Talk:Schizophrenia

References

The "references" section built incorrectly. You should list all the books used in this article at the bibliography subpage. & then list all the notes like <ref>Name, Year. page number.</ref> within the article. And name the section "Notes"

(Chunbum Park 11:20, 5 January 2008 (CST))

I'm not sure I understand. There are no books used in the article, only journal articles. The reference style I'm following seems fairly standard with other medical articles. If I've missed something here, let me know. Richard Pettitt 00:19, 7 January 2008 (CST)

Oh, books, or scholarly journal articles. 1) ppl want in which page you find the info within the article 2) it takes too much space & gets too complicated to copy-paste author date title chapter title isbn publisher copyright etc. So... all the author title date isbn publisher thing goes on the bibliography page. on the "notes section" within the mainspace article you just have "name, date. pp.x". See Japanese invasions of Korea (1592-1598). (Chunbum Park 15:16, 9 January 2008 (CST))

From what I know, the usual convention is to list which pages the article is found within the journal, but not to list which pages within the article you've found the material. Secondly, the references style I'm using isn't much work at all. Using pubmed.com gives you a PMID number which I plug into a template [1] and it does all the work for me. (Believe me, I'm not about to do more work than I have to.) That's why I'm leaving things the way they are. :) Richard Pettitt 13:39, 18 January 2008 (CST)

WHO study

I believe a WHO study showed that people who had less access to antipsychic meds had a higher quality of life than those who could afford the meds. I'm assuming this is the "in a glass jar" effect of being on meds. I'm not advocating no meds, but i think this data is something that should be mentioned and is significant.

I also believe I read that 2/3 of homeless in Los Angeles are schizophrenic. Tom Kelly 21:39, 14 January 2008 (CST)

Ok, 2/3 seems too high. Tom Kelly 22:14, 15 January 2008 (CST)

I'm not familiar with this WHO study. Could you dig it up? Also, I added a study on the prevalence of schizophrenia among the homeless.Richard Pettitt

Schizophr Bull. 2000;26(4):835-46.

Revisiting the developed versus developing country distinction in course and outcome in schizophrenia: results from ISoS, the WHO collaborative followup project. International Study of Schizophrenia. Hopper K, Wanderling J.

Evidence of differences in illness trajectory in favor of the developing centers was consistently found. Six potential sources of bias are then examined: differences in followup, arbitrary grouping of centers, diagnostic ambiguities, selective outcome measures, gender, and age. None of these potential confounds explains away the differential in course and outcome. We conclude with suggestions for further research, with particular attention to the need for close documentation of everyday practices in the local moral worlds that "culture" refers to.

Pierre-Alain Gouanvic 14:07, 28 January 2008 (CST)

From my reading of the article, it seems the matter of treatment outcomes in developed vs developing is far from clear. I'm not sure what we could add to this article that would be informative... maybe that there's a possible difference in treatment outcomes between developed and developing countries? Suggestions? --Richard Pettitt 21:43, 28 January 2008 (CST)

effect of war on schizophrenia

I believe this would be an important section to the article.Tom Kelly 21:47, 14 January 2008 (CST)

percentage of schizophrenics who chain smoke

can you say self medicate? One of those 2,000+ chemicals in cigarette smoke must be doing something we have not yet discovered. Tom Kelly 21:47, 14 January 2008 (CST)

I added something on cigarettes under the treatment section.Richard Pettitt

I know that one hypothesis, theory, and some preliminary data predict that another chemical in cigarettes may be the chemical they self-medicate with (because nicotine alone doesn't explain the smoking. I will ask around for more info. Tom Kelly 22:10, 15 January 2008 (CST)

Yes, tobacco contains monoamine oxidase inhibitors (harman, or something like that), and clinical research suggested that they are at least in great part responsible for reinforcement of the urge to self-administer tobacco. OTOH, MAOI can cause schizophrenia-like symptoms. There's definitely something to dig here, IMO. The research I have in mind was done in France. Gotta go. Pierre-Alain Gouanvic 13:24, 16 January 2008 (CST)

Neuropharmacology. 2007 May;52(6):1415-25. Epub 2007 Feb 20.

Tranylcypromine enhancement of nicotine self-administration.

Moreover, an increase in extracellular dopamine in the nucleus accumbens was detected, using microdialysis, following nicotine (60 microg/kg) injection in tranylcypromine pre-treated rats. Depending on the time of tranylcypromine pretreatment (20 or 1 h), MAO activity was decreased by 72% and 99% and nicotine intake at day 5 was increased by 619 and 997%, respectively. Taken together, these results indicate that in a stringent self-administration acquisition test, MAO inhibition increases the rewarding effect of low doses of nicotine, possibly via a dopamine-dependent mechanism.

Schizophrenia is an hyperdopaminergic disorder, IMAOs cause dopamine elevations; high dopamine contributes to the reinforcement of tobacco addiction; schizophrenics require lower doses of the IMAO in tobacco to get the reinforcing effect. IMO. Pierre-Alain Gouanvic 19:20, 17 January 2008 (CST)

Schizophrenia is a hyper- and hypo-dopaminergic disorder: mesolimbic and mesocorticol dopamine pathways, respectively. (I should probably get around to adding that to the article). So while what you're saying about nicotine's pharmacological effects are true, I believe that nicotine is consumed in an attempt to raise dopaminergic functioning to reduce negative symptoms, rather than for its pleasurable effects. Ideally I'd like an article that speaks more directly to the connection between nicotine's MAO inhibition action and schizophrenia before adding this to the article. Also, I've never heard of a MAOI-schizophrenia connection. I'd be interested in learning more if you could find that research you've mentioned.Richard Pettitt 13:39, 18 January 2008 (CST)

keyboard.problems...: Drugs of abuse, such as D-amphetamine, cocaine, morphine, or heroin, share the ability to cause addiction in humans and to increase release of dopamine (DA) in the nucleus accumbens...However, animal experiments indicate some discrepancies between the effects of nicotine and those of other drugs of abuse. For example, the stimulation of DA release in the nucleus accumbens after several nicotine injections remains controversial...One of the most striking differences between the effects of nicotine and those of other drugs of abuse concerns its locomotor effects. Although psychostimulants and opiates induce a substantial locomotor hyperactivity both in rats and mice, nicotine is a weak locomotor stimulant in rats and generally fails to induce locomotor hyperactivity in mice at any dose...Our data suggest that MAOIs contained in tobacco and tobacco smoke act in synergy with nicotine to enhance its rewarding effects. PMID: 16395299 Monoamine Oxidase Inhibitors Allow Locomotor and Rewarding Responses to Nicotine sorry...Pierre-Alain Gouanvic 15:32, 18 January 2008 (CST)

but: Schizophrenia and functional polymorphisms in the MAOA and COMT genes: no evidence for association or epistasis. PMID: 12116182 Pierre-Alain Gouanvic 16:52, 18 January 2008 (CST)

still: Efficacy of selegiline add on therapy to risperidone in the treatment of the negative symptoms of schizophrenia: a double-blind randomized placebo-controlled study.... as you said (in an attempt to raise dopaminergic functioning to reduce negative symptoms) Pierre-Alain Gouanvic 17:05, 18 January 2008 (CST)

I added an article on the link between nicotine as an MOAI and schizophrenia. Let me know what you think. Richard Pettitt 17:24, 19 January 2008 (CST)

I provided some details and distinguished nicotine from other psychoactive tobacco components; it gave me the opportunity to mention the use of MAOI in schizophrenia (as you underlined above). I'm going to contact Tom Kelly to let him know that we have followed up on his advice. Pierre-Alain Gouanvic 13:16, 28 January 2008 (CST)

First person account, to fill the gap left by the DSM copyright restriction

Hello,

I wonder if we could use the moving story told by an investigator in the fields of paranoia and schizophrenia research, published in Schizophrenia Bulletin 2007 33(1):166-17: Peer-Professional First-Person Account: Schizophrenia From the Inside—Phenomenology and the Integration of Causes and Meanings, Peter K. Chadwick. See top of page for permissions. Pierre-Alain Gouanvic 19:06, 17 January 2008 (CST)

I think having case studies within mental health articles is a great idea. I'm not sure how we'd use this particular story, however, due to its length. Maybe as a signed article?

I'm going to look to see if I can find any short and concise case studies we can use... Richard Pettitt 13:39, 18 January 2008 (CST) Update: I`ve emailed a professor for use of a case report he wrote... hopefully he gets back to me soon. --Richard Pettitt 10:05, 23 January 2008 (CST)

No first person accounts in the article. I addressed this with Pierre-Alain on another article. --Michael J. Formica 17:12, 27 January 2008 (CST)

I'm sorry, I didn't realize you had made the official policy on this. Could you link to this discussion you're talking about? -Richard Pettitt 17:27, 27 January 2008 (CST)

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I think a well-chosen, brief first person-account (or part of one), particularly an excerpt from one that is well-known, would add a great deal to the article and help "bring it home" to a lot of people. However, I don't think it should be within the main text. Instead, see Butler and scroll down and note the "Sidenotes" there that are separated from the main text. Like I said, I think one brief first-person account, situated like that, would be a very interesting addition to the article. Stephen Ewen 00:33, 29 January 2008 (CST)

Image

As an editor, I have taken the liberty of removing the image originally attached in this article. I do not feel it is appropriate, and lacks clinical distance. Comments welcome. --Michael J. Formica 17:14, 27 January 2008 (CST)

Could you explain what you mean by "appropriate", and how a painting could possibly have clinical distance? Had you looked at the origin of the image, you would have found the Public Library of Science - Medicine used the image with the caption: "This painting is frequently used to teach undergraduates what a person with schizophrenia experiences". The peer-reviewers at the PLoS clearly believe it is appropriate, and I do as well.--Richard Pettitt 17:24, 27 January 2008 (CST)

Manifestly, this (pictorial) first-person account, like other first-person accounts, is appropriate. Pierre-Alain Gouanvic 01:02, 28 January 2008 (CST)

That's the point...the picture does not have clincial distance. If you can find a documented reference, rather than a caption in a textbook, I'd be fine with it. --Michael J. Formica 08:10, 28 January 2008 (CST)

I'm not going to press this issue any farther, but I would appreciate if you took a look at the image's source. Thanks. --Richard Pettitt 18:49, 28 January 2008 (CST)

40's

"although a variant of the disorder, identified clinically as paranoid schizophrenia, typically evidences itself in the early 40's, with little or no demonstrable symptom history."

Two concerns. First, since we're having some disagreement over the word evidence, perhaps we could agree on the word 'manifest'? Secondly, can we get a reference for how the paranoid subtype occurs in the 40's? I'm not familiar with any sources that state this.--Richard Pettitt 17:46, 27 January 2008 (CST)

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Further, as I've noted, the word evidence used here is correct in that it is a verb in clinical jargon. Manifest would work.

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Blessings... --Michael J. Formica 07:58, 28 January 2008 (CST)

substances as risk factor. not worded as well as could be

Ok, you can argue that substances can fit the definition of a risk factor. HOWEVER, it is more likely that these individuals already were on track for developing psychotic events - a predisposition almost. So that when they decrease inhibitory neurons, the psychosis emerges. I may not be wording this correctly. Psychosis from substance abuse is a sign of possible problems to come. I would not exactly say it is a risk factor, but people say it is risk factor, because the texts still call it that. I would say, hmmm... unusually psychosis from substance... this patient may have a higher chance of showing schizophrenia in the future... I believe, obviously, that it is not alone causing schiz., but more that it is revealing something else. It's almost a forewarning. However, this is not well studied and is merely an observation by many (EDIT: i actually don't know how well this is studied; maybe worth looking up). There is no guarantee that psychosis is schizophrenia and delirium is probably more likely anyway - and as you probably know, delirium has a myriad causes. There is still much to uncover with chemicals and the brain, obviously. But, I think the wording is misleading about risk factor from cannabis. The same can be said about alcohol. I really, strongly feel that since the age of onset of schiz (in many individuals) is higher than age of trying substances, you see the psychosis, in a way, revealing the predisposition to schizophrenia or other conditions/diseases of the CNS/psyche. Yet, you're going to need multiple papers to add these ideas to the article. I would just recommend taking another look at the words risk factors relating substances like alcohol, marijuana, etc. Inhibitory neurons and neurotransmitters are fascinating by the way. Look up Dr. Zoltan Tokes. Tom Kelly 14:32, 28 January 2008 (CST)

Sorry I don't have time to help more. Tom Kelly 14:37, 28 January 2008 (CST)

A risk factor means something has been correlated with the disorder. The literature has been fairly consistent in reporting that the earlier a person begins smoking, and the more they smoke, the more likely they are to develop schizophrenia. Saying cannabis use is a risk factor is not making a causal link.--Richard Pettitt 18:45, 28 January 2008 (CST)

pregnancy / post partum schiz

while rare, it deserves mention. A lot of good articles out there on post-partum pysche issues. Tom Kelly 14:40, 28 January 2008 (CST)

as with most pregnancy related psych issues, developing initial problems after pregnancy is more common than during. However, I don't think applies for existing psych problems (taking patient off medication for pregnancy, etc). Tom Kelly 14:44, 28 January 2008 (CST)

cope wording

I don't like the words 'more easily' cope... would 'better cope' be better? Tom Kelly 14:50, 28 January 2008 (CST)

Sure, why not. If someone else feels strongly about it, I'm sure they'll change it.--Richard Pettitt 19:21, 28 January 2008 (CST)

..."identified as..."

That phrase in the lede is needless and rings to me like less than the best way to write it. The Mayo Clinic opens, "Schizophrenia is a chronic and often debilitating mental illness." I think the lede here should read, "Schizophrenia is identified as a mental disorder characterized by patterns of disordered thought, language, motor, and social function." Stephen Ewen 00:26, 29 January 2008 (CST)