Talk:Schizophrenia

Life expectancy

Might be short also, because tobacco use among sufferers is prevalent. --91.158.78.116 (talk) 19:16, 21 March 2014 (UTC)

Correct fact: Schizophrenia - coined by Jung on acid.

Shouldn´t this article actually state the actual FACTS on where the term "schizophrenia" comes from?

More like this: "Schizophrenia was coined by Jung on an acid trip". Please see "Liber Novus".

PBWY. — Preceding unsigned comment added by 84.211.129.189 (talk) 15:00, 4 April 2014 (UTC)

Confusing Sentence

This sentence did not make much sense phrased like this, "About 30 to 50% of people with schizophrenia do not have insight; in other words, they do not accept their condition or its treatment." So I am just going to rephrase it like this, "About 30 to 50% of people with schizophrenia fail to accept their illness or their recommended treatment." --DanaLPanetta (talk) 22:08, 15 April 2014 (UTC)

Sounds good. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:09, 7 May 2014 (UTC)

One sentence simple description of schizophrenia

We are currently having a discussion of what is the best one sentence simple description of schizophrenia. I am okay with "Schizophrenia is a mental disorder characterized by a breakdown in thinking and poor emotional responses" Others thoughts / suggestions? Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:25, 8 May 2014 (UTC)

I am really not a fan of the "poor emotional responses" and it's not something I'd put in a one-sentence encapsulation of the condition. Just trying to think what I would put in.... Cas Liber (talk · contribs) 13:36, 8 May 2014 (UTC)

Pubmed gives four aspects in simple language:[1]

• Tell the difference between what is real and not real
• Think clearly
• Have normal emotional responses
• Act normally in social situations

The first two pertain to thinking and the second two to emotions. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:16, 8 May 2014 (UTC)

How about, "Schizophrenia is a mental disorder characterized by hallucinations, delusions, inability to experience pleasure, and severe emotional distress"? Looie496 (talk) 03:37, 9 May 2014 (UTC)

Umm, "inability to experience pleasure" is not true. Cas Liber (talk · contribs) 04:03, 9 May 2014 (UTC)

We mention delusions and hallucinations in the next line. It is nice to have one simple line of text anyway. I am not sure what is wrong with the current wording. We could change it to "loss of normal emotions and not able to separate real from not real" Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:15, 9 May 2014 (UTC)

Whether or not anhedonia is a cardinal symptom of schizophrenia has been controversial throughout its history, so maybe it's best to leave it out of the introductory definition but discuss the controversy in the body.

DSM-IV's criteria were: disturbance present continuously for six or more months with a month or more experiencing three or more of delusions, hallucinations, disorganised speech, grossly disorganised or catatonic behaviour, negative symptoms and social/occupational dysfunction.

PubMed Health's paraphrase is accurate and simple, but their paraphrase of "negative symptoms" ("have normal emotions and responses") could be more informative, and they say nothing about duration. I'm not sure duration needs to be covered in our lede definition.

Regarding paraphrasing "negative symptoms", Ayd's Lexicon of Psychiatry, Neurology and the Neurosciences [2] says negative symptoms include: alogia, affective flattening, anhedonia/asociality, depressed appearance, avolition/apathy, psychomotor retardation and attentional impairment. How about, "and may involve inattention and reduced activity, social engagement and emotional expression"?

DSM-IV	PubMed Health	Proposed
delusions, hallucinations	tell the difference between what is real and not real	inability to distinguish what is real from what is not (I far prefer PubMed's wording. If we find that wording being used all over the place by all sorts of sources over a long period, we'd be justified in using it - but I haven't done that search yet.)
disorganised speech, grossly disorganised or catatonic behaviour	think clearly	confused or unclear thinking
negative symptoms	have normal emotions and responses	inattention, and reduced activity, emotional expression and social engagement
social/occupational dysfunction	act normally in social situations	abnormal social behaviour

This would produce something like: Schizophrenia is a mental disorder often featuring abnormal social behaviour, inability to distinguish what is real from what is not, inattention, confused or unclear thinking, and reduced activity, emotional expression and social engagement. Is that too much? Looie mentions distress. It isn't in the DSM's criteria but we aren't tied to the DSM. Is there a scholarly consensus outside the DSM that distress is a defining feature of schizophrenia? If so, is it worthy of inclusion in the defining sentence? Anthonyhcole (talk · contribs · email) 06:55, 9 May 2014 (UTC)

There are two important thing when trying to write in simple language. 1) Use short sentences 2) Use simple words. We could have "Schizophrenia is a mental disorder characterized by abnormal social behaviour and the inability to distinguish what is real from what is not. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:53, 9 May 2014 (UTC)

I'm OK with that, but saying it is characterised by these signs may be imprecise, since not all DSM signs and symptoms need to be present for a diagnosis - I think. How about, "Schizophrenia is a mental disorder often featuring abnormal social behavior and problems distinguishing what is real from what is not." Should we mention auditory hallucinations (hearing voices) early in the lede - I think they are by far the commonest kind of hallucination in schizophrenia.

What about changing from the present

Schizophrenia is a mental disorder characterized by a breakdown in thinking and poor emotional responses Common symptoms include delusions, such as paranoia; hearing voices or noises that are not there; disorganized thinking; a lack of emotion and a lack of motivation. Schizophrenia causes significant social and work problems. Diagnosis is based on observed behavior and the person's reported experiences.

to

Schizophrenia is a mental disorder often featuring abnormal social behavior and problems distinguishing what is real from what is not. Common symptoms include distress, hearing voices or noises that are not there, inattention, confused or unclear thinking, inactivity, and reduced emotional expression and social engagement. Diagnosis is based on observed behavior and the person's reported experiences.

--Anthonyhcole (talk · contribs · email) 12:23, 10 May 2014 (UTC)

I've added my proposed change. By all means revert, modify or discuss if you wish. --Anthonyhcole (talk · contribs · email) 15:03, 16 May 2014 (UTC)

Agree a good simplification. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:48, 17 May 2014 (UTC)

Schizophrenia is characterized neurologically by a single nervous subsystem attempting to recruit abnormally extreme amounts of nervous information (oversensitisation) from neighbouring subsystems not usually given to association with the said nervous subsystem (at least in such capacity), usually resulting initially in vary chaotic assemblies of information, such as hallucinations, delusions and voices. The description you have cultivated so far is external and lacking in objectivity, since it does not address the root of the development, nor even really describe it as a development. This distinction between development and disease is what most causes stigma and isolates people struggling with the condition from normal approaches to helping novel developments like this. The point being that such a development also has a synergistic zenith at which a great deal of creativity, insight and understanding is achieved. You might want to consider that.Gottservant (talk) 17:27, 19 May 2014 (UTC)

Ah? Way to complicated and not supported by refs. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:22, 20 May 2014 (UTC)

I think User:Anthonyhcole is on the right track but I would like to make a few modifications in the lead section:

It currently states:

Schizophrenia is a mental disorder often featuring abnormal social behavior and problems distinguishing what is real from what is not. Common symptoms include distress, hearing voices or noises that are not there, inattention, confused or unclear thinking, inactivity, and reduced emotional expression and social engagement. Diagnosis is based on observed behavior and the person's reported experiences.

I'd like it to state:

Schizophrenia is a mental disorder characterized by abnormal social behavior and a withdrawn reality. Common symptoms include distress, hallucinations, delusions, inattention, confused or unclear thinking, inactivity, and reduced emotional expression and social engagement. Diagnosis is based on observed behavior and the person's reported experiences, and the disorder can often lead to the onset of psychosis.

Let me know if anyone agrees, and if so, I will make those changes in the lead section. ATC ^{. Talk} 03:30, 20 May 2014 (UTC)

I don't know what withdrawn reality means. Is that commonly used in reliable sources? Even if it is, if the average reader won't know what it means, then it's not the simple, clear opening definition we were looking for. Am I the only person not understanding the term? Pinging ATC, Doc James, Cas Liber, Looie496, Gottservant. --Anthonyhcole (talk · contribs · email) 07:33, 20 May 2014 (UTC)

Have never heard of "a withdrawn reality" either. Doc James (talk · contribs · email) (if I write on your page reply on mine) 09:01, 20 May 2014 (UTC)

This is not clear either "and the disorder can often lead to the onset of psychosis." One of the symptoms of schizophrenia is psychosis. Doc James (talk · contribs · email) (if I write on your page reply on mine) 09:24, 20 May 2014 (UTC)

I see what you're saying. How about this instead:

Schizophrenia is a mental disorder characterized by abnormal social behavior and a loss of contact with reality. Common symptoms include distress, hallucinations, delusions, inattention, confused or unclear thinking, inactivity, and reduced emotional expression and social engagement. Diagnosis is based on observed behavior and the person's reported experiences.

Let me know if that wording is better. ATC ^{. Talk} 11:14, 20 May 2014 (UTC)

What don't you like with "problems distinguishing what is real from what is not"? Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:15, 20 May 2014 (UTC)

Both the proposed wording and the current "problems distinguishing what is real from what is not" are used in reliable sources in descriptions of psychosis. The proposed wording seems to be more common in reliable sources - judging from a Google Scholar search for "psychosis" and "loss of contact with reality" (1,350 results), "what is real from what is not" (43) and "what is real and what is not" (406). I'm wondering if the lay reader will find the current wording easier to grasp than the proposed wording, though. Doesn't "loss of contact with reality" describe complete unconsciousness? --Anthonyhcole (talk · contribs · email) 12:41, 20 May 2014 (UTC)

Right - I have not heard nor seen "withdrawn reality". I also don't like any form of "what is real/what is not" - what happens is that some people develop delusions - i.e. falsely-held rigid beliefs. Many of these are quite circumscribed, thus a person might develop an idea that they are being followed or filmed by someone, but they still otherwise are oriented to time, place and person, and know and remember friends/family etc. and hence have no "loss of reality" otherwise. Yes occasinally I will see people that are so psychotic they have a global breakdown in reality-testing, but this is rarer than seeing folks with more circumscribed/limited delusions. Hence only a minority of people with delusions have "failed reality testing". Accuracy is compromised too much by the wording.Cas Liber (talk · contribs) 13:03, 20 May 2014 (UTC)

Hence the best wording is

Schizophrenia is a mental disorder characterized by delusions, hearing voices, and disorganised thinking. Disturbed social and interpersonal functioning, cognitive problems, inactivity, and reduced emotional expression are common features. Diagnosis is based on observed behavior and the person's reported experiences.

A little complicated but okay. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:19, 20 May 2014 (UTC)

Thanks Cas. I'm more comfortable with that, as it mirrors the DSM better. It seems to say, though (or may be read as saying) that delusions, auditory hallucinations and thought disorder are all essential, while the other DSM signs and symptoms are common. My layman's understanding of the DSM criteria is that any three of delusions, hallucinations, thought disorder, negative symptoms and social/occupational dysfunction (along with the necessary time profile) are sufficient for a diagnosis. How do you feel about

Schizophrenia is a mental disorder often featuring delusions, hearing voices, and disorganised thinking. Disturbed social and interpersonal functioning, cognitive problems, inactivity, and reduced emotional expression are other common features. Diagnosis is based on observed behavior and the person's reported experiences.

Can you tell me where you're getting "cognitive problems" from? If it is referring to thought disorder, it's redundant. If it's referring to negative symptoms, can you point me to a definition of negative symptoms that you're paraphrasing with "cognitive problems", please? I'm hoping we can find a form of words that is clearer to the lay reader.

What is your reason for replacing the DSM's social and occupational functioning with social and interpersonal functioning? --Anthonyhcole (talk · contribs · email) 13:48, 20 May 2014 (UTC)

I agree with User:Casliber. While it may say "what is real/what is not" in the DSM, it is too wordy for an encyclopedia article in my opinion.

According to DSM criteria, it should state:

Schizophrenia is a mental disorder characterized by delusions, hallucinations, disorganized speech, and reduced emotional expression. Disorganized thinking, catatonia, and inactivity are other common features. Diagnosis is based on whether it impairs the person's social and interpersonal functioning as well as their observed behavior and reported experiences.

ATC ^{. Talk} 20:02, 20 May 2014 (UTC)

@Anthonyhcole - see, to me "characterised" does not mean "essential", but if it does to most others I am happy for it to be tweaked. Yeah remove the cognitive bit - it is not from DSM but from the fact of the findings of deficits in complex task formation when tested. Need to get in there somehow that the hallucinations are almost always auditory in nature - and whether 'hearing voices" is needed/desirable for accessibility over "(most commonly) auditory hallucinations"...the run-on "and" in ATC's version I am not thrilled about, and "while" is a tad contrastive -I like it but I think others would have a problem (???) Cas Liber (talk · contribs) 20:11, 20 May 2014 (UTC)

I was going by DSM's criterion. Also, "characterized" are used in the lead sections for the featured articles Autism, Tourette syndrome, and Asperger syndrome so I'm more comfortable with that word. Plus, by DSM's criterion, it's "hallucination" in general. You are talking about paranoid schizophrenia which is auditory mainly; the other ones vary which is why I wrote in more broad. ATC ^{. Talk} 23:41, 20 May 2014 (UTC)

Actually lets change "reduce" to "lack":

Schizophrenia is a mental disorder often characterized by false beliefs, hallucinations, disorganized speech, and lack of emotional expression. Other common symptoms include confused or unclear thinking, abnormal behavior, inactivity, and impaired social functioning. Diagnosis is based on the person's observed behavior and reported experiences.

ATC ^{. Talk} 23:59, 20 May 2014 (UTC)

When you are saying "there is a problem distinguishing real from not real" actually that is a problem of nerves correctly siphoning information from a dependable source (input source), that is, rerouting reliable information into neurological subsystems that generate delusions, voices and hallucinations. The condition is neither the information itself, nor the way it is used specifically, but the interaction of the two. Once again, you are making a problem of what is symptomatic of the problem as if that is the problem itselfGottservant (talk) 08:57, 22 May 2014 (UTC)

The current classification is dependent on descriptors. So far there are only hints at the pathological processes underneath.Cas Liber (talk · contribs) 13:09, 22 May 2014 (UTC)

The problems are basically objective siphoning errors = hallucinations, balance siphoning errors = delusions and subjective siphoning errors = voices. If its not any one of these you have contextual siphoning errors = disordered thinking.

EDIT: I realize that without sources I am basically delaying the conversation in a wikipedia context, but what I am hoping is that you will a) see the simplicity of identifying it as a procedural deviance (from normal neurological functioning) b) admit a difference between diagnostic and symptomatic definitions (I don't think you should give a symptomatic definition without explicitly stating it as such) and possibly c) adhere to a strict objective definition of it as a discreet state (not a "disease" or "pathological psychosis" et al)

If you sneeze while brushing your teeth, you don't say well this is a sneezism that results in toothpaste going everywhere and possibly some pjama soiling, no! You say it is a nervous reaction to an allergen, that has a spontaneous connection with muscle spasms. But you are currently arriving at a definition that sounds like the former!

Gottservant (talk) 14:47, 22 May 2014 (UTC)

I'm just saying symptomatically it is hallucinations, delusions and voices, but diagnostically in a precise sense, it is obviously some sort of process to do with nervous volatility (specifically the volatility of the siphoning of information, whether internally or externally because the effect is entirely perspectival).Gottservant (talk) 04:09, 23 May 2014 (UTC)

I'm in a remote location with limited internet access. (We were told internet was reliable but for now it involves climbing a rather high hill.) I'll re-engage here when we've secured a reliable connection but don't know when that will be. Please proceed without me. --Anthonyhcole (talk · contribs · email) 06:16, 25 May 2014 (UTC)

It might be helpful to define schizophrenia as being "out of sync" with reality, until such time as mechanisms are known. I can speculate that its a siphoning error, because it pertains to neurological processing and produces particular phenomena, but I can't substantiate that. But again I stress, it is not merely a disease (a term which is used very loosely by most people) nor necessarily pathological.Gottservant (talk) 03:43, 27 May 2014 (UTC)

Changes

Have reverted [3]

1. Not sure what "Many causes of schizophrenia also occur in causing psychosis." means
2. Not sure why "A significant proportion of people with schizophrenia use cannabis to help cope with its symptoms. " was moved
3. This ref does not work http://www.neuroscience.cam.ac.uk/publications/pubInfo.php?foreignId
4. This is a primary source [4] Please use secondary sources per WP:MEDRS
5. Please formatted refs the same as the rest of the article. WP:MEDHOW. Can help. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:46, 11 May 2014 (UTC)

Beans

Can somebody add to the article that beans can cause schizophrenia? The article itself unfortunately seems to be semiprotected. — Preceding unsigned comment added by 87.122.31.224 (talk) 11:54, 19 May 2014 (UTC)

To add that to this article -- or any of the other extremely unlikely claims you are making to other articles -- we would need reliable sources. - SummerPhD (talk) 14:05, 19 May 2014 (UTC)