the term 'schizophrenia' translates roughly as 'shattered mind,'" -- when I took a seminar in college where we discussed schizophrenia, the professor translated the term literally, as "split mind." There are also 111 results on Google Scholar for "schizophrenia 'split mind'" as compared to 14 for "schizophrenia 'shattered mind'".

...following up on one of those Google Scholar hits, I've found this: "Eugene Bleuler (1857-1939) ... introduced the term schizophrenia (Gr: 'split mind')... . Bleuler intended the term to describe a division between thought, emotion and behaviour in affected patients." in Schizophrenia: Genesis, Receptorology and Current Therapeutics, Capuano et al., Current Medicinal Chemistry 2002, 9, 521-548. Bleuler and his contribution to schizophrenia have been addressed elsewhere in the article, but I think we should a) change the rough translation to "split mind" as it's more commongly used, b) add in the citation, and c) maybe add a little bit about why Bleuler chose the term that he did. Thoughts?

- Josh 05:23, 12 July 2006 (UTC)

My thoughts are, a) Seems like a pointless debate over two words that are essentially the same, b) Why? The article cited attempts to assign motives for Bleuler, which the authors cannot possibly know, c) See b. As in, no one could possibly know that, so why waste time and space with pointless speculation. Change the translation, the rest is useless and unnecessary.

I agree that the translation we use should match the most common usage unless there is compelling evidence in print form that the other translation is used. Ram-Man 11:45, 17 July 2006 (UTC)

The English rendering 'split' of the Greek 'schizo-' converts it into an adjectival verbal past participle, which, arguably, makes the diagnosis seem more drastic, final, irreversible and stigmatising. 'Splitting' accurately depicts the social circumstances likely to precede and result from diagnosis. --Etaonsh 18:48, 7 August 2006 (UTC)

I very much doubt that there is any such thing as 'schizophrenia'. It is essentially a psuedo scientific term for a psuedo science. As a piece of software the brain is miraculous. Anyone who claims to understand a 'normally' funtioning brain is lying. Thus anyone claiming to understand - still less rectify - an abnormally functioning brain - is a double-liar. Thus we have the non-science of psychiatry. In parts of Africa and other places where this Western terminology has not penetrated they called people presenting similar symptoms possessed by evil spirits. This makes as much - or as little - sense. And their treatments, such as chewing a specific piece of tree bark, are just as successful. They just don't make so much money for multinational drug companies. SmokeyTheFatCat 18:01, 25 July 2006 (UTC)

You all are ignoring the second part of the word, (-phrenia, from phrenos). From http://www.etymonline.com/index.php?search=heart (see "Schiozphrenia") you'll see that Phrenos "could" mean "mind" but a better translation might be "heart" (elsewhere on the net, it might also be referred to as "Soul" as another translation). When you say (split or)"Broken heart" versus "Shaterred Heart" I'm sure, or I hope the difference between "Broken" and "Shaterred" makes more sense. In my opinion, a broken heart is probably a less serious form of schizophrenia then a "shaterred heart" (which would seem non-curable -- I'm careful not to say incurable which could also mean curable from within). Some things were apparently lost in translation. And yes, Smokey, there is a such thing as a Broken Heart Disease a.k.a. Schizophrenia, and it is disabling in more ways than you can imagine, and it's not just a simple 'get over it' thing because in my case I've been trying to get over it for 20 years or more and for some reason I can't figure out how (This is not the place to discuss this though, you're certainly not a therapist). Interestingly, with that # of years I've been suffering with this illness, i'm "only" 32 as I write this. Robwilkens 16:24, 11 March 2007 (UTC)

Evidence of effectiveness in community

BMJ this week a nice study on the effects of clozapine & olanzapine on needs for readmission etc. JFW | T@lk 09:55, 28 July 2006 (UTC)

Cleanup-Spam

I have added a clean-up spam tag because there are external links to E. Fuller Torrey and schizophrenia.com which promote the forced use of drugs. --Mihai cartoaje 15:26, 2 August 2006 (UTC)

Mihai, I've removed the tag as these are not spam. They are not trying to sell any particular product, they just promote a view that you don't agree with. Alternative viewpoints to your own are not spam, and the article should link to a diverse range of opionions. - Vaughan 15:31, 2 August 2006 (UTC)

I am removing schizophrenia.com because it breaks multiple wikipedia rules:

• Wikipedia's rule about external links which don't have content which cannot be included in the article.
• Wikipedia's rule about external links with false statements.
• It was added to the article to increase its ranking in google, so it meets the requirements of spam (promoting a website). --Mihai cartoaje 06:49, 3 August 2006 (UTC)

There appears to be an inappropriate double negative there, perhaps written in the heat of POV bluster(?). Continueddonations 07:42, 13 September 2006 (UTC)

can i barge in?

Mihai! Schizophrenia.com is a good, respected site. "Promoting the forced use of drugs" is not against the law, besides, people having psychosis should be medicated for the sake of their own health.

You clearly trying to impose your own rules on this article.

You say: "Wikipedia's rule about external links with false statements."

Well, there is not a single website on the web without some false statements of some sort. Besides, according to this "rule", you clearly should delete all the links to the "anti-psychiatric" websites critical of genetic factors etc., because they are sure brimful with false statements.

You say: " Wikipedia's rule about external links which don't have content which cannot be included in the article."

Too many "donts" and "cannots" to me. I'm not that good in understanding English. What do you mean by this rule and where can I read it in the original (link, please)? --CopperKettle 03:14, 7 August 2006 (UTC)

'Should' implies opinion (POV), not information. I think your English is better than you suggest, on the other hand - too many double negatives giving the opposite meaning to that intended. --Etaonsh 20:32, 7 August 2006 (UTC)

Here: http://en.wikipedia.org/wiki/Wikipedia:External_links. --Mihai cartoaje 19:09, 7 August 2006 (UTC)

Treatment addition

I just reverted an addition to the article about Schizophrenia being cured by a certain doctor for some time, referring the reader to some references. There is already a treatment section in the article, so I think the added content there is unnecessary (not to mention doesn't seem to be in a proper tone as it refers to the reader as 'you', and seems to read as more of an advertisement for the doctor). Hopefully the IP will come here and discuss his or her reasoning for including such information. Thanks. Oh, and there was a typo in the edit summary that was meant to say 'unencyclopedic', not 'unencyclopedia' :)Cowman109^Talk 18:22, 6 August 2006 (UTC)

Vandalism: Mention of genetic background is deleted

Whenever I have an opportunity, I will revert any vandalism considering the genetic factors in schizophrenia. Also, I'm planning to add a couple of lines on Reelin's role in schizophrenia (and RELN gene). These, along with the mentioned in the article genetic findings, are independently confirmed, even several times confirmed, by different groups of scientists. I'm quite irked by consistent vandalism on a part of Mihai (violence section deletion, for example). The Schizophrenia page is on my watchlist now. --CopperKettle 03:01, 7 August 2006 (UTC)

I find your own attitude aggressive and vandalous - towards patients and offspring - your lack of objectivity is such that the reader can conclude with certainty that you yourself are not stigmatised in a group of this kind. 'Schizophrenia' is well-known in the mental health community to be a vague, 'catch-all' diagnosis, more likely to be applied to those who, often thru poverty, unemployment, social exclusion, and social group peccadilloes, happen to come to the attention of diagnosticians, and we should consider all relevant scientific research in that light. Excessive claims are made in the article on the basis of the existing scientific research. The latter might show similarities between separated twins but this is in fact no certain guarantee of a genetic explanation. Furthermore, research on actual genes themselves does not support a socially contrived diagnosis of 'illness,' it merely supports the existence of inherited difference, which is a wholly different thing and not necessarily pathological - in fact, it often has survival value. Please approach this delicate subject with more care, humility, sensitivity and objectivity - tread softly, for you tread on our life chances. Also, such overt offensiveness re genes would not be tolerated in the case of physical disability and/or ethnicity, and it shouldn't be tolerated here. If you keep shooting your mouth off about large sub-groups of the population, you could well find your own health and survival chances affected. --Etaonsh 11:21, 7 August 2006 (UTC)

I don't think threats of violence are either wanted or necessary. However, it's important to note that your point is discussed in the article under the 'Diagnostic issues and controversies' section, which notes that the diagnostic approach is subject to a number of significant flaws. The article aims to present all main approaches to schizophrenia, however, so also discusses the results from genetic studies which typically focus on people who have been diagnosed, regardless of the possible flaws with this approach. Hence, deleting this section of the article because it doesn't fit your opinion is hardly in the spirit of NPOV to which Wikipedia adheres. - Vaughan 12:55, 7 August 2006 (UTC)

I don't think threats of violence are warranted or necessary either, but sadly that is what a diagnosis of schizophrenia in the modern world equates to. I agree that the 'Diagnostic issues and controversies' section is well crafted, but its important conclusions seem to be ignored in e.g., the section under discussion. It needs to be stated clearly in the article that what genetic research shows is genetic difference, not 'illness,' which is a non-value-free social construct. You are quite incorrect to associate me with the deletion of any of this article - do your homework. --Etaonsh 13:45, 7 August 2006 (UTC)

I concur with Vaughan. Etaonsh: I never "shoot my mouth off" anything. Watch your language, you're much too eloquent. You say: "your lack of objectivity is such that the reader can conclude with certainty that you yourself are not stigmatised in a group of this kind" - Well, my uncle did have schizophrenia, and I have some problems too, and this sparked my interest in psychiatry, but I did not come to Wikipedia to discuss this. I agree that schizophrenia is today a 'catch-all' diagnosis, but I beleive that the genetic linkage studies and subsequent unravelling of underlying pathways is the main way to make the diagnosis in the future more specific, maybe - sometime - split schizophrenia into several diagnostic forms, thus prompting the doctors to approach the sufferers with, as you aptly put it, more "care, humility, sensitivity and objectivity". Deleting the confirmed medical findings only hampers the understanding and research, not to mention the NPOV rule violation. --CopperKettle 13:56, 7 August 2006 (UTC)

My guess is that your admonition, 'Watch your language, you're much too eloquent' was intended in good humour, but it serves to show how positive attributes can become stigmatised in a social setting. Your reluctant personal 'admissions' still fail to counter my original deduction, and your reference to 'diagnosis' still fails to acknowledge the points made already about what genetic research does and doesn't show. Without wishing to offend, I expect a lot of Russian uncles were 'diagnosed' with schizophrenia - and worse. It is not in my interests, in the circumstances, to delete material which exposes the writers' misuse of psychiatric labelling - I have an interest in exposing, not deleting. --Etaonsh 14:00, 7 August 2006 (UTC)

P.S. to the "If you keep shooting your mouth off about large sub-groups of the population, you could well find your own health and survival chances affected." - Well, I value my health, but I am not so degraded and selfish yet as to put my "own health and survival chances" above the scientific facts (like genetic studies' results) that may bring hope to the millions of people , so your threat doesnt much work here, besides showing your own aggressivenes. --CopperKettle 13:56, 7 August 2006 (UTC)

Pseudo-scientific 'diagnosis' by a global monetarist conglomerate is not, I assure you, a hopeful experience for patients. A statement of likely consequences of actions does not constitute threat, and unsubstantiated assumption of threat is, again, not in the spirit of rational inquiry, and symptomatic of paranoia, albeit shared. --Etaonsh 14:05, 7 August 2006 (UTC)

P.P.S. As long as Schizophrenia is considered an "illness" by the world scientific community, it is an illness. And the Wikipedia article must state this, mentioning the non-mainstream views but not being governed by them. As soon as Schizophrenia-as-illness concept is abolished, you can put it as "non-value-free social construct" and erase all the linkage studies' data. But for now, such deletion is vandalism. --CopperKettle 13:56, 7 August 2006 (UTC)

Your first two sentences are authoritarian and compliant rather than informative, the third is fanciful, and the fourth exemplifies the type of non-evidential, blithely wrongful accusation which is characteristic of psychiatric misdiagnosis and all those who play a part therein. --Etaonsh 14:13, 7 August 2006 (UTC)

The paragraph says:

Evidence comes from research suggesting multiple chromosomal regions are transmitted to people who are later diagnosed as having schizophrenia.

That's not what the abstract says. The abstract says "Replication has been inconsistent for reports of significant genetic linkage." I tried to correct it but Skinnyweed reverted me without any explanation. --Mihai cartoaje 18:22, 7 August 2006 (UTC)

Hi Mihai, I can't find this statement in any of the three abstracts (refs 12, 13 or 75) that are used in this paragraph. Which abstract are you thinking of? - Vaughan 18:48, 7 August 2006 (UTC)

The one Coroebus added in the archives. --Mihai cartoaje 19:05, 7 August 2006 (UTC)

Neglected diagnostic issue/controversy: sociology of diagnosis

The section 'Diagnostic issues & controversies' fails to make mention of the fact, widely reported, that diagnosis is significantly more likely to affect some social and ethnic groups more than others, arguably reflecting inequalities compounded by correspondingly restricted diagnostic perceptions. Could someone assist me with the relevant stats, studies, and references, please? --Etaonsh 18:37, 7 August 2006 (UTC)

Misdiagnosis section

The recently added misdiagnosis section is a valuable addition, but I think the source should be from the peer-reviewed scientific literature rather than a book on nutrition

I shall look on PubMed, for relevant articles, but for those also wanting to search out there own articles 'differential diagnosis' and 'misdiagnosis' are good keywords.

Original text it below. - Vaughan 08:10, 9 August 2006 (UTC)

The section you refer to appears only here on the Talk page.

Accepting the view that the 'schizophrenia' diagnosis is and has been used as a general 'catch-all,' is it possible to diagnose it incorrectly? And, conversely, given individual differences in causation, is it not possible that all such diagnoses have some explanatory sub-diagnosis, rendering any diagnosis of 'schizophrenia' as such arguably inadequate, incorrect? --Etaonsh 07:49, 12 August 2006 (UTC)

---

Mis-Diagnosis

There are many conditions which sometimes present symptoms similar to schizophrenia. In the book Nutrition and Mental Illness by the late Carl C. Pfeiffer, Ph.D., M.D (of the Princeton Brain Bio Center) there is a list of 29 different conditions which have been mis-diagnosed as Schizophrenia. These include:

Well-known

1. Dementia paralytica 2. Pellagra 3. Porphyria 4. Hypothyroidism 5. Drug intoxications 6. Homocysteinuria 7. Folic acid/B12 deficiency 8. Sleep deprivation 9. Heavy metal toxicity

Less Well-known

1. Hypoglycemia 2. Psychomotor epilepsy 3. Cerebral allergy 4. Wheat-gluten sensitivity 5. Histapenia � copper excess 6. Histadelia 7. Pyroluria 8. Wilson's disease 9. Chronic Candida infection 10. Huntington's chorea

Almost Unknown

1. Prostaglandins 2. Dopamine excess 3. Endorphins 4. Serine excess 5. Prolactin excess 6. Dialysis therapy 7. Serotonin imbalance 8. Leucine, histidine imbalance 9. Interferon, amantadine, anti-viral drugs 10. Platelets deficient in MAO (monoamine oxidase)

If we include fevers, environmental pains, and drug reactions, there must be dozens of additional ways to be diagnosed as schizophrenic due to some other existing condition. Competent diagnosis would require the ability to eliminate these as a possible diagnosis.

---

Rehabilitation and Recovery: a sub-section under 'Prognosis'?

This is generally a long-term condition with, as the article states, some negative prognosis. Would it improve the article, and the situation, to have a special sub-section, under 'Prognosis,' devoted to 'Recovery and Rehabilitation?' --Etaonsh 17:28, 16 August 2006 (UTC)

Hi Etaonsh, I think this is an excellent idea. Especially with all the recent research interest in criteria for remission and recovery outcomes. - Vaughan 08:00, 17 August 2006 (UTC)

What you really should have said, what you really meant, here, was: 'Yes - why didn't I think of that? Go ahead and write something and then I will delete most of it if it fails to conform to my authoritarian predilections.' Cestlogique 12:17, 16 September 2006 (UTC)

Hi there,

The paragraphs I deleted from the section you mention were as follows:

The developed world, in spite of a greater set of resources, tends to hamper rehabilitation with difficult welfare regulations, competitive recruitment and political correctness. This often leads to a failure to give due consideration to groups not always equally able to deal with the diagnostic stigma, such as male breadwinners and displaced ethnic minorities. Instead of assisting in recognising group problems, there may be an imposed sense of equality that does not accurately reflect the true situation.

Social stigma is also a factor in undermining the image of recovery from schizophrenia. Given the prevalence of the diagnosis and the role of chance in personal success, it is likely that that the number of famous, successful people who received the diagnosis is far greater than indicated on this page. Stigma is the likely factor for non-disclosure of many people.

Given the implications of work-incompetence of the schizophrenia diagnosis, patients inevitably become the scapegoat for all these cultural and local shortcomings.

This contains both unreferenced claims and contains a number of POV claims (e.g. the whole of the first paragraph, "patients inevitably become the scapegoat...", "it is likely that...", "the implications of work-incompetence of the schizophrenia diagnosis...") and hence is not suitable for an encyclopedia entry.

I have left the initial paragraph in the article, which, incidentially, still needs referencing.

- Vaughan 15:06, 18 September 2006 (UTC)

Intro

The introduction seems to put too much emphasis on positive symptoms, which are not present in the case of simple schizophrenia, a catch-all term for non-manic clinical depression. --Etaonsh 21:38, 21 August 2006 (UTC)

Also, 'primarily thought to affect cognition' - says who? --londheart 23:44, 22 August 2006 (UTC)

Hi Etaonsh,

Simple schizophrenia is only present in the ICD-10 diagnostic critera, and is not listed is the DSM (the same presentation would be classifed under either residual or undifferentiated). Simple schizophrenia is actually rare, however, and is quite distinct from clinical depression.

'Primarily thought to affect cognition' is from the large amount of scientific literature and is really redescribing the symptoms as disturbances to the cognitive structure of perception, thought etc etc.

- Vaughan 09:56, 23 August 2006 (UTC)

Positive symptoms: It puzzled me that it takes so long for the article to get make the point that the positive symptoms are those of a psychosis. On reflection I believe that this may be a good thing, as the reader is not early on given the mistaken idea that schizophrenia = psychosis, or vice versa - and equally wrong - that psychosis = schizophrenia (which is what the above post on "Mis-diagnosis" / differential diagnosis was about).

Simple schizophrenia: Etaonsh's description of simple schizophrenia as a "catchall for clinical depression" is not my experience (but may be his/her's). The two may co-exist. The simple schizophrenic has an almost un-understandable shallowness of affect, such that achieving a state of empathy with the sufferer becomes a potentially exhausting exercise. The major difference seems to me that the "ordinary" depressive person has a sadness and hurt-suffering which one can relate to, whereas communicating with the simple schizophrenic does not cause that sense of sadness-hurt-suffering in the person.

Cognition: As to cognition, one could not conceive of a person being described as schizophrenic without there being clear disturbances of the information processing functions - which is one definition of cognition. Conversely, a person who demonstrates normal cognitive function - however one defines that - cannot be conceived of as being schizophrenic. Or am I wrong? --Seejyb 14:36, 27 August 2006 (UTC)

If someone's 'affect' or emotional range appears shallow, it could be a defensive cover. Be that as it may, I could understand empathy with a patient with deep emotionality to be a 'potentially exhausting exercise,' but the idea that you become exhausted by attempting to fathom that which you simultaneously diagnose as 'shallow' seems an obvious contradiction in terms, suggesting over-concentration/over-involvement on your, the diagnostician's part, or at least, failure to adopt a more fruitful strategy. Continueddonations 23:28, 12 September 2006 (UTC)

Schizophrenia does not equal psychosis, clearly, but you cannot have a schizophrenic who has never had a clear psychotic episode. Psychosis does not imply raving lunatic, but simply someone who is clearly out of touch with his environment and acting in a way that outwardly appears random, disorganized, etc. Once someone has had a psychotic break, they are often medicated, and continue to show ever decreasing signs of their psychotic state. --Animalresearcher 18:08, 23 October 2006 (UTC)

Notable People

I have read that Phil Spector is bipolar, not schizophrenic. This area really should be checked as the two are significantly different although they share some symptoms. Great page, otherwise.

A man in his position would surely demand, as you suggest, an extra pole(?). --londheart 23:46, 22 August 2006 (UTC)

Stigma

Schizophrenia surely deserves a separate section on 'stigma,' somewhere between 'Diagnosis' and 'Violence'(?). --londheart 08:05, 24 August 2006 (UTC)

(Reply by vandal Vaughan deleted).

"Violence" section wording

I do not wish to fiddle with this excellent article as it is, but have the following comments / suggestions: A family member was recently diagnosed as schizophrenic, and in six months I have had two questions about whether I feel it is safe to leave my kids alone with her in the house. Both instances were related to perceptions of uncontrollable violence. So as far as I am concerned, yes, the lay public seems to relate schizophrenia to violence. If the idea is general, then I would expect an encyclopedia to inform me as to whether such opinions are scientifically based.
However, the sentence under "Violence against people with schizophrenia" was difficult to interpret until I read the reference. As formulated, I had interpreted it to mean that the persons who were attacked were more likely to be schizophrenic than the persons who had done the attacking [were likely to be schizophrenic], or that the schizophenic was more likely to be the victim of violence than he was to be the perpetrator of violence, but the reference seems to have nothing to do with these interpretations. It seems to be making the point that the schizophrenic is more likely to be a victim of violence than a "normal" person is. May I suggest, using the same reference (which I unfortunately have available only as an abstract - bless the scientific publishers, whose prices for reading science are way beyond my financial capability):

"An Australian study has concluded that patients with schizophrenia spectrum disorders are at increased risk of victimization. Of the 348 patients studied, 4.3% of them were victims of a violent crime, during the one month follow-up period. This compares to a figure of X.X% for the general population. or This is X.X times the figure for the general population over the same period. or The expected figure for the general population in the area studied was X.X%."

The last (italicized) sentence is for giving the figure for what the "normal" rate of violent crimes would be, to give some meaning to the figure for schizophrenia. Does the complete article text give the figure for non-schizophrenics? If not, then any conclusion of "increased risk for victimization" does not seem to make sense/science. --Seejyb 15:15, 27 August 2006 (UTC)

Notable people thought to be affected by schizophrenia

In the List of people believed to have been affected by bipolar disorder there is an insistence that verifiable source citations must be included. There seems to be no such request in Notable people thought to be affected by schizophrenia.

There are no references for this list in spite of references being requested for quite some time. If this list is not referenced it will have to be deleted. --WikiCats 11:57, 3 September 2006 (UTC)

There has been no references added to this section, so it will have to be deleted. --WikiCats 09:56, 6 September 2006 (UTC)

This is what has been removed. When references are found for these entries they can be reinstated.--WikiCats 15:25, 9 September 2006 (UTC)

In many of those people's articles, their schizophrenia is mentioned, such as Ron Karenga and Roky Erickson.

Notable people thought to have been affected by schizophrenia

File:ClaraBow23.jpg

Actress Clara Bow was diagnosed with schizophrenia in 1949.

• 6025 (former rhythm guitarist of the Dead Kennedys)
• Walter Inglis Anderson (artist,writer 1903-1965)
• Talal ibn Abdullah (King of Jordan from 1951 to 1952)
• Lionel Aldridge (American football player, Green Bay Packers)
• Antonin Artaud (artist, poet, actor, theater philosopher)
• John Balance (vocalist and percussionist of Coil)
• Syd Barrett (founder of Pink Floyd)
• Maria Bernoulli (wife of German novelist Hermann Hesse)
• Nick Blinko (founder, singer, songwriter, guitarist and artist for Rudimentary Peni)
• Buddy Bolden (jazz pioneer)
• Clara Bow (actress)
• Bryan Charnley (artist)
• Eduard Einstein (son of Albert Einstein)
• Don Elkins, (engineer, metaphysician, writer, ufologist)
• Roky Erickson (founder of 13th Floor Elevators)
• Zelda Fitzgerald (painter and wife of F. Scott Fitzgerald)
• Frederick Frese (psychologist in Ohio and current Vice President of the National Alliance on Mental Illness)
• The Genain quadruplets (a set of four girls who each developed schizophrenia)
• Kurt Gödel (mathematician)
• Andy Goram (former footballer)
• Jim Gordon (drummer for the rock group Derek and the Dominos)
• Peter Green (founder of rock group Fleetwood Mac)
• Josef Hassid (violinist)
• Houston (R&B artist)
• H.R. Hudson (affected lightly by schizophrenia, leader of hardcore punk band Bad Brains)
• Lucia Joyce (dancer, daughter of James Joyce)
• Theodore Kaczynski (the Unabomber)
• Ron Karenga (author, academic, activist)
• Veronica Lake (actress)
• James Tilly Matthews (subject of first book-length psychiatric case study)
• William Chester Minor (army surgeon and major contributor to the Oxford English Dictionary)
• John Forbes Nash Jr (mathematician)
• Vaslav Nijinsky (ballet dancer and choreographer)
• Per Yngve Ohlin A.K.A. Dead (vocalist of black metal band Mayhem)
• Gene Ray (self-proclaimed doctor of cubicism)
• Daniel Paul Schreber (German judge)
• Ingo Schwichtenberg (original drummer for rock group Helloween)
• Dr Vashishtha Narayan Singh (mathematician and scientist)
• Phil Spector (music producer credited with creating the "Wall of Sound"
• Skip Spence (band member of Moby Grape and Jefferson Airplane)
• Nancy Spungen (girlfriend of Sid Vicious of the punk rock band The Sex Pistols)
• Vincent van Gogh (artist)
• Mark Vonnegut (son of the writer Kurt Vonnegut)
• Louis Wain (artist)
• Wesley Willis (musician)
• Adolf Wolfli (artist)
• Brian Wilson (member of The Beach Boys)
• Ronnie Kray (infamous British gangster)

Treatment-resistant schizophrenia

I saw in the Clozapine article that there's a variant of schizophrenia called "treatment-resistant schizophrenia", which apparently resists the effects of almost all other drugs but clozapine. (Or I'm assuming; it says the FDA hasn't approved any other drug for it). A Google search turned up the term "treatment-refractory" schizophrenia, as well. If anyone has access to a good resource on this, I think it's important to include something about it in the article -- I feel like I know way too little to try myself. Phoenix-forgotten 16:51, 15 September 2006 (UTC)

Genetics section

I've replaced the following paragraph with the previous version:

A recent review of linkage studies listed seven genes as likely to be involved in the diagnosis of schizophrenia or the risk of developing diagnosis of the disease. Evidence from linkage studies has stongly implicated different genetic loci chromosomal causing different genetic subtypes of schizophrenia in different families. Genetic association studies have suggested some strong candidate genes which may contribute to risk of getting the diagnosis. The strongest evidence points towards genes called NRG1 DAOA PCM1 and Epsin 4. Others such as dysbindin and COMT are still to be replicated fully.

Partly because the information seems to be at odds with recent reviews of the genetics literature (for example, the COMT statement seems to be correct, but not the statement on dysbindin - e.g. see review, and partly because the person changed the text and yet left the original references intact - which contain contradictory information.

I'll work on updating the section to be more accurate based on the latest reviews.

As an aside, if you wish to add new information, please also add new references. Otherwise we can't verify if the information is correct and it makes the text article confusing to have the references saying different things from the writing.

Thanks - Vaughan 14:39, 18 September 2006 (UTC)

I've now update the Schizophrenia#Genetic section with the candidate genes from the latest reviews. - Vaughan 14:57, 18 September 2006 (UTC)

I have seen many claims that support a direct link between genes and the development of Schizophrenia, yet I feel that the correlation has not been established to the degree that it would be considered fact. This should be recognized in the article, as the current section on genetics is misleading, suggesting that schizoid disorders have a proven direct link with genetic influences. Dr. Peter Breggin states in his book "Toxic Psychiatry" (St. Martins Press) that while schizophrenia tends to run in families, the genetic factor is just not there; "Can we think of any good reasons, other than genetics, why madness might sometimes afflict both members of a pair of identical twins? Indeed, wouldn't we expect it to happen sometimes as a result of the similarity of their enviornments as children? ...any sexual or physical abuse would probably be aimed at both of them at the same time.

    ...in 'Biological Theories, Drug Treatments, and Schizophrenia: A Critical Assessment,' David and Henri Cohen similarly conclude that 'the only unquestionable result of twin genetic studies is that they demonstrate the extensive contribution of 'enviornmental' factors to the etiology of the disorder'". -Peter R. Breggin, M.D. 

I feel the section on twin studies and genetic causes for schizophrenia should directly cite its sources in the assertion of genetic causes for schizophrenia. Additionally, the section on twin studies completely lacks recognition of enviornmental factors in the development of schizophrenia and related disorders. If the twins studied show development of schizoid disorders, the leap cannot be made to a genetic cause without considering enviornmental factors, as many twin studies are done with twins who were raised in the same enviornment.

DrGonzoDXM 23:58, 13 February 2007 (UTC)

Schizophrenia in the arts

"John Nash...made a substantial recovery without the use of antipsychotic medication."

This is misleading. Nash made a substantial recovery _with_ the use of antipsychotic medication, and _then_ was able to stop using the medication, with the approval and supervision of his doctors. There were times before this recovery when he stopped it on his own and was unable to deal with his symptoms.

68.40.167.60 01:30, 21 September 2006 (UTC)

Request for Comment

This request for comment was opened by Mihai cartoaje.

My comments:

1. Mihai's removal of the section "Schizophrenia and violence" was done in good faith. As a content dispute, it is not vandalism. Please be careful about throwing this term about to established editors; it is better to assume good faith.
2. I am not sure why this issue has come up again after it appears to have gone through mediation a few months ago.
3. I think the section on schizophrenia and violence should remain. I do not see it advocating "genocide" in any way. Mihai's comments aside, there is a common and false perception that psychotic persons are often violent, at least in part as a result of high-profile trials in which an insanity defense is used. The disputed section debunks that myth, explaining the facts in a verifiable manner.

--Ginkgo100 ^{talk • e@} 19:39, 9 October 2006 (UTC)

I think running through this RfC can still be valuable. It will bring in third parties that might not have been brought in through mediation.

I would note that while discussing the changes to be made (if any), edit warring is counter-productive (in other words, please leave the disputed section intact until this discussion has been closed). --Ginkgo100 ^{talk • e@} 21:15, 9 October 2006 (UTC)

People can have schizophrenia without having "psychosis", and people can have "psychosis" without having schizophrenia. "Psychosis" is actually a term from Freudian psychoanalysis.

That's a good distinction; psychosis and schizophrenia are certainly not synonymous. I re-read the disputed section, and it does not mention psychosis; it seems clear it is talking about people suffering from schizophrenia, not psychosis. --Ginkgo100 ^{talk • e@} 14:07, 15 October 2006 (UTC)

The abstract linked to in the violence section does not say that schizophrenia increases the risk of violence. It says that there is a higher rate of violence in the schizophrenia population. Schizophrenia is more likely to happen to people who are poor and live in cities or drink alcohol. In the words of this Slashdot poster[19]:

Everyone, let's say this together. Come on, I want everyone to join in. Let's all yell it at the top of our lungs until the media hears us. Ready? Here we go:

CORRELATION DOES NOT EQUAL CAUSATION!

CORRELATION DOES NOT EQUAL CAUSATION!

CORRELATION DOES NOT EQUAL CAUSATION!

Now stop reporting on every correlation between disease X and social variable Y as though it were somehow equivalent to a randomized double-blind study on the effects of Y on X. Thank you.

Nowhere in the violence section does it say that schizophrenia causes violence. It simply reports on the association. - Vaughan 17:12, 18 October 2006 (UTC)

A scientific study has found that schizophrenia does not increase the risk of violence. It is here: [20]. --Mihai cartoaje 09:35, 17 October 2006 (UTC)

The study doesn't say that, as the patient groups were not divided according to schizophrenia vs non-schizophrenia diagnosis. Please read the research. - Vaughan 17:12, 18 October 2006 (UTC)

Agreed, the abstract states that the study was divided between those with and without substance-abuse problems. Not a word specific to schizophrenia. --Ginkgo100 ^{talk • e@} 20:12, 18 October 2006 (UTC)

I find the section, as it is currently written fine. It seems accurate, well referenced and not stating or suggesting that schizophrenia 'causes' violence. I feel ok with the section staying as written. DPeterson^talk 01:23, 22 October 2006 (UTC)

Today's sockpuppet theater.--Mihai cartoaje 22:10, 22 October 2006 (UTC)

• Response to RfC: The section as it currently stands is well-referenced, and quite neutral. It never states that schizophrenia causes violence, but merely reports an association and gives sourced hypotheses as to its significance. As long as it stays in current format, I believe it is legitimate. --Nehwyn 11:28, 25 October 2006 (UTC)

I agree with Nehwyn's assessment. DPeterson^talk 13:45, 25 October 2006 (UTC)

I agree with Nehwyn's view on this issue. --CopperKettle 15:43, 27 October 2006 (UTC)

Also the claim is verifiably false since a scientific study has found schizophrenia to be inversly related to violence.--Mihai cartoaje 23:33, 1 November 2006 (UTC)

Information about the relationship between crime, violence, and various mental health conditions is quite relevant. If there is an inverse relationship, and a verifiable source can be provided, than that should be cited. DPeterson^talk 23:45, 1 November 2006 (UTC)

"the links don't say that Donnie is asked to commit crimes"

[[21]]

It's in the movie. Isn't the movie itself a usable source? Why'd you delete the whole paragraph if you only had an issue with that one sentence?

68.40.167.60 03:38, 23 October 2006 (UTC)

Because I didn't know how to rewrite it and it could be re-added if it was rewritten so as to be neutral.

By crimes do you mean killing other humans or generic illegal activities?

Whether insomnia and dramatic changes in mood are signs of schizophrenia is unsourced. "schizophrenia is explored" might not be accurate either. Seems to me that the director was trying to make a Total-Recall-like puzzle.

I found this in the Donnie article:

Yet in the deleted-scene commentary Kelly states that the pills being revealed to be placebos enforces the fact that Donnie is not crazy.

In an episode of Sabrina the Teenage Witch, other characters think that Sabrina is crazy because she says that she went for a rollercoaster ride on the rings of Saturn. I think that this is a common plot technique.

I have moved this discussion from my talk page. Anyone else has a comment or wants to take a jab at writing a neutral version?--Mihai cartoaje 11:52, 23 October 2006 (UTC)

RFC and blanking regarding the relationship between Schizophrenia and Violence

I think the RFC section above indicates that this material should remain. Rather than blanking and reverting, it would be more useful to have material included, with verifiable sources that describe the competing point of view. DPeterson^talk 13:58, 12 November 2006 (UTC)

Removed from article and placed on talk page

Renaming schizophrenia: a Japanese perspective, WPA journal - for someone who knows how to incorporate the info.

(don't know what it means, but didn't seem like vandalism to me, so here it is. Dina 23:30, 14 November 2006 (UTC))

Looks like a suggested source. Shimeru 23:40, 14 November 2006 (UTC)

REASON FOR PAGE PROTECTION

Hopefully the Administrator will place here the reason for protecting this page and then those involved in the dispute can each clearly and briefly describe what they would like included, deleted, and changed. This can then serve to prompt a dialogue whose aim would be reaching some consensus on the disputed content. DPeterson^talk 13:22, 15 November 2006 (UTC)

Mihai cartoaje (talk • contribs) has been revert-warring to remove the section on violence, claiming, without citing any evidence, that some of those who support its inclusion are sockpuppets. The reason given for sprotection was "Continued edit warring -- forcing discussion", but the section's inclusion has already been discussed in the RFC on this talk page and a supermajority to include it has been reached. In addition to removing a section in spite of RFC consensus, the current version contains a broken interlanguage link and a section that is misplaced in the appendices when it belongs above the "See also" section in the article body, per WP:GTL guidelines. --Muchness 13:27, 15 November 2006 (UTC)

DISPUTED MATERIAL

It seems that it is the following that is disputed:

Schizophrenia and violence

Violence perpetrated by people with schizophrenia

Although schizophrenia is sometimes associated with violence in the media only a small minority of people with schizophrenia become violent, and only a minority of people who commit criminal violence have been diagnosed with schizophrenia.

Research has suggested that schizophrenia is associated with a slight increase in risk of violence, although this risk is largely due to a small sub-group of individuals for whom violence is associated with concurrent substance abuse and ceasing psychiatric drugs. For the most serious acts of violence, long-term independent studies of convicted murderers in both New Zealand and Sweden found that 3.7%–8.9% had been given a previous diagnosis of schizophrenia.

There is some evidence to suggest that in some people, the drugs used to treat schizophrenia may produce an increased risk for violence, largely due to agitation induced by akathisia, a side effect sometimes associated with antipsychotic medication. Similarly, abuse experienced in childhood may contribute both to a slight increase in risk for violence in adulthood, as well as the development of schizophrenia.

Violence against people with schizophrenia

Research has shown that a person diagnosed with schizophrenia is more likely to be a victim of violence (4.3% in a one month period) than the perpetrator.

References

---

However, as pointed out above, this issue has been discussed in the Request for Comment.RalphLender^talk 17:01, 15 November 2006 (UTC)

Retain/include disputed section

1. RalphLender^talk 17:01, 15 November 2006 (UTC)the material is well referenced with reliable and verifiable sources. In addition, the RFC clearly shows that the vast majority of editors want the material included, based on reliable and valid and verifiable sources.
2. Per above and arguments raised in previous RFC. --Muchness 17:20, 15 November 2006 (UTC)
3. Mihai's text blanking has now been discussed several times [22] [23] [24], gone to mediation twice (once by his request [25], once by mine [26]) and on both occasions he has pulled out of the process at the final stages when it wasn't going his way. It has recently been referred for a RFC, and all commentators agreed the section should stay. Despite this, he persists in text-blanking the section he doesn't agree with. The section is referenced by the latest review articles in the area, and refutes the myth that people with schizophrenia are necessarily violent. - Vaughan 19:35, 15 November 2006 (UTC)
4. Yes, include and keep...this material is verifiable. If an editor disputes it, better to include/add alternative material with appropriate sources and references which meets the Wikipedia standard of being verifiable. DPeterson^talk 13:28, 16 November 2006 (UTC)

Exclude/delete disputed section

1. No other article has violence statistics. --Mihai cartoaje 23:04, 30 November 2006 (UTC)

Please refrain from undoing other people's edits repeatedly. If you continue, you may be blocked from editing Wikipedia. Rather than reverting, discuss disputed changes on the talk page. The revision you want is not going to be implemented by edit warring. Thank you.

Please do not replace Wikipedia pages or sections with blank content. It is considered vandalism. Please use the sandbox for any other tests you want to do. Take a look at the welcome page if you would like to learn more about contributing to our encyclopedia. Thanks.

DPeterson^talk 23:31, 30 November 2006 (UTC)

Comment

RalphLender and DPeterson have been the object of a suspected sockpuppetry report. We don't have the results of the RFCU yet. More information is here: [27]. --Mihai cartoaje

And the result was the fact that this was not the case...that I am not related to RalphLender and that we are separate individuals. Your accusattion is not only unfounded but is antithetical to wiki policy in that it is irrelvant and and does not assume good faith and is a personal attack DPeterson^talk 01:50, 6 January 2007 (UTC)

This seems to be a reprisal by Mihai cartoajebecause of the filing of: http://en.wikipedia.org/wiki/Wikipedia:Mediation_Cabal/Cases/schizophrenia in which is appears he was acting in a manner inconsistent with Wikipedia policy and practices. DPeterson^talk 01:54, 6 January 2007 (UTC)

He, Mihai cartoaje, has a history of deleting material he does not like(see his talk page history) and a history of what can be interpreted as distruptive editing and vandalism see: http://en.wikipedia.org/wiki/Wikipedia:Mediation_Cabal/Cases/2006-10-20_User:Hungrygirl for an example. DPeterson^talk 02:02, 6 January 2007 (UTC)

He seems to have a habit of deleting and edting comments rather than acknowledging his mistakes. For example, his previous comment was changed by him from "RalphLender and DPeterson have been the object of an investigation for being a single user operating multiple accounts. We don't have the results of the RFCU yet. More information is here:" to the above. DPeterson^talk 14:19, 6 January 2007 (UTC)

Also note the previous difficulties:

Your edits to Schizophrenia Please do not remove the schizophrenia and violence section without prior discussion on the article's talk page. A consensus of editors has agreed that this content should remain in the article. --Muchness 21:00, 30 November 2006 (UTC) Removing Material on Schizophrenia Page Please do not delete material from the Schizophrenia page that is referenced and appropriately sourced. There is a place on the discussion page to discuss the issue...but deleting material as you have might be considered vandalism. Discussing your concerns on the talk page would be a better (more constructive) approach. DPeterson^talk 21:44, 30 November 2006 (UTC) :There has been a lot of discussion regarding that section of the Schizophrenia article, including an RfC. Every user, as far as I can see, supports its inclusion. You are going against a consensus of everyone, which is disruptive, and if you remove that section again you will be blocked. -- Steel 21:59, 30 November 2006 (UTC)

from his talk page. DPeterson^talk 14:24, 6 January 2007 (UTC)

Causes

Just a note to say I've rejigged the causes section a bit, slightly different headings and including a new psychological studies section. This was discussed back in March as a good idea, by me in a previous incarnation and Vaughan. Plan to do a bit more of this if this seems OK. EverSince 13:11, 16 November 2006 (UTC)

Looks fine to me...why the name change?DPeterson^talk 13:28, 16 November 2006 (UTC)

Just personal preference after not coming here for about six months. Thanks, EverSince 14:07, 16 November 2006 (UTC)

Thanks EverSince, great stuff, a very useful addition. Just made some minor tweaks. Thanks for retidying up the section as well DPeterson, as I accidentally went over your previously fixes in an edit conflict box. - Vaughan 14:59, 16 November 2006 (UTC)

Thanks for retidying my edits DPeterson. Vaughan, you mention minor tweaks but I think you've rewritten the psychology paragraph, removed the reference I gave, and reverted some of the heading changes. I'm not sure whether to just try to change things again - I guess I will when I get time again, unless you want to discuss EverSince 15:27, 16 November 2006 (UTC)

Hi there,

I did re-write the paragraph, larging keeping your content but adding in some of the additional findings from the cognitive literature and some clarifications for accuracy. The Aaron Beck paper is not a particularly good guide to the extent of the cognitive work in this area, and it is worth noting that CBT practictioners tend to use 'cognitive' to mean something a little different from cognitive scientists. Also, despite the name, the Beck paper largely discusses psychological work on delusions, rather than schizophrenia per se. Hence, I replaced the reference with a more recent review paper on the area from a journal that is listed on PubMed. I changed some of the headings you suggested to make it clearer exactly what is being talked about in certain areas, although I agree some of the existing ones were a bit wordy. - Vaughan 15:47, 16 November 2006 (UTC)

Thanks for clarifying. I didn't add the Beck ref as a review of the area but as 'a source' for the statement next to it about feelings of vunerability etc. I had that one to hand but was deciding on/checking which others would best cover the angles. Both cognitive science and cognitive therapy approaches have something to add, as do those focusing in other ways on emotional/social issues, and those trying to synthesise with the biomedical. Regarding the rewording, I feel replacing (rather than parenthesising) plain statements with technical terms from cognitive science makes it overall less clear for a general audience. My concern with the headings is only that they fairly balance the different lines of work. When I get time I'll try to edit in line with this again unless you want to discuss further. EverSince 16:59, 16 November 2006 (UTC)

I think the edits you suggest would be fine...with me at least. DPeterson^talk 17:13, 16 November 2006 (UTC)

I agree with that, as well. RalphLender^talk 19:49, 20 November 2006 (UTC)

I've had another go at the headings & expanding the psychological/social section. The 'early developmental influences' paragraph stands out as overlapping with the 'environmental' section. EverSince 17:35, 29 November 2006 (UTC)

I've rejigged that paragraph so it's more about how the gene/environment causes are played out or mediated in childhood/adolescent development, so less overlap. Could maybe do with something on links between specific genes and specific developmental abnormalities.

I hope the subheadings and their order make some sense developmentally and bio-psycho-socially. EverSince 13:10, 30 November 2006 (UTC)

Vandalism

I am finding the vandalism of this page quite annoying...I wonder if there isn't some way to better stop it other than constantly having to check edits?RalphLender^talk 19:49, 20 November 2006 (UTC)

pov

I have added a pov tag because there is no agreement on having violence statistics in the article. --Mihai cartoaje 11:21, 1 December 2006 (UTC)

There actually is agreement that the statistics meet Wikipedia standards for being verifiable. You have repeatedly been warned to stop blanking that section of this article as that is vandalism. Adding tags in such a manner is also disruptive. Please stop. I have put a notice on your talk page, but I see that you removed that, so let me put it here as a second notice for you. DPeterson^talk 12:26, 1 December 2006 (UTC)

Your edits to Schizophrenia

Please do not remove the schizophrenia and violence section without prior discussion on the article's talk page. A consensus of editors has agreed that this content should remain in the article. --Muchness 21:00, 30 November 2006 (UTC)

Removing Material on Schizophrenia Page

Please do not delete material from the Schizophrenia page that is referenced and appropriately sourced. There is a place on the discussion page to discuss the issue...but deleting material as you have might be considered vandalism. Discussing your concerns on the talk page would be a better (more constructive) approach. DPeterson^talk 21:44, 30 November 2006 (UTC)

There has been a lot of discussion regarding that section of the Schizophrenia article, including an RfC. Every user, as far as I can see, supports its inclusion. You are going against a consensus of everyone, which is disruptive, and if you remove that section again you will be blocked. -- Steel 21:59, 30 November 2006 (UTC)

Vandalism

While you are free to delete material from you talk page, continued deletions of material form the Schizophrenia article will be considered vandalsim. Many others have posted such comments here and you have deleted them. Please stop vandalizing the article. DPeterson^talk 23:26, 30 November 2006 (UTC)

Please refrain from undoing other people's edits repeatedly. If you continue, you may be blocked from editing Wikipedia. Rather than reverting, discuss disputed changes on the talk page. The revision you want is not going to be implemented by edit warring. Thank you. DPeterson^talk 23:30, 30 November 2006 (UTC)

Please do not replace Wikipedia pages or sections with blank content. It is considered vandalism. Please use the sandbox for any other tests you want to do. Take a look at the welcome page if you would like to learn more about contributing to our encyclopedia. Thanks.

If you have any questions, please feel free to respond to my talk page.DPeterson^talk 23:33, 30 November 2006 (UTC)

If you feel strongly about this, the proper steps at this point would be to request mediation. The poll and RfC both show that the section should stay, but if you continue to disagree, please consider following Wikipedia procedures and move to mediation as a way to end the dispute; although you must recognize that you may not be happy with the result. DPeterson^talk 12:31, 1 December 2006 (UTC)

Mediation cabal case now open

I welcome all concerned parties to comment at Wikipedia:Mediation Cabal/Cases/schizophrenia whilst I look over the dispute fully  Glen  23:45, 1 December 2006 (UTC)

Okay, this is naughty but Ive taken one stab at a middle ground

Okay, see what you think. I moved the "violence section" under diagnosis (and under controversy as it happens) which seems to be a better fit, and I removed the section title "Violence perpetrated by people with schizophrenia" which to me implies a connection where there isnt shown to be one. Also removed the header (left content) re violence towards those diagnosed as flows much more nicely now. This will be my only attempt  Glen  00:40, 2 December 2006 (UTC)

I guess that's ok. I am more concerned with keeping the content as the section seems to clearly meet the Wikipedia standard of having verifiable content that uses reliable sources and be written in a NPOV. However, if you are asking for opinions, I'd have to say that the section should probably be a separate section or, if it had to go under anything, maybe under Incidence and Prevalence or under Prognosis. I'm interested in what other editors think. DPeterson^talk 01:15, 2 December 2006 (UTC)

Well, it does it (in my mind) under Diagnosis, and is still sectioned via the heading Research findings on violence and schizophrenia --> I do maintain that the old one almost asserted a relationship, and that change is the main one I wanted to make. Yes, others thoughts most welcome  Glen  01:32, 2 December 2006 (UTC)

And, of course please change my edit as you see fit - that goes without saying :)  Glen  01:33, 2 December 2006 (UTC)

I like the new title...but I do think the section belongs as a separate section before Treatment and after Incidence...I will wait to move it until others have had a chance to comment on this as I'd like to see a consensus. DPeterson^talk 01:41, 2 December 2006 (UTC)

I would agree that Diagnosis is not the best section as violence is neither diagnostic for schizophrenia, nor has any implications for the diagnostic criteria. I think that a seperate section or in the Prognosis section would be fine. Like the new title, by the way. Seems much more appropriate. Mihai, what do you think? - Vaughan 09:21, 2 December 2006 (UTC)

With you 100%. Sorry thought Id explained then saw Im chatting about this in two places. Please make the changes, my concern was the title so Im thrilled.  Glen  11:10, 2 December 2006 (UTC)

Oh, you were clear, I was just being cautious given the contentious nature of the section. I will go ahead and move it to a separate section. If others have comments on this action, please let me know either here and/or on my talk page. DPeterson^talk 13:37, 2 December 2006 (UTC)

Why is the "Psychosocial influences" section under the causes area?

I agree, it does seem better in its own section and with a more neutral heading.

Does make me wonder about other, perhaps more positive, things that are often linked to some individuals with schizophrenia that could also be mentioned in such a section to give balance (sensitivity, creativity? I know some only link these to schizotypy). Guess nothing catches the attention like violence though EverSince 20:31, 5 December 2006 (UTC)

Don't think this is quite what I meant about the positive, but just noticed:

When a schizophrenic deficit becomes a reasoning advantage "More generally, the outcome of the present work prompts us to not characterise schizophrenia as a collection of cognitive deficits, but rather as a particular cognitive profile that, in some circumstances, can be more suitable than the cognitive profiles found in normal subjects. Interestingly, a recent work supported this hypothesis by showing that schizophrenic patients could perform better than healthy subjects in a syllogistic reasoning task (Owen et al., 2006). The authors argued that their patients were less influenced by common sense and more influenced by theoretical reason, an interpretation which is in agreement with our own observation." Owen et al., 2006 G. Owen, J. Cutting and A. David, Are people with schizophrenia more rational than normal controls, Schizophr. Res. 81 (2006) (Supplement 1), p. 21. EverSince 23:00, 20 December 2006 (UTC)

Location of "Psychosocial influences"

Why is the "Psychosocial influences" section under the causes area?

Is this comment from Glen S, as above? Is it motivated by a particular belief that psychological and social variables are not causative, or referring to the fact that the section is currently headed psychosocial 'influences' rather than causes (from an edit, by Vaughan I believe, whilst I was creating/expanding this section)

In my view, this section does belong with the neuro factors but could be headed something like 'psychosocial factors'. According to commonly held biopsychosocial models, neurological, psychological and social factors (or levels of explanation) are (a priori) equally legitimate as potential components of a causal framework. Much of the research, in regard to cog neuroscience as well as psychosocial studies, is correlational or has other issues that leave the debate open (incl. studies of the effects of interventions). Likewise tricky to divide in to onset vs maintenance factors.

Alternatively the whole area could be called 'causes or influences' (a fuzzy distinction with such a complex, changing, multifactorial condition) EverSince 19:39, 5 December 2006 (UTC)

It seems that the overall section on causitive dimensions should include this subsection "psychosocial factors." It is presented as a section with information on the psycho-social dimensions of the illness and as caustive factors. DPeterson^talk 01:55, 6 December 2006 (UTC)

Perceptions

Shouldn't it be mentioned at the bottom of the introduction that schizoprenia or schizophrenic symptoms were historically thought to represent madness, insanity and even today the perception of schizphrenic symptoms being portraying insanity holds? I find it striking that it is nowhere mentioned in the article. Editor18 18:25, 8 December 2006 (UTC)

Interesting...what language would you suggest adding? Maybe you could post a suggestion here for comment?DPeterson^talk 20:24, 8 December 2006 (UTC)

very helpful

Just a note to let you guys know that you have done an excellent job with this article and hae done the community a huge service. --Dematt 03:40, 12 December 2006 (UTC)

Two causes documented and ignored.

I will hopefully come back after Christmas to find the sites that substantiate two cause of symptoms that will be so labelled.

The first is PPA, an over the counter drug, that was found in many cold medications. Research has suggested that many people developed these symptoms after flu like symptoms. The possibility arises that these individuals took some over the counter cold mediations that created the conditions. PPA is a amphetamine like substance.

The other cause is intestinal problems. Research suggests that intestinal problems often accompany the disease, and attributed to stress. There is research to suggest that intestinal problems like IBS and Crohns can damage the chemical absorption system within the body, creating the condition.

--Son of Maryann Rosso and Arthur Natale Squitti 00:33, 13 December 2006 (UTC)

A side note a tenant of ours was labelled as such, and latter developed full blown Crohns.

Research suggests that many common bacterial infections are not detected and in these cases the symptom is labelled incorrectly.

--Son of Maryann Rosso and Arthur Natale Squitti 00:33, 13 December 2006 (UTC)

Phenylpropanolamine

I thought I had posted this somewhere.

--Son of Maryann Rosso and Arthur Natale Squitti 00:34, 13 December 2006 (UTC)

Smoking additions

The paragraph below was added recently. It looks like sensible stuff except it referenced to a secondary source which is only accessible if you register with the site, so I've removed it and hopefully someone can provide the references to peer-reviewed research - Vaughan 07:41, 14 December 2006 (UTC)

It is argued that the increased rate of smoking in schizophrenia may be due to a desire to self-medicate with nicotine. One possible reason is that smoking produces a short term effect to improve alertness and cognitive functioning in persons who suffer this illness. It has been postulated that the mechanism of this effect is that schizophrenics have a disturbance of nicotinic receptor functioning which is temporarily abated by tobacco use.

I think this material can be added back. The articles are available (although you must register, it is free.) Articles on MedScape are peer-reviewed. So, would you consider adding it back? DPeterson^talk 13:42, 14 December 2006 (UTC)

I've been trying to locate another source. A few articles (e.g. Kelly & McCreadie, 2000) seem to reference Lavin et al, 1996 ("What is the clinical importance of cigarette smoking in schizophrenia", American Journal of Addictions 5:189-208). I can't find this freely available, but Kelly & McCreadie writes: "Another suggestion is that patients smoke as a form of self-medication with nicotine, which may help regulate a dysfunctional mesolimbic dopamine system. It may increase dopamine release in the pre-frontal cortex and alleviate positive and negative symptoms (Lavin et al, 1996)."

By the way, this anonymous edit is mine. Comments appreciated. /skagedal^... 15:11, 14 December 2006 (UTC)

Just noticed the smoking paragraph has been re-added which is no problem, but is it possible to add the primary source references used in the MedScape articles, rather than referencing the medscape articles themselves. I don't think we should be referencing anything which wouldn't be referenced in the scientific literature to back up empirical points. MedScape, however useful a resource, doesn't really cut the mustard in this instance. - Vaughan 19:12, 17 December 2006 (UTC)

Yes, I added it back and hope that's ok. The Medscape articles are primary sources in that these are original articles...which happen to also be in a professional peer reviewed publication. MedScape seems to meet the Wikipedia standard of providing verifiability to the content. DPeterson^talk 20:38, 17 December 2006 (UTC)

The threshold for inclusion in Wikipedia is verifiability, not truth. "Verifiable" in this context means that any reader should be able to check that material added to Wikipedia has already been published by a reliable source. Editors should provide a reliable source for material that is challenged or likely to be challenged, or it may be removed.

DPeterson^talk 20:40, 17 December 2006 (UTC)

Finally, wp:rs describes primary, secondary, and tertiary sources of in the policy on Reliable Sources. DPeterson^talk 20:44, 17 December 2006 (UTC)

While MedScape might qualify as a reliable source by Wikipedia standards, it would be even better to have articles published in scientific medical journals that are primary sources in the sense that they are written by the same scientists that did the research. Given that this article is quite long, is a featured article and has high quality sources, I can see why Vaughan wants to not let any material in unless it is top quality referenced. On the other hand, just adding the primary references used in the article without actually reading them is against Wikipedia:Cite sources#Say where you got it. The Medscape article (why are we using plural? :-)) references a whole bunch of articles on this topic, some of which are hard to find without access to a good library. I'm not sure what I think, this is interesting information and Medscape seems to be a reasonable source, I think the paragraph can stay as is (but not under "causes"!)... /skagedal^... 22:50, 17 December 2006 (UTC)

Your relocation is good...better than where it was; thanks. Whether other references are difficult to find, unless you have access to a U library should not be relevant...but I do like the Medscape material as it is an good source of other references and is, itself, easily accessible. DPeterson^talk 00:34, 18 December 2006 (UTC)

Citing MedScape articles is, ultimately, a second option compared to citing the primary sources. Again, we don't know the peer review process for MedScape (peer review may mean it's just read by a technical editor rather than other specialist researchers). Also, it makes it more difficult for readers to verify the facts, as they have to register for MedScape, read the article, and then read the articles it references. If you could post the references used in the MedScape articles, I would be happy to verify they correctly support the cited facts. - Vaughan 02:28, 18 December 2006 (UTC)

(←) Excellent! The Medscape article cites the following references for "[...] the neurobiologic effects of nicotine, such as its interactions with dopaminergic circuits" [which are relevant in literature on smoking and schizophrenia]:

• Combs DR, Advocat C. Antipsychotic medication and smoking prevalence in acutely hospitalized patients with chronic schizophrenia. Schizophr Res. 2000;24:129-137.
• Beratis S, Katrivanou A, Gourzis P. Factors affecting smoking in schizophrenia. Comprehensive Psychiatry. 2001;42:393-402.
• Lyon ER. A review of the effects of nicotine on schizophrenia and antipsychotic medications. Psychiatr Serv. 1999;50:1346-1350.
• Dalack GW, Meador-Woodruff JH. Smoking, smoking withdrawal and schizophrenia: case reports and a review of the literature. Schizophr Res. 1996;22:133-141.
• Poirier M, Canceil O, Bayle F, et al. Prevalence of smoking in psychiatric patients. Progress Neuropsychopharmacol Biol Psychiatry. 2002;26:529-537.

The following references are cited to support that "[...] nicotine may ameliorate some of the negative symptoms of schizophrenia, [...]" and that "[n]icotine also may improve auditory gating impairments in persons with schizophrenia [...]":

• Lyon ER. A review of the effects of nicotine on schizophrenia and antipsychotic medications. Psychiatr Serv. 1999;50:1346-1350.
• Dalack GW, Meador-Woodruff JH. Smoking, smoking withdrawal and schizophrenia: case reports and a review of the literature. Schizophr Res. 1996;22:133-141.
• Leonard S, Adler LE, Benhammou K, et al. Smoking and mental illness. Pharmacol Biochem Behav. 2001;70:561-570.

Further, "[...] cigarette smoking may partially ameliorate specific psychiatric symptoms (such as negative symptoms) and cognitive measures [...]" is supoorted by:

• Carmody TP. Affect regulation, nicotine addiction, and smoking cessation. J Psychoactive Drugs. 1989;21:331-342.
• Dalack GW, Healy DJ, Meador-Woodruff JH. Nicotine dependence in schizophrenia: clinical phenomena and laboratory findings. Am J Psychiatry. 1998;155:1490-1501.
• Carosella AM, Ossip-Klein DJ, Owens CA. Smoking attitudes, beliefs, and readiness to change among acute and long term care inpatients with psychiatric diagnoses. Addictive Behav. 1999;24:331-344.
• Lucksted A, Dixon LB, Sembly JB. A focus group pilot study of tobacco smoking among psychosocial rehabilitation clients. Psychiatr Serv. 2000;51:1544-1548.
• Forchuk C, Norman R, Malla A, et al. Schizophrenia and the motivation for smoking. Perspectives Psychiatr Care. 2002;38:41-49.
• Lawn SJ, Pols RG, Barber JG. Smoking and quitting: a qualitative study with community-living psychiatric clients. Social Sci Med. 2002;54:93-104.
• Patkar AA, Gopalakrishnan R, Lundy A, Leone FT, Certa KM, Weinstein S. Relationship between tobacco smoking and positive and negative symptoms in schizophrenia. J Nerv Ment Dis. 2002;190:604-610.
• Sacco KA, Termine A, Seyal A, et al. Effects of cigarette smoking on spatial working memory and attentional deficits in schizophrenia: involvement of nicotinic receptor mechanisms. Arch Gen Psychiatry. 2005;62:649-659.

The article then states that "[...] the general "self-medication" hypothesis [...] has not been supported by all studies", but this is unreferenced!

Finally, "[t]he higher prevalence of smoking found among individuals [...] who later develop schizophrenia may further indicate that impaired nicotinic neurotransmission is involved in the pathophysiology of schizophrenia." is supported by:

• Weiser M, Reichenberg A, Grotto I, et al. Higher rates of cigarette smoking in male adolescents before the onset of schizophrenia: a historical-prospective cohort study. Am J Psychiatry. 2004;161:1219-1223.

—skagedal^... 09:24, 18 December 2006 (UTC)

OK, I've linked all the references above to their PubMed entries, which should make things a little easier to verify. - Vaughan 13:24, 20 December 2006 (UTC)

Great...Thank you. That's a big help. DPeterson^talk 13:31, 20 December 2006 (UTC)

References

For stuff pasted into talk page that uses <ref>.

Citations

I noted the star denoting this as an FA. I was, however, surprised to read 12 paragraphs (the lead and the first section) without a citation to support any of it. This is not FA quality. Can someone clean this up? I'll be nominating this for FAR within a week if it remains in this state. Hbdragon88 07:28, 21 December 2006 (UTC)

This is a summary of the rest of the article, where everything is/should be referenced. However, I'd argue that there's quite a lot of summary with both the lead and the overview. There's a lot of duplication of information. I think this article would be better off a bit shorter, with sections split off into their own articles (Treatment of schizoprenia, etc.). /skagedal^... 07:45, 21 December 2006 (UTC)

I think the idea of the summary and overview is to give a 'pyramid' structure to the article. i.e. It starts with the main points, then expands further into the overview, then gives full referenced detail in the body of the text. This means a casual reader gets an broad view of the topic if they only read the first few paragraphs. I think it's a good idea to keep these reference-free as it makes reading easier, and, like Skagedal noted, every point in the introduction is covered in more detail and referenced in the later sections. - Vaughan 08:41, 21 December 2006 (UTC)

As a reader, I don't think I should have to go play hide and seek and read the entire article to find out who thinks that this disorder "affects cognition." Also, a complete lack of references in the opening paragraphs has been cited by some FAR reviewers [28] as worthy of review, which indicates to me that even the inclusion of such refs below isn't quite enough. On an unrelated note, what happened to the FAC that got this article promoted? The box on the top is a red link. Hbdragon88 09:45, 21 December 2006 (UTC)

As the introduction is a summary of the whole of the rest of the article, almost every word would need to be referenced. This would make the paragraph virtually unreadable. You don't have to play 'hide and seek' you just need to go the the contents and look at the relevant section. All fairly straightforward. - Vaughan 16:10, 21 December 2006 (UTC)

I'm also kind of curious about what happened to the FAC. The article had {{featured article}} added to it on 31 January 2006 by Lupin, but I can't find a FAC anywhere in the logs from around that time. Anyone remember? /skagedal^... 22:45, 23 December 2006 (UTC)

Personally I don't feel an article with such high quality information and referencing should be demoted just because it has an easy-to-read overview section. I guess that could be a bit shorter and a few of the key articles linked in perhaps? EverSince 00:08, 25 December 2006 (UTC)

As I remember, 'schizophrenia' was among the first batch of articles to get FA status, so you may have to look way back, if it used the current system at all. Your best bet is to look for the point in the history at which FA status was granted. - Vaughan 13:38, 26 December 2006 (UTC)

Indeed! I got fooled by the {{featured article}} template. Schizophrenia got added to Wikipedia:Featured articles (then called "brilliant prose") on 21 August 2003. There was no voting like there is now, this is the "FAC". I'll add this information to Wikipedia:Featured article candidates/Schizophrenia so new visitors won't have to wonder. /skagedal^... 16:02, 26 December 2006 (UTC)

Oneiroid states

This bit of text has been repeatedly added to the "History" section by an anonymous editor:

It was an important contribution, made by Meyer-Gross in the late 30s with the description of the oneiroid states, developed in the study of S.Stoyanov (1961) of the oneiroid syndrom in the course of catatonic schizophrenia. It traced the pathway for further interpretations on this specific form of the disease [www.springerlink.com/index/M8857763174102L3.pdf]

I asked for references, which we now got (thank you; although I can't view this article, or even see what it's called...), but I have removed it again. This information, in this form, does not seem very fitting to this article. I don't know if the theory of "oneroid states" is relevant to an article on schizophrenia (I don't think so, I've never heard of it, but I'm no expert), but in this form, it is certainly not fitting. The article is to be written to an audience who are not to be expected to already know a lot on the subject, so if you don't know what "oneiroid" is or who "Meyer-Gross" is, this paragraph is just confusing. Maybe you should consider writing an article on oneiroid syndrome?

Anyway: Please discuss this issue here before adding this bit again. /skagedal^... 13:08, 30 December 2006 (UTC)

Violence and schizophrenia

Mihai added the {{pov}} tag; I removed it. I agree with others that it is important to have this section, just so we can debunk the common misconception that schizophrenia (or mental illness in general) is associated with violence. However, maybe we can do a better work to make the section justify its own existance:

Although schizophrenia is sometimes associated with violence in the media [...]

Does anyone have any sort of reference for this? Is there research on how often schizophrenia and violence is mentioned together in media, or some such? /skagedal^... 01:19, 31 December 2006 (UTC)

Yep, this paper is a good source. - Vaughan 16:10, 1 January 2007 (UTC)

The template says that there is a neutrality disagreement, and that is exactly the case. --Mihai cartoaje 12:21, 10 February 2007 (UTC)

The edit by EverSince is better; more a more accurate presentation of the material. DPeterson^talk 14:33, 6 January 2007 (UTC)

The paper talks specifically about ceasing medication as a risk factor for violence. See the first paragraph of the paper (quoted below)

To date, three factors have been suggested to identify those with psychosis at increased risk of committing violent acts: co-morbid substance misuse (Swanson et al., 1990; Cuffel et al., 1994; Tiihonen et al., 1997; Brennan et al., 2000; Arseneault et al., 2000 and Walsh et al., 2001), medication noncompliance (Swartz et al., 1998) and active psychotic symptoms (Taylor, 1985; Swanson et al., 1990 and Swanson et al., 1996).

- I've merged this in with the points taken directly from the empirical findings additionally included in the referenced paper (i.e. "Previous violence and alcohol abuse predicted assault, replicating other studies. While low IQ did not predict violence, the receipt of special education in childhood did."). Vaughan 16:06, 6 January 2007 (UTC)

OK, I've looked at the article, and you are absolutely correct. The beginning part of the paper states what you quote...sorry for not checking the article directly myself before I commented. The other articles are quite interesting and your additions to the article are cogent. Again, sorry about my misunderstanding. DPeterson^talk 17:44, 6 January 2007 (UTC)

No problem, in fact the new version with the additional information you added is an improvement on the earlier version. Vaughan 18:53, 6 January 2007 (UTC)

I've reworded it again. The original summary listed the research findings of that particular article, not the intro points - except then including 'ceasing medication'. I must admit that's why I originally got annoyed hence the edit comment. However, it is actually the case that the article does NOT "specifically" say that or support that claim. Here's my issues

That intro says 'non-compliance' not 'ceasing medication'. It does not define this - the whole intro is one short paragraph. Why choose the latter wording? The source they give for this issue is 1 article, from 1998. One. Here's what is actually says:

"Medication noncompliance was measured by the subject's self-report or the report of a family member or collateral informant. Informants were asked 1) whether there had been prescription medications or shots (for mental or emotional health problems) that the subject was supposed to take but did not, or 2) whether the subject had never or almost never taken the shots or oral medications as prescribed."

The sample was less than 60% schizophrenia or schizoaffective disorder (doesn't actually report the % schizophrenia), the rest affective or misc, involuntarily admitted to hospital.

They actually report finding NO significant link to medication non-compliance. They did find that being male, being a victim of crime - since "victimized subjects are likely to feel more threatened and may engage in violent acts at least partly in self-protection." - and being African American (due to living environment and being more likely victim of violence they postulate) and substance abuse was a 'predictor' (statistically, not prospective causal) of more violent incidents (and not a greater risk compared to the general population or a representative comparision sample, just within the sample).

They then report a quite different kind of significant finding re non-compliance in an additional complex analysis, undertaking by creating a new "dummy variable" and redoing the analysis looking at the combined effect of substance abuse and non-compliance. They found that non-compliance was linked to more violent incidents if there was also substance abuse, but not if there wasn't.

Even re this finding they warn that "However, it is also possible that both variables—noncompliance and substance abuse—result from some other latent factor such as general disaffiliation from treatment or unspecified personality traits"

So there is no way this should be reported on Wikipedia as supporting the claim that if someone with Schizohprenia comes off their meds, they're more likely to start being violent.

The article does cite this paper: Characteristic hostility in schizophrenic outpatients which, just going by the abstract for now, it seems to misleadingly cite as if demonstrating a connection between noncompliance and violence.

EverSince 20:53, 6 January 2007 (UTC)

Good work EverSince. I haven't got access to the Schwartz paper, but it seems you may have picked up a fallacy in this study. Doing a lit search there is some more recent work (with seemingly better methods) suggesting that medication non-adherence is a risk for violence (e.g. this Ascher-Svanum et al. (2006) paper - too recent to be included in the referenced Walsh et al. (2004) study), and this Soyka (2000) paper suggests that substance misuse to both non-adherence to medication and violence in schizophrenia. This latter paper suggests a more complex relationship. I think these might be preferable references for the non-adherence statement.

However, the qualifying statement about "at least in inner-city urban areas" isn't true, as the studies review by the Walsh paper include several that included rural samples, especially two studies that used a Finnish and Danish whole population birth cohort sample respectively.

Comments appreciated! - Vaughan 21:15, 6 January 2007 (UTC)

I'd like to keep this clear. I think we are agreed that the claim that stopping medication is associated with an increased risk of violence (we should specify what "violent" acts we're talking about) was not supported by that original source. Indeed, the central finding of the article cited by the source was actually that violent actions were linked to other people being violent against the person with schizophrenia, or living in generally violent areas! (how the article title ended up not reflecting that, but instead implying a direct link to nonadherence, is sad (and makes me angry...though not violent). We do then get in to interactions between substance use and violence and mental disorder, as with the 2000 paper you mention, but this is a different issue.

I'll look through the full text of that 2006 article sometime, good work finding it. The abstract is not clear on how they controlled for all the confounding variables in the big list of things, including victimization, that they imply flow directly from not adhering to an antipsychotic regime. I don't think we should make a claim about this on the page until this can be assessed. I'll note one thing for now. This study was sponsored/funded by the pharmaceutical company, and major manufacturer of antipsychotics, Eli Lilly.[29] Studies funded by this company tend to produce the results the company wants [30].

I have a problem with this whole terminology of "non-compliance" or "non-adherence", and with this actually quite strange idea of trying to link violence to NOT taking something. Doesn't seem like an NPOV perspective. But I can't quite summarise it clearly yet so I'll wait on that one. EverSince 23:24, 6 January 2007 (UTC) p.s. the point about inner city areas was made to accurately reflect the only source that was there or that was detailed. If there's more then great.

I think everything you've mentioned above makes sense but all the factors are likely to be heavily linked. For example, someone who is maintained on antipsychotic medication who stops taking it might be more likely to become psychotic, and therefore victimised, which then leads to them being more likely to react violently. I think it's also important to bear in mind that it's not a link between violence and non-adherence. It's a link between risk of violence and non-adherence.

In terms of not controlling for certain variables and funding, I think these are important issues, but perhaps better left to the literature itself rather than trying to figure out on Wikipedia. I feel our responsibility is to go with the major studies in the mainstream literature and trust that the peer-review process has done its job in screening out obviously flawed studies. Of course, this isn't a perfect process (as the CJP paper you cited above shows) but I think to damn certain studies on the basis of general tendency would lead to quite a subjective view based on how much faith an individual Wikipedia author has on the drug industry in general, or even the publishing journal, rather than in a specific study. Vaughan 08:43, 7 January 2007 (UTC)

Hi Vaughan. You are putting words and claims in to my mouth that I didn't say. I did not say anything about "damning" or excluding that study. I simply noted that it was funded by a major antipsychotic manufacturer, and that this has been shown (peer-review) to distort findings. These are NPOV (and peer-reviewed) facts about the validity and reliability of the source. If you don't think this is relevant then that's your point of view. I specifically said I would look at the full text, not just dismiss it. And I didn't say I would dismiss based on methodology. I said I thought we should check the primary source before we made controversial claims about violence on Wikipedia. Reasonable, no? It's not about not going with the peer-reviewed studies, it's about accurately describing what they found in a balanced way EverSince 13:35, 7 January 2007 (UTC)

Hi there, I'm not intending to put words in your mouth, just warning (not claiming that you said it) against excluding a study purely because it's drug company funded. Despite the general bias, industry studies still produce valuable findings. As it is almost impossible to determine whether an individual study is biased or not, I'm not sure this finding is particularly relevant for judging this individual study. If there were a large number of relevant studies, it would make more sense to favour the independently conducted ones, but unfortunately, we are not in that situation. - Vaughan 14:30, 7 January 2007 (UTC)

Well that peer-reviewed study of the effect of this funding is specifically about these specific antipsychotics being specifically referred to here, so it seems like something relevant and notable to me - and again, not about excluding relevant studies, but about a balanced NPOV representation EverSince 14:57, 7 January 2007 (UTC)

p.s. I'm not sure about your claim that these studies are of "risk" of violence not actual violence. They are assessing actual acts of violence, as reported by participants or third parties or records, and producing population estimates based on that. They are not conducting risk assessments or producing probability risk figures. But I certainly agree that all these factors are, of course, highly inter-linked and sorting out the causality is incredibly difficult - which should be reflected EverSince 13:35, 7 January 2007 (UTC)

A population estimate based on a sample is a form of risk estimate in this situation (i.e. what is the risk of a violent act occurring in the population given the sample data?) although I agree that the studies themselves are not on risk/prediction studies as you outline above. Just making the point that we need to be careful not to say 'violence is linked to x' based on these studies when the only conclusion we can draw is 'an increased risk of violence is linked to x' (same point that you're making I think). Vaughan 14:30, 7 January 2007 (UTC)

I think we agree, I would also add we need to be careful not to talk about everyone with schizophrenia having some unusual 'risk' of being violent, when it's actually acts by a minority that are being assessed, and linked to numerous personal and social factors, just as in the general population EverSince 14:57, 7 January 2007 (UTC)

No doubt others will have read the article by now, and no doubt other sources may have been found to support claims, but to comment as I said I would:

I would say the abstract of Ascher-Svanum et al. (March 2006) isn’t balanced, but doesn’t appear grossly misleading like Swartz et al. (1998). It isn’t a source for a claim of causation, something that is only obliquely indicated in the abstract by the term ‘naturalistic’ - it’s just an observational study, albeit with large numbers of individuals with a schizophrenia spectrum diagnosis. This isn’t an experimental trial that tells you about cause and effect, except via highly hypothetical assumptions. Nor is it a source about ceasing medication, as opposed to just never taking it. While they say at one point “at enrollment, almost all patients were treated with at least 1 antipsychotic” what they actually mean is that almost all patients were already being prescribedat least 1 antipsychotic, of which they report about 20% were non-adherent.

Incidentally, numerous other studies similar to this (including one suggesting that taking olanzapine was significantly associated with less violent behavior when other correlates were controlled for, but this association not found for risperidone) are all derived from the same large-scale observational study of people diagnosed with schizophrenia, called SCAP. This was set up and funded by Eli Lilly & Co, with data collection contracted out. Statistical “consultation” was provided by Eli Lilly. Similarly to the others, the first four authors of Ascher-Svanum et al. (March 2006) are actually non-medic employees of Eli Lilly, and the contact address is Eli Lilly offices. And very strangely, this study failed to report measures of adverse effects (and therefore their correlations with violence) even though they were part of the SCAP study. A SCAP study published separately although totally inter-related (same journal, Ascher-Svanum et al., July 06), showed that the main correlates of non-adherent status at enrollment were prior non-adherence, recent illicit drug use including alcohol use, prior treatment with antidepressants, and more cognitive impairment (and other adverse effects were also highly significant correlated, although somehow didn’t make it through the more complex covariate analyses).

Anyway, I’m sure numerous sources could be provided re stopping medication. It actually would be surprising if stopping an antipsychotic – which often restrain behavior & thinking & feeling across the board – had no effect on behaviors including violence. The key for me is putting this is in context with sufficient caveats. E.g. surely ceasing medication when you’re “better”, as is the supposed goal of psychiatric treatment, isn’t associated with increase in violence? Surely, it’s not really an increase in violence in the same sense as other risk factors – it’s a return (perhaps) to the risk factor present before taking the medication. Or if it’s worse, that’s not exactly a plus point for the medication…. And non-adherence, is that a failure of a patient or a failure of a drug?

I don’t think these points can be sufficiently covered in a short paragraph, so I’m planning to build up a page on Schizophrenia and violence (or maybe Mental disorder & violence) along the general lines suggested by Skagedal given the length of this article already. There's certainly a big enough literature and notable body of opinion. EverSince 20:39, 10 January 2007 (UTC)

p.s. I have to say something about this journal, the Journal of Clinical Psychiatry, which I'm sure is no different to many others, & not to invalidate its featured research, much of which I'm sure is superb - just for context. July issue (apparently no diff to others): the back-cover is an ad for an antipsychotic. The inside of the front and back covers are ads for an antipsychotic (Eli Lilly's) for a women 'on the edge'. Around 30 more glossy pages of medications ads are spread throughout the black & white peer-reviewed print. One is actually within the text of the Svanum et al. The most alarming starts with a page-sized picture of the tip of iceberg, caption in small writing next to it: “In Schizophrenia”, bigger writing below ”sometimes what you see…” (Turn over to double-spread: huge mass of iceberg disappearing in to the depths.) “…can be misleading”. Huge type on yellow warning banners “PARTIAL COMPLIANCE A hidden danger in schizophrenia”. “look for the following risk factors: [lists 7, incl. “tendency to discontinue medication when feeling better”] then “Partial compliance can lead to serious consequences. DON’T WAIT TO TAKE ACTION!”

p.p.s. Apparently the CATIE trial, which was randomized, addressed issues of antipsychotics and violence, not sure when the later phases are to be reported.

Wording on violence and summary of paper

I don't think the wording suggested by EverSince completly track the language of the article. Furthermore, I find the wording lacking clarity and specificity. I prefer the wording of Vaughn. If this is a major issue, then I'd suggest we either conduct a poll or an RFC. DPeterson^talk 01:22, 7 January 2007 (UTC)

Hi DPeterson. You seemed OK with the clarity of my original wording, before Vaughan revised it again and said the article did specifically mention "ceasing medication", when in actual fact it doesn't specifically mention that - nor is this claim supportd by the cited article. So please can that not keep being re-inserted. Unless there is a source for it that someone's actually read, and perhaps when we've discussed this POV approach of linking violence to NOT taking something, rather than the normal accepted method of showing that an intevention has a particular effect or not. I accept that there was some compromise phrasing halfway through all this, that wasn't particularly clear.

The point about being the victim of violence was based on Swartz et al., 1998 which is cited by the sourced article, although I accept that Swartz et al. should itself be added, which I shall do. Please feel free to reword to accurately capture the sources as you see it, I do'nt have any problem with this. EverSince 13:35, 7 January 2007 (UTC)

It's my experience that schizophrenics tend to be in a lower income strata than the general population. I wonder if there is a correlation between being a victim of violence and schizophrenia or if being a victim has more to do with the individuals income and subsequent standard of living. 72.89.0.244 02:12, 13 January 2007 (UTC)

p.s. I think phrases like "substance abuse" are not very clear or specific, even if people in technical circles know what's being referred to. Also not everyone agrees that it should be termed abuse.

'Substance abuse' refers to a specific category in the DSM. See here. Vaughan 14:32, 7 January 2007 (UTC)

It can do, but the source specifically excluded people with a comorbid substance abuse diagnosis. They're talking about the use of non-prescription drugs including alcohol, so why not say that. EverSince 14:48, 7 January 2007 (UTC)

Removed line

I removed the line, "In addition, an act of violence committed by an individual with schizophrenia is not necessarily attributable to schizophrenia." because that should probably have a citation...it is a conclusion. However, if others diagree with my opinion, pls state it here and then the line should be re-inserted if a that is the consensus. DPeterson^talk 17:11, 7 January 2007 (UTC)

The sources we've been discussing link violent acts to e.g. being the victim of violence. So this is a source for them not being directly caused by schizophrenia. In any case, it's a logical fallacy to say that because someone commits an act of violence, and they are a person with a diagnosis of schizophrenia, then the violence was due to schizophrenia. Surely that requires a source. Incidentally you seem to have removed the sources & the formatting is all messsed up.

You've also reinstated a point for at least the 3rd time ("ceasing medication") which I have repeatedly contested, that isn't specifically sourced by the current sources, and despite my asking for time to establish exactly what a new suggested source actually says. Rather than waste time rewording again, I'm going to leave this topic for now. EverSince 17:25, 7 January 2007 (UTC)

I think both versions are acceptable, and am quite happy to wait until EverSince (or anyone else) has had a chance to read the Ascher-Svanum et al. (2006) paper before re-inserting the bit on ceasing medication. The study seems sound, but I'd be interested to hear others' analysis. - Vaughan 17:42, 7 January 2007 (UTC)

I read the article you referenced and think the point about ceasing medication should be reinserted. The study meets Wikipedia standards as for being verifiable. The study states,

RESULTS: Nonadherence was associated with poorer functional outcomes, including greater risks of psychiatric hospitalizations, use of emergency psychiatric services, arrests, violence, victimizations, poorer mental functioning, poorer life satisfaction, greater substance use, and more alcohol-related problems (all p < .001). Adherence was relatively stable, with 77.3% of patients maintaining the same adherence status from the first year to the second year. Nonadherence in the first year predicted significantly poorer outcomes in the following 2 years. CONCLUSIONS: Findings highlight the importance of adherence with antipsychotic medication in the long-term treatment of schizophrenia and its potential beneficial impact on the mental health and criminal justice delivery systems.

DPeterson^talk 17:55, 7 January 2007 (UTC)

So, why don't you go ahead an reinsert that line? DPeterson^talk 17:55, 7 January 2007 (UTC)

That's not from the paper itself, that's the abstract. For something as controversial as this, why not wait until seeing what the paper actually says, esp. as that conclusion seems ideally suited to the interests of the funder ("important", "long-term", benefit to "criminal justice") (which isn't to say the paper might not source the claim re non-adherence). And lets not forget there's already one source, as described above, reporting finding no main significant link with non-adherence. None of which uses this phrase 'ceasing medication'. Anyway sorry I am leaving this discussion now EverSince 18:24, 7 January 2007 (UTC)

Regarding the "one source, as described above, reporting finding no main significant link with non-adherence," that is excellent, and can also be cited. Nice work DPeterson^talk 18:56, 7 January 2007 (UTC)

Balance

I would be grateful to know if there would be objection to, or reversion of, rewording the bit on violence to include (with sources): a point about the link between ongoing victimization and committing violent acts, merging this with the points already there about childhood abuse and the relative likelihood of violence by or against the self; a point to clarify that it is not being suggested that because a person has a diagnosis of schizophrenia, any violent act they commit is due to schizophrenia rather than other aspects of a person and those with whom they interact (unless this is being suggested by anyone); a point about conflict within the family environment, perhaps the most common setting of violence related to schizophrenia; and a balanced point about interventions (medication/psychotherapy/other services), including issues of adherence and adverse effects, addressed separately to the above but still within that section. EverSince 16:18, 12 January 2007 (UTC)

Why don't you post your specific suggestion/wording here? If you put here what you want to remove and what you want to add, the other editors can comment and we can build consensus. DPeterson^talk 18:37, 12 January 2007 (UTC)

Hi EverSince, I think this is an excellent idea. I'm just keen that the main thrust of the article reflects the mainstream opinion on schizophrenia as far as possible (i.e. the consensus opinion in the literature) rather than simply our personal interpretations of the evidence (whether that's mine, yours or anyone else's). Of course, there's plenty of room to add some of caveats and controversies from the literature as well. I look forward to reading some more of your excellent contributions. - Vaughan 16:16, 14 January 2007 (UTC)

I haven't thought of removing anything. So it's just to add some sourced points and reorder/balance. I would prefer to edit the text directly in the usual way, having given an outline of my intentions above since this is a controversial topic. I didn't mean to imply it couldn't then be changed or objected to, of course, but I wanted to check if anyone had any prior objections in principle to my attempting any of the above. If they do, I will address the specific wording here as you suggest EverSince 16:27, 14 January 2007 (UTC)

Thanks, and I also think that is very important Vaughan. I believe Wikipedia is intended to cover both mainstream opinion & evidence, + notable minority opinion & evidence, + caveats and controversies (incl. notable info on sources, conflicts of interest etc). To be overall NPOV and not biased by individual interpretations. I look forward to getting there too EverSince 16:51, 14 January 2007 (UTC)

The violence section is now longer, and yet doesn't include the important link between childhood abuse etc, and later violence in those with schizophrenia, or violence against the self (suicide and self-harm), or the issue of prevention/treatment. Are these more general issues better dealt with in the relevant sections? (e.g. prognosis covers some, treatment covers some). Or else how to include them in the violence section in a balanced way with caveats, without expanding it too much? EverSince 15:27, 20 January 2007 (UTC)

Hi Eversince, The updates you've made to the violence section are excellent. Brilliant work. I'm not sure whether we need much (any?) details about treating violence in schizophrenia as this is quite a specialist topic in forensic psychiatry and might just be too much detail for the general schizophrenia article, but perhaps suitable if the section is expanded into its own article. - Vaughan 16:18, 20 January 2007 (UTC)

Schizophrenia and over the counter cold medications.

While doing research on this subject, it was noted that many people developed schizophrenic symtpoms after flu like symptoms.

The first logical step would be to think that this may be related to the casue of the flu like symptom, ie virus or bacteria.

Then I stumbled upon the drug PPA or Phenylpropanolamine a common over the counter cold medication that had side effects that were first reported in 1960s. The drug was not taken off the market until after the year 2000.

The warning was:

"Failure to recognize PPA as an etiological agent in the onset of symptoms usually led to a diagnosis of schizophrenia or mania, lengthy hospitalization, and treatment with substantial doses of neuroleptics or lithium. "

Can you read between those lines...?

A great tragedy for some ?

--Son of Maryann Rosso and Arthur Natale Squitti 23:17, 5 January 2007 (UTC)

So the next question is what other over the counter drugs, can cause these symptoms in some people...

--Son of Maryann Rosso and Arthur Natale Squitti 21:05, 9 January 2007 (UTC)

Auditory, olfactory and visual hallucinations

Please be aware that it not only auditory hallucinations that are symptoms of schizophrenia. Olfactory hallucinations are also indicative although less commonly reported, perhaps because of the difficulty in recognition. Visual hallucinations, while much less common (or at least reported) are also indicative of schizophrenia. I speak as a diagnosed schizophrenic in which the disease presented as delusional thinking and olfactory hallucinations. —The preceding unsigned comment was added by 72.89.0.244 (talk) 00:19, 12 January 2007 (UTC).

Hi there,

I agree that both of these can appear in schizophrenia, however, the text describes the symptoms that 'typicaly characterize' the condition. In this instance, auditory hallucinations are linked to the condition in both public perception and are priviledged in the diagnostic criteria as being something on which you can make a differential diagnosis of schizophrenia compared with other forms of psychotic disorder. In other words, visual and olfactory hallucinations can be present in other forms of psychotic disorder whereas certain types of auditory hallucination typically characterize schizophrenia.

- Vaughan 07:53, 12 January 2007 (UTC)

Me again - I have worked as a peer counselor for schizophrenics for many years and can assure you that auditory hallucinations, while the most common, are not the only hallucinations used to Dx schizophrenia. In my experience and backed by the staff psychiatrists where I work, schizophrenics present with a wide variety of hallucinations (auditory, taste, smell, touch, visual). To imply at the top of the article that auditory hallucinations are the sole presentation is misleading. I have changed it to remove the word "auditory" and just leave "hallucinations". If you check mental health site (like nimh.org) you will see this is correct. 72.89.0.244 13:29, 12 January 2007 (UTC)

I agree with Vaughn's analysis. However, it can get a bit murky. For example, an individual with Bipolar I who is in a manic episode and having psychotic symptoms can have delusions, and visial and auditory hallucinations. DPeterson^talk 11:59, 12 January 2007 (UTC)

To the person who keeps reverting the page. I realise the diagnosis of schizophrenia is not limited to auditory hallucinations. However, it is typically characterised by them, as enshrined in the diagnostic criteria, which is exactly what the sentence you keep changing says. The sentence is not about the absolutes of schizophrenia, but about commonalities. - Vaughan 13:30, 12 January 2007 (UTC)

Me again. If you check the DSM-IV TR, you will see that the criteria state "hallucinations", not just auditory ones, as indictative of schizophrenia. If you have any valid evidence to the contrary, I would be interested in reading it.72.89.0.244 13:46, 12 January 2007 (UTC)

To quote the DSM-IV-TR diagnostic criteria "Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behavior or thoughts, or two or more voices conversing with each other." In other words, auditory hallucinations are particularly characteristic (i.e. pathognomic) of schizophrenia compared to other types of hallucinations. This doesn't mean that you can't have AHs in other psychotic disorders, or that it is possible to have schizophrenia without AHs, or even schizophrenia with other types of hallucinations, but that they are so characteristic as to be given special weight in diagnosis.- Vaughan 14:51, 12 January 2007 (UTC)

A source on the relative prevalance of modes of hallucination would be preferable, DSM criteria are concerned with cut-offs for clinical utility rather than typicality per se. EverSince 16:37, 12 January 2007 (UTC)

One problem is the under-reporting of hallucinations other than auditory. Many people have olfactory hallucinations and don't even realize it. Likewise for gustatory hallucinations.72.89.0.244 20:38, 12 January 2007 (UTC)

That is an interesting statement. Do you have a citation to support it? DPeterson^talk 21:57, 12 January 2007 (UTC)

I have gathered that information from my 20+ years as a peer counselor working with schizophrenics. Since it is personal research, I didn't add it to the article but instead placed it here on the discussion page. However I will research to see if other MH sources can verify this.72.89.0.244 02:00, 13 January 2007 (UTC)

I think that the statement by Vaughan regarding auditory hallucinations (the quote from the DSM) is most compelling so far and supports the inclusion of that material in the article. It certainly meets the Wikipedia standard of being verifiable and thus worthy of inclusion. If anyone.DPeterson^talk 21:57, 12 January 2007 (UTC)

Unfortunately the quote from the DSM was slightly out of context and incomplete. If you refer to the DSM-IV TR, you will see one of the "A" criteria is hallucinations of all types. Granting that auditory hallucinations are the most definite indictor, other hallucinations nevertheless fall under this criterion. At any rate, the point has become moot (for the time being) as the sentence at the top of the article has been rephrased so as to be more inclusive. 72.89.0.244 02:00, 13 January 2007 (UTC)

Hi there, the quote is neither out of context or incomplete. The full criteria are here. This note says that if the hallucination is auditory of a certain type (i.e. a first-rank symptom), it is the only psychotic symptom needed. If the hallucination is non-auditory, other psychotic symptoms are also needed. Therefore, auditory hallucinations are specifically diagnositic diagnostic for schizophrenia. The ICD-10 criteria also priviledge auditory hallucinations as particularly diagnositic for schizophrenia.

Also, it is pointless looking for sources that examine the relative prevalence of auditory hallucinations in schizophrenia, because there very presence makes it more likely that the person will get a schizophrenia diagnosis. Epidemiological studies are only generally useful where the phenomenon is not part of the definition. However, I think the new wording is fine and capture both angles we're discussing. - Vaughan 16:09, 14 January 2007 (UTC)

I think the new wording is a good balance. Primary sources on the data are necessary and of value even if they must be viewed in the context of diagnostic practices (which is the case with very many things). After all, APA and WHO decisions on criteria are based on data, but the criteria are not themselves empirical sources (and tend to exaggerate features of the data, to draw them out of a complex background, to enable clinical categorization). Quick search shows some oldish abstracts e.g. High prevalence of visual hallucinations in research subjects with chronic schizophrenia The frequency of visual hallucinations in schizophrenic patients in Saudi Arabia which I mention as examples of the existence and potential benefit of such research, not as necessarily the best sources to be used or to contest that auditory pathways are the most commonly (though most often jointly) affected. EverSince 17:24, 14 January 2007 (UTC)

Autoimmune theory

My comments added underneath each point. - Vaughan 18:19, 16 January 2007 (UTC)

And my follow-ups below - Raoul NK 10:33, 17 January 2007 (UTC)

I guess that we need write more about autoimmune theory. In my point of view this is the most scientifically proved theory explaining the facts taken of a whole, especially this:

• Disease is starting mostly in mature age, sometimes in childhood but never from birth and practically never after 40

Actually, the peak incidence of schizophrenia is approximately 18-25, but there is another, smaller peak later in life (previously diagnosed as paraphrenia, now late-onset psychosis (incidence at 40+) or very-late-onset psychosis (incidence 60+). See ISBN 1841843946 for a up-to-date research review on this. - Vaughan 18:19, 16 January 2007 (UTC)

Some autoimmunities can also show this behavior. And also there may be a two slightly different forms of autoimmunity (of course, this requires careful work). - Raoul NK 10:33, 17 January 2007 (UTC)

• Disease has a malignant form rapidly leading to deep dementia or even death

There is no dementia in schizophrenia. The name was changed from dementia praecox precisely because there is no rapid cognitive decline. Although the mortality rate is high, this is generally due to secondary factors (suicide, substance abuse etc). Psychosis itself is not neurotoxic. - Vaughan 18:19, 16 January 2007 (UTC)

Febrile schizophrenia has a high risk of lethal outcome.[31] - Raoul NK 10:33, 17 January 2007 (UTC)

About 'death from psychosis itself': this seems to be a terminological dispute. In overwhelming majority of cases we see only psychotic symptoms and therefore call this disease a psychosis. But if the same pathogenetic process lead to fatal damage of brain, can we speak about 'death from schizophrenia itself'? I say yes. - Raoul NK 08:27, 18 January 2007 (UTC)

• Disease has a classical for autoimmune disorders course with attacks and remissions and with gradual increasing of defect (mental in this case)

Not necessarrily, many people will have one psychotic episode only and / or will show no cognitive decline despite ongoing psychosis. - Vaughan 18:19, 16 January 2007 (UTC)

This is also true for some autoimmunities (possibility of only one attack per life). - Raoul NK 10:33, 17 January 2007 (UTC)

• Infections can trigger starting a disease (this fact gave a reason for 'virus hypothesis')

True, but so can just about anything. - Vaughan 18:19, 16 January 2007 (UTC)

• Heredity is an important but not crucial factor

True. - Vaughan 18:19, 16 January 2007 (UTC)

• Disease shows evident correlation with another autoimmune disorders

Although the effect is small. - Vaughan 18:19, 16 January 2007 (UTC)

I haven't found a researches on correlation between different autoimmunities (e.g. between rheumatoid arthritis and type 1 diabetes). Maybe, it has the same order. On the other hand, schizophrenia has negative correlation with cancer.[32] This may be interpreted as increased circumspection of autoimmunity. - Raoul NK 10:33, 17 January 2007 (UTC)

Recent works (see two last links in autoimmune section) do autoimmunity to be the most probably pathogenetic mechanism and give us a real hope to find an objective biochemical diagnostics and pathogenetic therapy. There also are already a works on using an immunosuppressants (e.g. corticosteroids) in complex therapy with positive results.

I'm not a big specialist in this issue, and have a bad english, could anybody help in this? Raoul NK 14:41, 16 January 2007 (UTC)

Why don't you write something here, with appropriate references that are verifiable and then other editors can comment and help. Also, pls remember to sign your posts with the four '~'

DPeterson^talk 13:38, 16 January 2007 (UTC)

I think the important thing is to reflect the mainstream literature, rather than our own opinions. There is actually very little research on this, although fleshing out the section which you kindly added (and I think is a valuable addition to the article) is definitely worth it. - Vaughan 18:19, 16 January 2007 (UTC)

I agree, an encyclopedia article should have reliable and verifiable sources and not POV.RalphLender^talk 16:56, 17 January 2007 (UTC)

Please 'SIGN' your statements with the 'four "~"' and do not insert comments into the comments of another...place your comments in a new paragraph after the section you are commenting on. RalphLender^talk 16:56, 17 January 2007 (UTC)

OK, sorry, I just follow by Vaughan's example. I have added signatures for all the statements and paragraph breaks. Is this correct now (sorry if no)? - Raoul NK 08:27, 18 January 2007 (UTC)

Not a problem...it just makes it difficult to follow the thread of one editor's thought if there are interjections by other editors into the first editor's statements. The indentations allow one to follow the back and forth. I also think Ralph's note about signing is so that we can follow who is saying what....sort of a way to get to know each other better; at leat that's my view. DPeterson^talk 13:16, 18 January 2007 (UTC)

A question left unanswered

Just wondering, schitzophernia is seeing things and hearing things etc., but what about fantacy? What I mean is what if a person constantly lived in a fantacy world(metaphorivally speaking)because they dislike the "real world"? What is the person constantly talks to themselves and even getting into arguments with ones self? What is the person acted out situation of their fantacy's regularly? What are the sick with? Schitzophernia? I doubt it and I know it's not multi-personality disorder because the person is aware of what if going on and does it as a retreat to a safe place. It is something I have always woundered about. Typicaly the person whith these symptoms would to this in private and with out anyone knowing and with out any intention of telling anyone about it. It is a question lest unanswered for so long. 167.135.18.57 18:26, 18 January 2007 (UTC)

Perhaps your question is about unprofessional meaning a term 'schizophrenia'. Of course, every case should be regarded thoroughly by experienced, well-wishing psychiatrist. I guess, even if a person escapes in his/her fantastic world completely and convinces himself/herself of reality of his/her dreams then, in many cases, this can be unrelated to subject and interpreted, at most, as a neurotic symptom or psychopathic trait and can be a task for a sympathizing psychotherapy rather than pharmacology. Unfortunately there were too many speculations about subject especially in unfree countries. I hope we shall give an objective immunological approaches to diagnostics and non-neuroleptic treatment of schizophrenia in not so far future (see autoimmune section). - Raoul NK 18:38, 19 January 2007 (UTC)

Medical tests and schizophrenia

Hi Eversince, I'm not sure about the wording in the introduction that 'No medical test for schizophrenia exists'. There are many medical tests for schizophrenia in the form of structured psychiatric interviews. Psychiatry is, of course, a branch of medicine. The original wording reflected the idea that, unlike with some other disorders, there is no objective biological basis on which to make a diagnosis, which is a key reason why the condition is contentious. - Vaughan 16:21, 20 January 2007 (UTC)

I'm not sure about the wording either, but the concept of no "biological test" stood out as an unusual usage. "Medical test" seems to be the standard phrase that people will recognize as referring to a blood test or brain scan or some procedure like that. There are standardized interview and questionnaire assessments of course (often designed and carried out by psychiatrists, but also by clinical psychologists etc as no doubt you are aware) but they're not usually termed "medical tests". In any case the same issue effects the alternative phrasing, since psychological and behavioral functioning is very much a part of biology.

I didn't originally add this issue to the article, but the intended point seems to be that there is no "laboratory test" that gives a "yes/no" answer, although there are test results that can be evidential. People are not being diagnosed on this basis in routine clinical practice, although there are standardized psychological assessments to judge whether someone meets diagnostic criteria. EverSince 15:37, 21 January 2007 (UTC)

Hi EverSince, I think the phrase "no laboratory test" is much better and describes what we're trying to get across. I'll include this unless there are any objections. - Vaughan 15:54, 21 January 2007 (UTC)

I agree the phrase, "no lab test" is more accurate. No objection here. DPeterson^talk 17:02, 21 January 2007 (UTC)

Does anyone want to figure out how to delete that LSD/Ass comment?

I vote for this article to be protected from anonymous editing - Raoul NK 10:21, 22 January 2007 (UTC)

That would be fine with me. You can do so by making a request for page protection. DPeterson^talk 16:20, 22 January 2007 (UTC)

go to WP:RFPP DPeterson^talk 02:51, 23 January 2007 (UTC)

Changing medical to laboratory test, done by Vaughn, is an improvement. Thanks Vaughn DPeterson^talk 23:35, 29 January 2007 (UTC)

POV tag

I don't see that as necessary or appropriate. There may be some content disagreements in some sections, but the bulk of the article is not disputed. DPeterson^talk 13:17, 13 February 2007 (UTC)

Rather than engage in mindless reverts, pls discuss the issue here. JonesRD_talk 23:46, 13 February 2007 (UTC)

Pls stop adding the POV tag...if you disagree, at least try to resolve the dispute using Wikipedia dispute resolution procedures. DPeterson^talk 21:40, 16 February 2007 (UTC)

I stopped arguing with some other accounts when they started making personal attacks. We are allowed to add a pov template during neutrality disagreements.

(I wrote this yesterday; it hasn't appeared probably because I forgot to pass the no-edit-summary screen.)--Mihai cartoaje 02:42, 17 February 2007 (UTC) PS: I have written on this talk page an explanation of why I added a pov tag: [33]. --Mihai cartoaje 11:02, 22 February 2007 (UTC)

There is no POV issue if you are not stating what you disagree with and working to resolve the dispute. Just putting up a POV tag is almost vandalism.DPeterson^talk 13:05, 17 February 2007 (UTC)

The improper use of dispute tags is a form of vandalism on Wikipedia. This includes added dispute tags without identifying the issue in dispute, or adding dispute tags to sections that have been independently reviewed and found to be balanced and verifiable (as has been done several times with the violence section). Because of the persistent adding of the POV tag to this page after these reviews, and Mihai's previous continued blanking of the article, I have added a vandalism warning to his talk page. - Vaughan 18:44, 17 February 2007 (UTC)

Thank you. DPeterson^talk 01:35, 18 February 2007 (UTC)

Vandalism by User:Mihai cartoaje

User:Mihai cartoaje continues to vandalize this page by adding the POV tag without engaging in any disucssion. If you review that editor's talk page (note, you will have to go into the history to read a version edited by another editor since Mihai cartoaje removes the numerous references to his un-wiki-like conduct) you will see that this has been an ongoing problem with this editor. DPeterson^talk 14:21, 18 February 2007 (UTC)1

Sad but true. I have schizophrenia page on my watchlist and contemplate this tug-of-POV-tags quite often. --CopperKettle 14:42, 18 February 2007 (UTC)

I think it is time to file notice in the proper location to see about having him banned from editing this article. Does anyone know what the proper procedure is and where I go to initiate that? I will be glad to file the necessary report or start this process. MarkWood 21:21, 19 February 2007 (UTC)

I think the proper place to leave a complaint is at http://en.wikipedia.org/wiki/Wikipedia:Administrator_intervention_against_vandalism#User-reported I've done so.MarkWood 13:22, 20 February 2007 (UTC)

If you go to http://en.wikipedia.org/wiki/Wikipedia:Requests_for_comment/Mihai_cartoaje#Statement_of_the_dispute You can put your comments regarding an Rfc regarding his conduct. DPeterson^talk 23:30, 21 February 2007 (UTC)

therapies/services

The treatment subsections mix up meds/hospitals on the one hand and therapies/community services on the other. This seems to be building assumptions into the structure. I plan to split it instead into the different therapies (pharma/ect/psych/social) and, separately but obviously linked, the different modes/settings of health services (inpatient, outpatient, community (incl. ACT, supported housing etc)) EverSince 15:42, 1 March 2007 (UTC)

Perhaps as subsections of the larger section on Treatment? RalphLender^talk 19:09, 1 March 2007 (UTC)

Yep. Perhaps calling it Treatments and Services or something like that. EverSince 19:52, 1 March 2007 (UTC)

I concur DPeterson^talk 00:13, 2 March 2007 (UTC)

Psychosocial heading

Hi Eversince, psychosocial typically means factors including both psychological and social processes (i.e. see Reber's Dictionary of Psychology). I notice there's stuff in the paragraph about processes that aren't explicitly social (e.g. latent inhibition, attentional bias, source monitoring), hence my suggestion for a title change to 'Cognitive and psychosocial factors' as these aren't covered elsewhere. - Vaughan 20:25, 1 March 2007 (UTC)

Hi Vaughan. I think that's a fair point about a common definition, although I think the section content is in line with it in this context, and cognitive processes are also covered in the 'neuropsychology' section. I don't really mind if you want to change it back. p.s. could move this talk in to the 'causes' discussion above for continuity EverSince 20:55, 1 March 2007 (UTC)

I think that the change in section title is fine...provides more detail. While psycho-social factors would include cognitive factors, the new title is more explicit. DPeterson^talk 00:17, 2 March 2007 (UTC)

"healthy" counterparts?????

"Patients diagnosed with schizophrenia typically live 10-12 years less than their healthy counterparts, owing to increased physical health problems and a high suicide rate. Unemployment and poverty are common".

You have already said that schizophrenia is not fully considered a physical disease and then you say something like this. Schizophrenia in itself is not a cause of physical ill health and this just shows the underlying attitude of people who haven't experienced this illness. people who haven't had shizophrenia are not 'healthy counterparts' they are just people who don't suffer from schizophrenia.

So why don't you just call them 'non-schizophrenics' or something like that???

82.21.133.59 00:31, 11 March 2007 (UTC)

"non-schizophrenics" sounds good to me. Just edit the article. —Cesar Tort 05:29, 11 March 2007 (UTC)

Another factor is that it may not be the disease or illness of Schizophrenia that causes early death. The CDC ACE's studies ( see: http://www.acestudy.org/ ) shows that adverse early experiences lead to a whole host of difficulties and early death. DPeterson^talk 13:54, 11 March 2007 (UTC)

Agreed: Disorder is not disease. —Cesar Tort 19:02, 11 March 2007 (UTC)

Mental health is affected by mental illness. Healthy can therefore means not mentally ill, surely? - Vaughan 11:03, 12 March 2007 (UTC)

It hasn’t been proven that mental disorders are biomedical entities. That’s why neurology and psychiatry are separated. —Cesar Tort 11:15, 12 March 2007 (UTC)

Vaughan is correct here. Schizophrenia is an illness, a mental illness. It is also a disorder per DSM. Both terms are accurate. The opposite of illness or disorder is health. DPeterson^talk 13:32, 12 March 2007 (UTC)

Mental “illness” is a metaphor. The DSM never states that the major DSM disorders, such as schizophrenia, are biomedical entities. Take a look at this and this. —Cesar Tort 19:52, 12 March 2007 (UTC)

Regardless, Schizophrenia is a mental illness and a mental disorder, whether or not you subscribe to the notion that it is or is not a "biomedical entity." DPeterson^talk 20:37, 12 March 2007 (UTC)

To call "illness" a disorder is inexact to say the least. The American Psychiatric Association has acknowledged in above-mentioned article:

“ Brain science has not advanced to the point where scientists or clinicians can point to readily discernible pathologic lesions or genetic abnormalities that in and of themselves serve as reliable or predictive biomarkers of a given mental disorder or mental disorders as a group. ”

Therefore, it has not been proven that mental disorders are "diseases" or "illnesses". —Cesar Tort 21:02, 12 March 2007 (UTC)

Schizophrenia is only defined as an illness by how sufferers are different to 'normal', and don't fit into society. Many people of above average I.Q. have suffered from schizoprenia. I think people don't understand what this mental condition is and neither do I; thats why I don't define schizophrenia as a disease just because it is so different to normal ways of thinking. Many people have had religious insight and experiences and have been a great benefit to civilisation. So just because they come back to the state of mind which we call normal we see them in a totally different way. In shamanistic societies it is a part of life for the shaman to do strange and bizarre things, and he can act like a 'madman' yet he is respected above all others in thier social hierarchy.82.21.133.59

Regardless, in the literature cited in this article and elsewhere, Schizophrenia is described as a mental disorder and as a mental illness. Regardless of whether or not "pathologic lesions or genetic abnormalities" have been found, it is defined as an illness and a disorder. There do not need to be biological bases or "biomedical entities" for it to be defined as it is in the prevaling literature. Take a look at the cited references for many examples of schizophrenia being described as an illness and as a disorder. DPeterson^talk 00:44, 13 March 2007 (UTC)

But what is most important is how the DSM-IV defines schizophrenia, and it definitively uses the word disorder, not illness. —Cesar Tort 01:15, 13 March 2007 (UTC)

Medicine does not make a principalled distinction between disorder and illness. The DSM (which only lists diagnostic features and is not intended to say anything about the ontology of the diagnoses it lists) chooses to use the term 'psychiatric disorder', which is synonymous with mental illness. The World Health Organisation explicitly define schizophrenia as a mental illness. However, I think this is a very minor point and both wordings which are proposed are fine (although I think 'people not diagnosed with schizophrenia' is better than 'non-schizophrenics' as describing people as 'schizophrenic' is becoming increasingly uncommon). - Vaughan 11:23, 13 March 2007 (UTC)

Good points. I agree. DPeterson^talk 12:18, 13 March 2007 (UTC)

Agreed. "People not diagnosed with schizophrenia" sounds better. —Cesar Tort 22:33, 13 March 2007 (UTC)