User talk:Stefanie Iskia

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Welcome![edit]

Hello, Stefanie Iskia! Welcome to Wikipedia! Thank you for your contributions. You may benefit from following some of the links below, which will help you get the most out of Wikipedia. If you have any questions you can ask me on my talk page, or place {{helpme}} on your talk page and ask your question there. Please remember to sign your name on talk pages by clicking or by typing four tildes "~~~~"; this will automatically produce your name and the date. If you are already excited about Wikipedia, you might want to consider being "adopted" by a more experienced editor or joining a WikiProject to collaborate with others in creating and improving articles of your interest. Click here for a directory of all the WikiProjects. Finally, please do your best to always fill in the edit summary field when making edits to pages. Happy editing! Spyder212 (talk) 16:12, 30 June 2019 (UTC)[reply]
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Welcome to Wikipedia from the Medicine WikiProject![edit]

Welcome to Wikipedia and WikiProject Medicine

Welcome to Wikipedia from WikiProject Medicine (also known as WPMED).

We're a group of editors who strive to improve the quality of medical articles here on Wikipedia. One of our members has noticed that you are interested in editing medical articles; it's great to have a new interested editor on board. In your wiki-voyages, a few things that may be relevant to editing Wikipedia articles are:

  • Thanks for coming aboard! We always appreciate a new editor. Feel free to leave us a message at any time on our talk page. If you are interested in joining the project yourself, there is a participant list where you can sign up. Please leave a message on the WPMED talk page if you have any problems, suggestions, would like review of an article, need suggestions for articles to edit, or would like some collaboration when editing!
  • Sourcing of medical and health-related content on Wikipedia is guided by our medical sourcing guidelines, commonly referred to as MEDRS. These guidelines typically require recent secondary sources to support information; their application is further explained here. Primary sources (case studies, case reports, research studies) are rarely used, especially if the primary sources are produced by the organisation or individual who is promoting a claim.
  • The Wikipedia community includes a wide variety of editors with different interests, skills, and knowledge. We all manage to get along through a lot of discussion that happens under the scenes and through the bold, revert, discuss editing cycle. If you encounter any problems, you can discuss them on an article's talk page or post a message on the WPMED talk page.

Feel free to drop a note on my talk page if you have any problems. I wish you all the best on your wiki voyages! Spyder212 (talk) 16:13, 30 June 2019 (UTC)[reply]

Asking questions of reader[edit]

Hi Stefanie Iskia, I removed a sentence that you added to Schizophrenia. Wikipedia style guide says Do not address the reader with the Socratic method by asking and answering questions.. I wanted to explain because there are so many policies and guidelines and instructions for Wikipedia articles that it's impossible to learn them all, especially when you first start editing. I happened to know that one because I stumbled across it myself. Happy editing! UrbanToreador (talk) 16:36, 30 June 2019 (UTC)[reply]

Welcome[edit]

Welcome to Wikipedia and Wikiproject Medicine

Welcome to Wikipedia! We have compiled some guidance for new healthcare editors:

  1. Please keep the mission of Wikipedia in mind. We provide the public with accepted knowledge, working in a community.
  2. We do that by finding high quality secondary sources and summarizing what they say, giving WP:WEIGHT as they do. Please do not try to build content by synthesizing content based on primary sources.
  3. Please use high-quality, recent, secondary sources for medical content (see WP:MEDRS; for the difference between primary and secondary sources, see the WP:MEDDEF section.) High-quality sources include review articles (which are not the same as peer-reviewed), position statements from nationally and internationally recognized bodies (like CDC, WHO, FDA), and major medical textbooks. Lower-quality sources are typically removed. Please beware of predatory publishers – check the publishers of articles (especially open source articles) at Beall's list.
  4. The ordering of sections typically follows the instructions at WP:MEDMOS. The section above the table of contents is called the WP:LEAD. It summarizes the body. Do not add anything to the lead that is not in the body. Style is covered in MEDMOS as well; we avoid the word "patient" for example.
  5. We don't use terms like "currently", "recently," "now", or "today". See WP:RELTIME.
  6. More generally see WP:MEDHOW, which gives great tips for editing about health -- for example, it provides a way to format citations quickly and easily
  7. Citation details are important:
    • Be sure cite the PMID for journal articles and ISBN for books
    • Please include page numbers when referencing a book or long journal article, and please format citations consistently within an article.
    • Do not use URLs from your university library that have "proxy" in them: the rest of the world cannot see them.
    • Reference tags generally go after punctuation, not before; there is no preceding space.
  8. We use very few capital letters (see WP:MOSCAPS) and very little bolding. Only the first word of a heading is usually capitalized.
  9. Common terms are not usually wikilinked; nor are years, dates, or names of countries and major cities. Avoid overlinking!\
  10. Never copy and paste from sources; we run detection software on new edits.
  11. Talk to us! Wikipedia works by collaboration at articles and user talkpages.

Once again, welcome, and thank you for joining us! Please share these guidelines with other new editors.

– the WikiProject Medicine team Doc James (talk · contribs · email) 22:47, 30 June 2019 (UTC)[reply]

Moving here for further work[edit]

This needs more work per the above. Specifically it should be based on review articles and needs to follow WP:MEDMOS. Please share these with the rest of your class. Best Doc James (talk · contribs · email) 22:49, 30 June 2019 (UTC)[reply]

Schizophrenia and sleep

Currently, little research is done on the relationship of schizophrenia and sleep.[1][2] Recent evidence shows that sleep distortions with insomnia like symptoms are very common in schizophrenic patients.[1] Studies found that up to 80% of schizophrenic patients are suffering from sleep distortions or comorbid sleep disorders.[1][3]

However, the common presence of sleep distortions in schizophrenia is not reflected in the diagnostic criteria of schizophrenia in the DSM-V.[4] In contrast, they have made their way into the German ‘Leitlinie’. [5] The ‘Leitlinie’ contains the most recent research and serves therapists as a guidance instrument for therapy.[5]

At present, little is known about schizophrenia and its therapy.[2] Most schizophrenic patients suffer of sleep distortions which suggests the presence of a potential relationship between the two phenomena.[6] Thus, treating sleep distortions might enhance overall functionality and well-being of the patients.[2] Furthermore, comorbid sleep disturbances lead to more severe clinical symptoms.[3] It has been shown that a treatment of sleep disturbances in schizophrenic patients improves overall functioning, the clinical status[3] and sleep quality.[7]

Insomnia and other sleep disorders or disturbances should be targeted in the treatment of schizophrenia, all the more as there is evidence showing that insomnia can precede psychotic experiences.[8] It has also been shown that a treatment of sleep distortions can reduce psychotic symptoms.[8] Moreover, understanding sleep distortions in schizophrenia helps to better understand schizophrenia and additionally offers new pathways of multimodal treatment.[9]

Sleep distortions in schizophrenia may be caused by psychosis, sleep apnoea, motor activity or side effects of medication.[5][10] Deregulation of certain clock genes and insufficient light exposure are two more factors with the potential to lead to sleep distortions.[10]

Sleep distortions lead to higher levels of the neurotransmitter ‘dopamine’ and increase the sensitivity for dopamine.[11] At the same time, a lot of dopamine alters the circadian rhythm and leads to sleep distortions.[11] A research group argues that therefore, sleep distortions should be addressed directly in the treatment of schizophrenia.[11]

Furthermore, social factors influence sleep in schizophrenia.[2] Schizophrenic patients might take sleep as an opportunity to escape.[2] Additionally, a weak social ‘Zeitgeber’ (lack of a time structuring social environment) may lead to sleep distortions. [10] That means that schizophrenic patients have a tendency for a less time-structuring social environment.[10]

A research group proposes an integrated approach with a psychological or environmental stressor starting a vicious circle and leading to sleep distortions.[11] These sleep distortions provoke an alteration in dopamine receptor activity which leads to psychosis. [11] A psychosis is then followed by increased activity levels which leads to circadian abnormalities, causing further sleep distortions.[11] Genetics may influence the vicious circle at any point.[11]

In schizophrenic patients, insomnia constitutes the most frequently present sleep disorder.[3] Schizophrenic patients particularly have problems with sleep-onset and maintenance.[10][9] Analyzing the sleep architecture, slow-wave sleep (SWS) and Rapid Eye Movement Sleep Onset Latency (REMOL) was shown to be altered in schizophrenia.[10] In contrast, Rapid Eye Movement (REM) sleep does not show irregularities.[10] Other symptoms are for example an altered total sleep time, sleep latency, and a higher number of awakenings.[12]

Sleep in schizophrenic patients is affected at two different points.[12] Disturbances of the circadian rhythm (macrostructure) and changes in sleep architecture (microstructure) were found.[12][13] Changes in sleep architecture are particularly represented by a reduced number of sleep spindles.[14][15]

In 2012, a study with schizophrenic patients found macro structural abnormalities in the form of severe circadian misalignments in 50% of the participants.[16] They occurred in the form of phase advanced or delayed circadian rhythm or non-24h-cycles of sleep-wake rhythm and cycle of melatonin production.[16] In addition, excessive sleep or fragmented sleep epochs were observed in half of the patients.[16]

It has also been shown that thalamocortical structures are altered in schizophrenia.[17][18] These structures influence delta sleep.[17] Therefore, schizophrenic patients show a smaller number of delta waves throughout the night[15][17], which leads to an instability of sleep-cycles.[13] However, while some studies link reduced delta sleep to negative symptoms[9][17][14], others link it to positive symptoms such as psychosis.[9] [18]

A study conducted in 2014 found a high correlation between the severity of clinical schizophrenia symptoms and disturbances during sleep which was measured using polysomnography (PSG).[12] Testing 30 schizophrenic patients and 30 healthy controls (and 30 patients with major depression), they were able to detect schizophrenia correctly with a chance of 88%.[12] The research group did so only by watching PSG parameters of participants during sleep, while conducting an LDA (linear discriminant analysis).[12]

Recent research proposes that insomnia in schizophrenic patients may lead to the development of psychotic episodes. [9][8] This is predominantly caused by insomnia increasing negative affect.[8] The link between insomnia and psychotic episodes appears to be bidirectional, although psychotic episodes leading to insomnia seems to occur less frequently.[8] This shows once more that insomnia should be targeted in therapy.[8]

Presently, limited research exists on the effects of antipsychotics on sleep.[19] Typical, 1st generation antipsychotics (e.g. haloperidol, thiothiexene, flupentixol) seem not to increase sleep architecture.[20] Atypical, 2nd generation antipsychotics (e.g. clozapine), conversely, seem to have a direct effect on sleep architecture.[19][21] Antipsychotics should therefore be considered carefully as withdrawal could have negative effects on sleep quality and drug weaning could provoke rebound insomnia.[19]

  1. ^ a b c Wulff, K., Gatti, S., Wettstein, J. G., & Foster, R. G. (2010). Sleep and circadian rhythm disruption in psychiatric and neurodegenerative disease. Nature Reviews Neuroscience, 11(8), 589–599. https://doi.org/10.1038/nrn2868
  2. ^ a b c d e Faulkner, S., & Bee, P. (2017). Experiences, perspectives and priorities of people with schizophrenia spectrum disorders regarding sleep disturbance and its treatment: A qualitative study. BMC Psychiatry, 17(1). https://doi.org/10.1186/s12888-017-1329-8
  3. ^ a b c d Laskemoen, J. F., Simonsen, C., Büchmann, C., Barrett, E. A., Bjella, T., Lagerberg, T. V., … Aas, M. (2019). Sleep disturbances in schizophrenia spectrum and bipolar disorders – a transdiagnostic perspective. Comprehensive Psychiatry, 91, 6–12. https://doi.org/10.1016/j.comppsych.2019.02.006 Cite error: The named reference "Laskemoen2019" was defined multiple times with different content (see the help page).
  4. ^ American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
  5. ^ a b c DGPPN e.V. (Hrsg.) für die Leitliniengruppe: S3-Leitlinie Schizophrenie. Kurzfassung, 2019, Version 1.0, zuletzt geändert am 15. März2019, verfügbar unter: https://www.awmf.org/leitlinien/detail/ll/038-009.html
  6. ^ Monti, J. M., BaHammam, A. S., Pandi-Perumal, S. R., Bromundt, V., Spence, D. W., Cardinali, D. P., & Brown, G. M. (2013). Sleep and circadian rhythm dysregulation in schizophrenia. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 43, 209–216. https://doi.org/10.1016/j.pnpbp.2012.12.021
  7. ^ Cohrs, S. (2008). Sleep Disturbances in Patients with Schizophrenia: Impact and Effect of Antipsychotics. CNS Drugs, 22(11), 939–962. https://doi.org/10.2165/00023210-200822110-00004
  8. ^ a b c d e f Reeve, S., Nickless, A., Sheaves, B., & Freeman, D. (2018). Insomnia, negative affect, and psychotic experiences: Modelling pathways over time in a clinical observational study. Psychiatry Research, 269, 673–680. https://doi.org/10.1016/j.psychres.2018.08.090
  9. ^ a b c d e Chung, K.-F., Poon, Y. P. Y.-P., Ng, T.-K., & Kan, C.-K. (2018). Correlates of sleep irregularity in schizophrenia. Psychiatry Research, 270, 705–714. https://doi.org/10.1016/j.psychres.2018.10.064
  10. ^ a b c d e f g Monti, J. M., BaHammam, A. S., Pandi-Perumal, S. R., Bromundt, V., Spence, D. W., Cardinali, D. P., & Brown, G. M. (2013). Sleep and circadian rhythm dysregulation in schizophrenia. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 43, 209–216. https://doi.org/10.1016/j.pnpbp.2012.12.021
  11. ^ a b c d e f g Yates, N. J. (2016). Schizophrenia: The role of sleep and circadian rhythms in regulating dopamine and psychosis. Reviews in the Neurosciences, 27(7), 669–687. https://doi.org/10.1515/revneuro-2016-0030
  12. ^ a b c d e f Ilanković, A., Damjanović, A., Ilanković, V., Filipović, B., Janković, S., & Ilanković, N. (2014). Polysomnographic sleep patterns in depressive, schizophrenic and healthy subjects. Psychiatria Danubina, 26(1), 0–26.
  13. ^ a b Sasidharan, A., Kumar, S., Nair, A. K., Lukose, A., Marigowda, V., John, J. P., & Kutty, B. M. (2017). Further evidences for sleep instability and impaired spindle-delta dynamics in schizophrenia: A whole-night polysomnography study with neuroloop-gain and sleep-cycle analysis. Sleep Medicine, 38, 1–13. https://doi.org/10.1016/j.sleep.2017.02.009
  14. ^ a b Wilson, S., & Argyropoulos, S. (2012). Sleep in schizophrenia: Time for closer attention. British Journal of Psychiatry, 200(4), 273–274. https://doi.org/10.1192/bjp.bp.111.104091
  15. ^ a b Keshavan, M. S., Reynolds, C. F., Miewald, J. M., Montrose, D. M., Sweeney, J. A., Vasko, R. C., & Kupfer, D. J. (1998). Delta Sleep Deficits in Schizophrenia: Evidence From Automated Analyses of Sleep Data. Archives of General Psychiatry, 55(5), 443–448. https://doi.org/10.1001/archpsyc.55.5.443
  16. ^ a b c Wulff, K., Dijk, D.-J., Middleton, B., Foster, R. G., & Joyce, E. M. (2012). Sleep and circadian rhythm disruption in schizophrenia. The British Journal of Psychiatry, 200(4), 308–316. https://doi.org/10.1192/bjp.bp.111.096321
  17. ^ a b c d Sekimoto, M., Kato, M., Watanabe, T., Kajimura, N., & Takahashi, K. (2011). Cortical regional differences of delta waves during all-night sleep in schizophrenia. Schizophrenia Research, 126(1), 284–290. https://doi.org/10.1016/j.schres.2010.11.003
  18. ^ a b Vukadinovic, Z. (2011). Sleep abnormalities in schizophrenia may suggest impaired trans-thalamic cortico-cortical communication: Towards a dynamic model of the illness. European Journal of Neuroscience, 34(7), 1031–1039. https://doi.org/10.1111/j.1460-9568.2011.07822.x
  19. ^ a b c Cohrs, S. (2008). Sleep Disturbances in Patients with Schizophrenia: Impact and Effect of Antipsychotics. CNS Drugs, 22(11), 939–962. https://doi.org/10.2165/00023210-200822110-00004
  20. ^ Taylor, S. F., Tandon, R., Shipley, J. E., & Eiser, A. S. (1991). Effect of neuroleptic treatment on polysomnographic measures in schizophrenia. Biological Psychiatry, 30(9), 904–912. https://doi.org/10.1016/0006-3223(91)90004-6
  21. ^ Wirz-Justice, A., Haug, H.-J., & Cajochen, C. (2001). Disturbed Circadian Rest-Activity Cycles in Schizophrenia Patients: An Effect of Drugs? Schizophrenia Bulletin, 27(3), 497–502. https://doi.org/10.1093/oxfordjournals.schbul.a006890
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