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Lamotrigine

I strongly recommend someone attend to the misleading drug references in the 'Medications' section of the article; "The mainstay of treatment is a mood stabilizers such as lithium carbonate or lamotrigine". While it is true that Lamotrigine is a popular anticonvulsant class treatment for bipolar, it is not as commonly used as Sodium Valproate, for instance. So why does the article preference it? In fact this sentence looks like a sneaky advertizement for Lamotrigine, stated as "the mainstay of treatment" which is misleading. I recommend removing the reference to Lamotragine and Lithium from that sentence, or otherwise adding in Sodium Valproate.

In the very next sentence we again have a reference to Lamotrigine's benifits (even before mentioning Lithium!), but no equivalent mention of the benefits of Sodium Valproate (eg best in rapid-cycling and mixed states, and for mania in numerous studies), nor is there mention in this lead of other drugs such as SSRIs or Atypical Antipsychotics. Here's the sentence; "Lamotrigine has been found to be best for preventing depressions, while lithium is the only drug proven to reduce suicide in people with bipolar disorder".

Lamotrigine is again mentioned a few lines below, repeating the above mention that the drug is beneficial for depression; "lamotrigine, which is the first anticonvulsant shown to be of benefit in bipolar depression." This duplication also needs to be removed.

As millions of professionals and consumers consult this Wikipedia entry for guidance, I think we need to remove this preferencing of Lamotrigine as "The mainstay of treatment", especially with the concerning side effects of this drug (eg major, potentially life threatening skin disorders), not to mention its lack of efficacy for controlling mania/hypomania. We need to delete at least one of the three(!) references to this drug, or balance them out with an equal number of references to the other popular bipolar medications. I recommend the following reconstruction be used as a base to replace the current version, though someone will need to locate a few citations as I do not have time;

The mainstay of treatment are mood stabilizers such as lithium carbonate, sodium valproate, or lamotrigine. A second line of medications are antidepressants or atypical antipsychotics. These medications have a variety of different benefits, for instance lithium is effective for controlling both mania and depression, and is the only drug proven to reduce suicide in people with bipolar disorder.[73] Sodium Valproate, the most widely used mood stabilizer, is effective treatment for controlling mania, affords mild antidepressant protection, and is the most effective medication for managing rapid cycling and mixed states.[citations needed] Lamotrigine has been found to be effective for depression but not for mania.[citation needed] The first known and "gold standard" mood stabilizer is lithium,[74] while almost as widely used is sodium valproate.[75] Other anticonvulsants used in bipolar disorder include carbamazepine, reportedly effective in rapid cycling bipolar disorder [76] Atypical antipsychotics have been found to be effective in managing mania associated with bipolar disorder.[78] Antidepressants have not been found to be of any benefit over that found with mood stabilizers.[78] Omega 3 fatty acids, in addition to normal pharmacological treatment, may have beneficial effects on depressive symptoms, although studies have been scarce and of variable quality.[79] The effectiveness of topiramate is unknown.[80]

124.185.193.58 (talk) 23:02, 18 February 2012 (UTC)

Hi - it's great to see people getting involved with the article, I'm afraid we're might struggle to find the citations you've used to add the information in - could you give us some notes on where you got the information? Thanks x Fayedizard (talk) 23:16, 18 February 2012 (UTC)

No I cant, I don't have time. Anyone can type the name of each drug into Google Scholar, and they will find hundreds of quality references confirming the details I suggested in the above paragraph- an embarassment of riches. Sorry I cant help, just wanted to alert editors to the problem. 124.185.193.58 (talk) 23:17, 18 February 2012 (UTC)

That is not the way Wikipedia works. What you have written without providing sources is original research and other editors should not just search for any references which happen to support it. Anyone changing existing content or adding new content should familiarise themeselves with the necessary sources, write content based on them without violating copyright and provide suitable references. You are welcome to do so when you have the time, of course. --Mirokado (talk) 00:04, 20 February 2012 (UTC)

FWIW, I agree that lamotrigine is not a mainstay of treatment - just need to digest and clarify some consensus statements.....Casliber (talk · contribs) 00:43, 20 February 2012 (UTC)

The hyping of lamotrigine seems to be the result of a good-faith but imprecise effort to improve the article back in October 2008. --Anthonyhcole (talk) 06:53, 20 February 2012 (UTC)

Agreed. Whilst lamotrigine is highly effective for some patients, including many who are resistant to other medications, it's by no means the mainstay of treatment. Let's see if we can be a bit more balanced here. Unfortunately the anon IP who started this conversation has not given any source for their block of quoted text, and attempts to find it using search engines have come up with blanks, so that's less than helpful. -- The Anome (talk) 17:30, 20 February 2012 (UTC)

I've rejigged what we have and stumbled over a 2009 cochrane review on olanzapine for maintenance. Must update for later reviews as surely there must be some, as I suspect there is firmer evidence one way or the other now for the other agents. More later. Note we have a primary study n lamotrigine which we'll relegate once we get some review material....Casliber (talk · contribs) 19:37, 20 February 2012 (UTC)

Damn - no lamotrigine for bipolar on cochrane :(((( Casliber (talk · contribs) 21:45, 20 February 2012 (UTC)

These searches might be a useful starting point for systematic reviews etc. that mention lamotrigine:

• http://scholar.google.com/scholar?hl=en&q=lamotrigine+bipolar+systematic+review
• http://scholar.google.com/scholar?hl=en&q=lamotrigine+bipolar+evidence+based

and, combining theses two searches, this:

• http://scholar.google.com/scholar?hl=en&q=lamotrigine+bipolar+evidence+based+systematic+review

and then, restricting the search to only papers punlished since 2011, this:

• http://scholar.google.com/scholar?hl=en&q=lamotrigine+bipolar+evidence+based+systematic+review&as_sdt=0%2C5&as_ylo=2011&as_vis=0

-- The Anome (talk) 23:47, 22 February 2012 (UTC)

. . — Preceding unsigned comment added by 121.222.43.174 (talk) 11:00, 28 February 2012 (UTC)

In the medication section it should be mentioned that Lamotrigine is not effective in the treatment of acute mania. Also, the current wording that "there are concerns about the studies done" is too vague. I recommend the second sentence covering Lamotrigine be replaced with the following;

Two studies have shown it to have some benefit in preventing further episodes, however the studies have serious methodological weaknesses with a very limited evidence that lamotrigine is beneficial. Lamotrigine is of no benefit for controlling rapid cycling nor acute mania.[72]

Citation - Van Der Loos, M. L.; Kölling, P.; Knoppert-Van Der Klein, E. A.; Nolen, W. A. (2007). "Lamotrigine in the treatment of bipolar disorder, a review". Tijdschrift voor psychiatrie 49 (2): 95–103. PMID 17290338.

121.222.43.174 (talk) 13:03, 25 February 2012 (UTC)

The medication section reads much better. However there is an unbalance in reporting the innefectual aspects of some medication. For instance it is mentioned that lithium is not effective in treating depression. Carbamazepine "is less effective in preventing relapse than lithium". However when it comes to Lamotrigine, and unlike lithium and Carbamazepine, only the positives are mentioned despite the greater innefectuality and side effects of Lamotrigine. So for balance I recommend removing the above mentions of limitations of Carbamazepine and lithium, or better, simply adding mention of the limitations of Lamotragine so that all three medications are treated equally;

Two studies have shown it to have some benefit in preventing further episodes, however the studies have serious methodological weaknesses with a very limited evidence that lamotrigine is beneficial. Lamotrigine is of no benefit for controlling rapid cycling nor acute mania.[72]

Citation - Van Der Loos, M. L.; Kölling, P.; Knoppert-Van Der Klein, E. A.; Nolen, W. A. (2007). "Lamotrigine in the treatment of bipolar disorder, a review". Tijdschrift voor psychiatrie 49 (2): 95–103. PMID 17290338.

One final suggestion, again for balance, perhaps it is worth noting why Valproate is so popular, ie. in what way is it beneficial? (eg. is it beneficial or superior for hypo/mania, mixed states and rapid cycling? If anyone has this knowledge and the citations it can be mentioned as with the other meds). 121.222.43.174 (talk) 21:21, 29 February 2012 (UTC)

Good question - will look into it. Agree about adding limitations of lamotrigine, I was just musing on best source. Casliber (talk · contribs) 23:16, 29 February 2012 (UTC)

Apologies, a weakness was already mentioned in the revised section on Lamotrigine; "...no benefit in rapid cycling disorder". While the former weakness is worth noting, this medication's lack of effectiveness against mania is also a critical factor determining its use. 121.222.43.174 (talk) 21:33, 1 March 2012 (UTC)

Edit request on 20 February 2012: thyroid tests

Under "Diagnosis", please consider adding after "hypo- or hyperthyroidism" "(including TSH levels, as well as T4, T3 and antibodies)"

Note from editor: Doctors generally test for TSH levels, but not for T4, T3 and antibodies. Autoimmune thyroiditis is detected by antibodies, not TSH levels. Reference here: http://www.medscape.com/viewarticle/732977 "The authors suggest that autoimmune thyroiditis, using the marker of thyroperoxidase antibodies, is a possible endophenotype for bipolar disorder."

77.75.88.75 (talk) 12:58, 20 February 2012 (UTC)

Not done: We couldn't insert a "note from editor" in the text, it would appear unencyclopedic. We could add that as a footnote if you can find a reliable source which includes the conclusion. The source you provided does not talk about what tests doctors generally perform. Thanks, Celestra (talk) 17:52, 20 February 2012 (UTC)

Wrong word: "hyperthymia"

"Hyperthymia" (or something close to it) is used in this article...I'm guessing what they mean is hypoMANIA ("less than" mania). It should be corrected--I've never edited anything in Wikipedia so I don't know how to do it.

I see other discrepancies and would like to suggest that there be a statement at the very beginning of the page to say that for a definition of bipolarity, one should seek symptoms and description on on-line mental-health sites, rather than Wikipedia. Individual definitions of mental disorders are often subjective and don't hold in general. —Preceding unsigned comment added by Nikovich4 (talk • contribs) 23:27, 31 October 2010 (UTC)

As with any word, there is some fuzziness at the edges, but I've been in therapy and medication for bipolar disorder for seven years now, and "hypomania" is an episode, "hyperthymic" is a symptom. I can say "I'm feeling hyperthymic" as a summary word for a cluster of sensations with as much certainty as I can say "I'm feeling cold"; "I'm going hypomanic" is a judgement call -- from hyperthymia, sleep and so on. --201.53.107.136 (talk) 04:32, 11 June 2012 (UTC)

According to our articles, the two are not the same thing. Basically, hyperthymia is considered a healthy state of elevated mood; hypomania is unhealthy; mania is very unhealthy. Looie496 (talk) 17:02, 5 November 2010 (UTC)

Suggested inclusion for the History section

The following may be useful for the history section as the article does not mention any history of nonpsychotic version of the disorder.

The first diagnostic distinction to be made between manic-depression involving psychotic states, and that which does not involve psychosis, came from Carl Gustav Jung in 1903. Jung’s distinction is today referred to in the DSM-IV as that between ‘bipolar I’ (involving psychotic episodes) and ‘bipolar II’ (without psychosis). In his paper Jung introduced the non-psychotic version of the illness with the introductory statement, “I would like to publish a number of cases whose peculiarity consists in chronic hypomanic behaviour” where “it is not a question of real mania at all but of a hypomanic state which cannot be regarded as psychotic”. Jung illustrated the non-psychotic variation with 5 case histories, each involving hypomanic behaviour, occasional bouts of depression, and mixed mood states, which involved personal and interpersonal upheaval for each patient. 58.165.118.171 (talk) 12:33, 7 May 2012 (UTC)

References

A seizure disorder?

I've heard that bipolar may be caused by subcortical seizures. Is there empirical evidence to support this? If so, would someone mind including in the article? --1000Faces (talk) 13:58, 1 December 2010 (UTC)

Never heard of it (and I work in the field) - given the size of the article, we have to stick to broad material covered in secondary sources (review articles and textbooks). If it turns up there, worth including but I doubt it will. Casliber (talk · contribs) 20:26, 1 December 2010 (UTC)

I don't think there is even such a thing as a subcortical seizure. Cortical seizures, on the other hand, are known to counteract depression, but have no special effect on bipolar disorder as far as I know. Looie496 (talk) 21:06, 1 December 2010 (UTC)

This Google search for "bipolar disorder subcortical seizure" finds a few references to this concept, particularly page 9 of Handbook of Psychopharmacology Trials: An Overview of Scientific, Political and Ethical Concerns by Marc Hertzman and Douglas E. Feltner, ISBN 0814735320, but I don't think it's yet anywhere beyond being an hypothesis within bipolar disorder research. The text on that page refers to an NIH group and a Japanese group that were working on testing the hypothesis, but I can't find any cites for this in the Google Books preview: it would be interesting to know who these were, and to have a cite for their research. -- The Anome (talk) 12:16, 3 December 2010 (UTC)

(edit conflict) Yeah, there are things like this which is a single case and sounds like the authors are suggesting causation when coincidence isn't ruled out. Nothing much else grabs me either. Casliber (talk · contribs) 12:21, 3 December 2010 (UTC)

This was a hypothesis for a while -- it links manic depression to the more societally accepted condition of epilepsy, provides a theory for the long-term worsening of bipolar patients (seizure kindling) and explains the unreasonable effectiveness of antiepileptic medication for bipolar disorder -- heck, even old stuff like Dilantin has shown effectiveness. Trouble is -- lithium lowers seizure thresholds; many people with temporal lobe epilepsy (which mimics bipolar to some extent) find out during the first days of treatment, yet lithium works well long-term. I'd love for manic-depression to be proven a seizure disorder and collected supporting evidence for a while (there are hungarian studies; "epileptogenesis of bipolar" is a good search term), but was eventually dissuaded by the evidence in genetic markers and epigenetic activation of schizophrenia, etc. And lithium.----Dnavarro (talk) 20:42, 12 June 2012 (UTC)

Too many big words

Parts of this article need to be rewritten so that the average reader can form a clear picture in their mind. My father has bipolar and I came here to try to find out whether the illness is carried through a daughter down to the next generation. That's what I've been told. Instead I'm left trying to figure out what heterogeneity means and how it applies to this context. 71.17.200.66 (talk) 20:11, 12 June 2012 (UTC)

A condition is only inherited in the simple way you describe when it is caused by a defect in one specific gene -- Huntington's disease is an example of such a condition. Our article says that Bipolar disorder has a strong genetic component, but can be produced by many different kinds of genetic disruptions. Nobody can rule out that there are some variants that work in the simple way you describe, but if so they have not yet been discovered, and they make up at most a small minority of cases. I'm not sure it would be possible for our article to make all this clear without including background in genetics that would be tangential to the main topic. Looie496 (talk) 22:55, 12 June 2012 (UTC)

Image

The van Gogh image has been here a long time. I feel it adds to the page. Images improve our articles. I would be happy to see other proposals. Comments? Doc James (talk · contribs · email) 21:59, 21 April 2011 (UTC)

I feel that it has no direct connection to bipolar disorder, so it should be left out, despite the case in the caption that attempted to connect it. --SarekOfVulcan (talk) 22:07, 21 April 2011 (UTC)

It has no connection to bipolar disorder at all. I'm amazed it was allowed to stay up for a day as it gives a retrospective diagnosis. I imagine this was because no-one could be bothered to argue about it. Span (talk) 16:09, 26 April 2011 (UTC)

I would support the change to any image that's more serious than the one currently up. A cartoon of two masks from the theater (tragedy and comedy, I think) are hardly appropriate for a medical condition. O76923 (talk) 09:27, 27 June 2012 (UTC)

Edit request: van Gogh image

Please change from "[[File:Van Gogh the blooming plumtree (after Hiroshige), 1887.jpg|alt=|thumb|[[Vincent van Gogh]] is one of several artists whose creativity was influenced by mental illness]]" to "[[Image:VanGogh-starry_night_ballance1.jpg|thumb|Some historians believe [[Vincent van Gogh]] suffered from Bipolar Disorder]]"

The article is currently illustrated with van Gogh's Plum tree after Hiroshige and the caption "Vincent van Gogh is one of several artists whose creativity was influenced by mental illness".

In the first place it's difficult to understand why Plum tree is chosen. This is a minor, relatively unknown painting, executed at a time when van Gogh had yet to exhibit clear signs of burgeoning insanity.

In the second place, the caption is very problematic. Art historians agree that van Gogh avoiding working (or writing) during his periods of insanity, indeed was generally unable to, and his diaries are not in fact the testimony of an anguished or tormented individual. Indeed the only significant painting of his executed (possibly) during or immediately after, while convalescing, from an attack of insanity is At Eternity's Gate, and that is also problematic to cite since it really amount to nothing more than a color study of a drawing of a worn out (it was entitled Worn Out) old man executed some six years before when van Gogh was in good health, meant to be an image of diginity and resignation contemplating death rather than of suffering, hence the original title. It would be truer to say van Gogh's work was "impacted", rather than "influenced", by mental illness. His condition was entirely debilitating and he worked in spite of it.

The caption is also something of an absurd understatement. Whatever van Gogh's position (who incidentally believed insanity was forced on artists), the fact of the matter is that very many artists', not just "several", work is plainly "influenced" by mental illness.

Can I suggest we revert to the original edit [[Image:VanGogh-starry_night_ballance1.jpg|thumb|Some historians believe [[Vincent van Gogh]] suffered from Bipolar Disorder]].

The Starry Night is an immensely popular image most people recognise as reflecting at the very least an exceptional vision and is routinely cited as evidence of van Gogh's mental illess, both as evidence of bipolar disorder and epilepsy, the two main candidates for a modern diagnosis of his condition. 138.199.79.79 (talk) 23:51, 24 June 2012 (UTC)

Not done for now: I agree that the choice of image may not be ideal for this article, although I don't necessarily follow all of your reasoning. For instance, I think affective disorders tend to be characterized by more than just "periods of insanity" and periods of "good health", and I'm not sure it's particularly relevant what van Gogh's mental state was when he created a particular painting. I wonder if one of his self-portraits might not be a better choice than either of the others, since it would illustrate both the man and his work. In any event, with no prejudice toward your proposal, I think input from more editors would be a good idea before proceeding. Rivertorch (talk) 06:57, 25 June 2012 (UTC)

Yes, fair points. I don't have any objection to one of Vincent's paintings illustrating the article, in fact I think it's a good idea, but we do need to be careful about the caption I think. Portrait a good idea, but I would prefer The Starry Night because it is referenced so often in the literature as evidence of his condition, and it so popular and such an undisputed masterpiece. I mean it is a truly great painting and comforting proof that popular public opinion is not always wrong. 138.199.79.70 (talk) 23:43, 25 June 2012 (UTC)

To address your remarks about affective disorders being more than just periods of crisis and good health, I'm sure that must be right (though I have no expertise), but the fact of the matter is that, as I mentioned, Vincent didn't display any preoccupation with the usual introspections about self and role in his letters, the only real source we have for his life. People who turn to these in the expectation of gaining an insight into a tormented artist's mind are disappointed. That's why I urge caution in describing his work as 'influenced' by mental illness. To give an example, his work in the last two months of his life at Auvers after leaving the asylum at Saint-Remy is in general exceedingly placid and beautiful, the turbulent expression of Wheatfield with Crows being the exception rather than the rule. "Impacted" would be much the better word and also borne in mind should be that bipolar disorder is only one candidate for his condition. His most recent biographers (easily his most comprehensive), the same Naifeh and Smith who suggest his death was a manslaughter rather than a suicide, favour epilepsy. 138.199.79.47 (talk) 06:48, 26 June 2012 (UTC)

I think you make a decent case for the changes and am just sorry nobody else has chimed in yet. I have put a query to one other editor and will wait to see if he cares to comment. Rest assured you won't be ignored. Rivertorch (talk) 08:00, 26 June 2012 (UTC)

Just seen - bit busy. Need to think about this one as a delicate subject. Casliber (talk · contribs) 09:28, 26 June 2012 (UTC)

I'm persuaded by your case, 133.199.79.47, and agree with both suggestions: replacement with Starry night and "impacted". --Anthonyhcole (talk) 10:06, 26 June 2012 (UTC)

Yeah, the more I think about it the more I am okay with it. Casliber (talk · contribs) 10:56, 26 June 2012 (UTC)

In looking it over again, I'm confused. The IP's proposed change was to ''[[Image:VanGogh-starry_night_ballance1.jpg|thumb|Some historians believe [[Vincent van Gogh]] suffered from Bipolar Disorder]]'', which doesn't include the word "impacted". I'll go ahead and switch images but will leave the caption alone until it's clear what the new wording is to be. Rivertorch (talk) 19:41, 26 June 2012 (UTC)

Thanks for this and the attention you've given me. I suggested a revert to the original edit whose caption simply said that van Gogh was believed by some historians to have suffered from bipolar disorder, which is indeed factually so. That was at a time when the article had a section on creativity. Left to my own devices as the aticle is at present I would caption this rather as something along the line of "Vincent van Gogh is an example of an artist whose creativity was informed/influenced/affected/impacted by mental illness". Worded like this, including him as part of a group of artists in general who suffered mental illness, I don't think "influenced by" is objectionable, and perhaps that would be the best word. While it is true that van Gogh worked in spite of his condition, whose attacks were very debilitating indeed, and not because of them, it's also certainly true that The Starry Night has been cited by historians (most recently by Naifeh and Smith 2011 pp 692-3) as direct evidence of mental illness; Naifeh and Smith suggesting that he was directly depicting the sort of (epileptic) storms in his head they suggest he suffered, so I'm content with "influenced" worded like that and it is the least fussy word on reflection, the one that naturally comes to mind. In general I think the article should have a section on the link between bipolar disorder and creativity: I have always supposed there was one, but perhaps that is not so and in any case I certainly can't make any suggestions by way of edist. Thanks again for your attention. 138.199.79.32 (talk) 23:16, 26 June 2012 (UTC)

Okay, then. I'm making a change along the lines of your suggestion—just a bit more concise. Agree with you about covering the relationship between bipolar and creativity. There is an article with a relevant section. I haven't studied it in depth, but if it's well written and well sourced I suppose some of it could be summarized here. (This represents two topic areas I tend to avoid, so I'll bow out of the discussion now.) Rivertorch (talk) 05:38, 27 June 2012 (UTC)

Yes, I think that's fine. Thanks for your time and trouble and thank you for pointing me to the article about creativity and mental illness. I'll have a read. Might be an idea to put a link to it in the article somewhere?

It is odd that van Gogh continues to be an icon for the "tortured artist" stereotype. The truth is that he was nothing of the sort, no hint of a tortured personality from his letters (to be frank he is rather pedestrian in his views and tastes, really) and no other contemporary sources suggest it at the time although it's certainly true that towards the end of his life he frightened people, even to the extent of a public petition being raised against him in Arles. I don't suppose the exact nature of his illness will ever be determined: modern students are likely to learn eplilepsy from the 2011 Naifeh and Smith biography, destined to become the standard. However bipolar disorder has certainly been suggested and it's true that his personality was decidedly manic as a young man; grandiose ideas of forming artistic communities with Gaughin, that sort of thing. That he suffered in life is surely true considering how desperately ill he became, whether he can be truly said to have suffered for art's sake another matter altogether. Certainly his reputation is assured, no need to continue the grand romantic myth any longer: I don't see what is to be achieved by needlessly perpetuating it, and happily this article doesn't do that.

Thanks again. Appreciated. 138.199.79.94 (talk) 12:35, 27 June 2012 (UTC)

replaced American Psychiatric Association 2000a refs

American Psychiatric Association 2000a citations were dead links, however i found American Psychiatric Association and after working around the intneral links of the web site came accross this Work Group on Bipolar Disorder and i have used the DOI to create a new citation. This 2006 guide would appear to be a revision of the 2000 previously listed. The 2006 version could be used to replace other out of date citation used in the article. (for those who do not know me, I have an information processing disability which prevents me from in depth copy editing on Wikipedia) dolfrog (talk) 18:41, 5 July 2012 (UTC)

cite regression

I've reverted Dolfrog's massive regression of the citation mechanisms in use in this article. Cas says above that he likes {{sfn}} and dolfrog's been cutting that was claiming he's doing what Cas wants; cutting {cite pmid} and {cite doi}, too, and pasting them back inline. There's a long discussion objecting to this at User talk:Dolfrog/Archives/2012 1#Bipolar disorder. No comment on the other changes, which may or may not be re-applied as others see fit. Br'er Rabbit (talk) 13:44, 8 July 2012 (UTC)

Going through now - some good updates and I am reintegrating. Casliber (talk · contribs) 14:35, 8 July 2012 (UTC)

The cited target book for APA2000 has disappeared from the bottom of the references section....hmmmm :/ Casliber (talk · contribs) 14:36, 8 July 2012 (UTC)

Got most of dolfrog's definite fixes - I need to sleep now. That scan helped me identify some other sources that can be replaced by better ones...but sleep beckons...Casliber (talk · contribs) 14:50, 8 July 2012 (UTC)

I stepped through it all. I'll work on it tomorrow, too. vcite, for example, is for the birds. Br'er Rabbit (talk) 14:53, 8 July 2012 (UTC)

Well due to the nature of my disability the system of citation preferred by talk is a barrier which prevents me from contributing to an article, so from my perspective to insist on a single alien form of communicatio9n is discrimination. I do not have to time nor the energy to prevent further discrimination by some editors who seem not to want to understand the differences and different communicatio9n needs of others. Good luck with the article. But currently some are excluding me from participating on grounds of communication disability. dolfrog (talk) 15:05, 8 July 2012 (UTC)

WOW. and not. Br'er Rabbit (talk) 15:16, 8 July 2012 (UTC)

I had anticipated this type of vandalism. You may find more research papers included in my PubMed Bipolar research paper collection dolfrog (talk) 15:19, 8 July 2012 (UTC)

WOW. and not. see WP:VANDALISM. Br'er Rabbit (talk) 15:28, 8 July 2012 (UTC)

The APA2000 citation never has been in the article as far as I can tell. See above: "There is also a missing APA citation (tagged with Full), I have asked the original author for help." I don't think I ever received a reply to my query, sorry I forgot to follow that up. (update) But see the previous section mentioning a replacement for that. --Mirokado (talk) 15:31, 8 July 2012 (UTC)

The APA2000 will be from DSM IV TR - chunks of which are used elsewhere using the behavenet pages as URLs to illustrate. I am not sure if this is an official relationship between behavenet and the APA about reproducing DSM material (I have a suspicion it is but will double check). There are usually copies of DSM IV TR lying around at work - I'll try and find a hard copy. Casliber (talk · contribs) 00:17, 9 July 2012 (UTC)

@dolfrog - I am very sorry you got mass-reverted. The vagaries of citation system on wikipedia probably has about 98% of editors here confused most of the time, so fiddling and fine-tuning pages like this is commonplace, especially when editors find new and easier ways to reference things. The more the merrier on this article, having a few folks could be the impetus to give it a shove to GA or FA. More than anything, GA and (especially) FA status act as the closest approximation to a Stable Revision marked in the history, where future versions can be compared with and improvements kept and substandard material dispensed with. That is an intriguing list and I am seeing things already worth adding. Casliber (talk · contribs) 00:22, 9 July 2012 (UTC)

The APA2000 would be this fix, which I just restored. I've no issue with this (or with finding the missing one). Br'er Rabbit (talk) 01:14, 9 July 2012 (UTC)

I've finished merging. With the exception of a few bits by citation bot, these are restorations of dolfrog's edits, not mine. Then citation bot cleaned up further. Br'er Rabbit (talk) 01:58, 9 July 2012 (UTC)

Aah, here is the APA citation to format:

{{cite book | title = Diagnostic and statistical manual of mental disorders, Fourth Edition, Text Revision: DSM-IV-TR | author = American Psychiatric Association | publisher = American Psychiatric Publishing | location = Washington, DC | year = 2000a | isbn = 978-0-89042-025-6 | ref = {{sfnRef | American Psychiatric Association | 2000a}} | author = American Psychiatric Association }}

So Do What Thou Wilt. Casliber (talk · contribs) 02:04, 9 July 2012 (UTC)

{{vcite book}} is evil, and I've already removed the half dozen or so usage in the article (and above; and {{sfnRef}} is preferred). Br'er Rabbit (talk) 03:24, 9 July 2012 (UTC)

....which is why I left it here for you to play with rather than slot it in....Casliber (talk · contribs) 04:00, 9 July 2012 (UTC)

Using the above would entail a manual revert or merge of this. I'm quite neutral on whether this is done. My concern is the use of better referencing mechanisms. Anyway, I have the whole German navy to do. See here for example (know that's RN, but mostly I'm doing the High Seas Fleet). Br'er Rabbit (talk) 04:28, 9 July 2012 (UTC)

"Some patients may have difficulty maintaining loving relationships"

This sentence should either be expanded, or deleted. Some people have difficulty maintaining loving relationships with no diagnosis.93.96.148.42 (talk) 02:56, 11 July 2012 (UTC)

I think the implication of that sentence is meant to be that a greater proportion of people with bipolar disorder have relationship problems than in the general population, but you're right, it's badly phrased and unsupported by a citation to the literature, and should come out unless it can be improved and supported by citation. -- The Anome (talk) 09:02, 11 July 2012 (UTC)

I came to it it after being shocked having read "People with histrionic personality disorder, narcissism and bipolar disorder may have a limited or minimal capability of experiencing love." in Love which is mis-cited to the same citations. I imagine that it was put in this article and then modified.93.96.148.42 (talk) 14:04, 11 July 2012 (UTC)

Argh. That's pretty unpleasant. I've now changed it to "Some patients may have difficulty in maintaining relationships", which lacks the pejorative associations of the previous version. I've also edited out the reference to bipolar disorder in the sentence in the Love article: it appears to be generalized from a tiny part of the sources given, and then the phrasing gives an unfortunately misleading impression that the problems experienced by a few are the general case: as you say, a similar state of affairs can often be found in the general population. -- The Anome (talk) 18:41, 11 July 2012 (UTC)

Update: I've now removed the second cite completely, as it definitely does not support the content. The section quoted was about PTSD, not bipolar disorder in general. -- The Anome (talk) 19:02, 11 July 2012 (UTC)

Thank you very much!93.96.148.42 (talk) 01:08, 12 July 2012 (UTC)

Subtypes

I'd suggest an inclusion of the proposed "new" subtypes of bipolar disorder, more specifically the ones proposed by Akiskal. Like Bipolar II½ (bipolar II with dysphoric hypomania + cyclothymia), Bipolar III (antidepressant-triggered mania) etc.

Of course, these aren't included in DSMIV or ICD10 (and probably won't be included in the next edition of DSM), but what is important is that people (ie psychiatrists) actually use these labels to a significant extent. At least bipolar type II½ is pretty known.

That Akiskal guy seems to be regarded as one of the leading experts in this field, however i reckon that there are other definition of terms going as well. I don't think that there's room for this in the main article about bipolar disorder, but perhaps in the article about a bipolar spectrum? With a sentence in the main article (subtype section) something like "there's a discussion about extending the diagnososis, see bipolar spectrum".

Again, not in the DSM (which seems to be the yardstick here, perhaps due to a great part of the wikipedians being from the US?), but the same goes for loads of disorders (and diseases) with their own articles on wikipedia. Do a google search on "bipolar spectrum" and you'll find some 10 million hits.

Healthcare pros use the terms, articles are being written about them, people encounter them in mass media and while surfing the net. Then they should be able to look it up on Wikipedia. — Preceding unsigned comment added by 83.233.139.17 (talk) 00:15, 12 July 2012 (UTC)

It depends how widely certain terms are used. I've read Akiskal's work and am unsure of how widely accepted his views are. This is one of the reasons we try to stick to Review Articles in medicine. DSM is widely used in many countries (such as Australia), though not sure about Europe. Have the proposed new subtypes been mentioned in Review Articles? Casliber (talk · contribs) 01:53, 12 July 2012 (UTC)

Crazy idea again...

Hi all,

So about six months ago - I tried to drum up a bit of support for taking this article to the GA nominations, there wasn't a massive amount of interest so I put my energy into the Stephen hawking article instead. Hawking just got it's FA thanks to some wonderful reviewers and it would be nice to re-open the conversation. Truth be told - I'm not an editor of this article, my motivation is from looking at the table of the most viewed disability-project articles:

Rank	Page	Views	Views (per day average)	Assessment	Importance
1	Stephen Hawking	488806	15767	FA	???
2	Asperger syndrome	455163	14682	FA	High
3	Schizophrenia	349689	11280	FA	High
4	Bipolar disorder	344181	11102	B	???
5	Multiple sclerosis	309566	9986	FA	???
6	Autism	244360	7882	FA	High
7	Parkinson's disease	232401	7496	FA	???
8	Oscar Pistorius	212919	6868	GA	Mid

(I've shamelessly cut the list off before we ran out of GA+ articles - the original list is at Wikipedia:WikiProject_Disability/Popular_pages#List)

...and this article rather stands out in the list. How would people feel about the GA process with this article? What sort of things would have to change, or be updated or taken away? I'm quite happy to shoulder a lot of the prose, and the logistics of dealing with the review(ers) and so on - but I'm well out of my league with the medical stuff (and part of the reason I'm wanting to make this a team effort is because I could do with some experience on the 'more medical' disability articles...)

How do we feel? Fayedizard (talk) 21:32, 3 September 2012 (UTC)

Agree it is something we really should fix....enthusiasm for this fluctuates. I need to read the article again and look at the archives to see where we're at. Bit busy with core contest judging right at the minute though. Maybe we should list the sections below and review what is right/what is wrong/what is missing in each of them in the first instance Casliber (talk · contribs) 22:31, 3 September 2012 (UTC)

Sounds like a good ideaway forward, and I'm quite pleased that nobody is objecting to the idea...overall goal - so we're looking at the following sections:

• Signs and symptoms

The line "Because a bipolar diagnosis requires a manic or hypomanic episode, many patients are initially diagnosed and treated as having major depression." could do with a citation - anything spring to mind? Fayedizard (talk) 10:29, 10 September 2012 (UTC)

• • Depressive episode

As below. Fayedizard (talk) 10:29, 10 September 2012 (UTC)

• • Manic episode

As below. Fayedizard (talk) 10:29, 10 September 2012 (UTC)

• • Hypomanic episode

As below - these three sections (that have subarticles) all appear find to me, possibly as a consequence of the summary style approach.Fayedizard (talk) 10:29, 10 September 2012 (UTC)

• • Mixed affective episode
  • Associated features
• Causes
  • Genetic
  • Physiological
  • Environmental
• Diagnosis

I've delinked the dab for sensitivity (which is missing a suitable entry and incidentally leads to a pandora's box of poor articles about measurement and electronic circuits...), this probably needs clarification in the article text. The ref abstract refers to sensitivity to change but that may well not be all that is meant here. --Mirokado (talk) 21:26, 6 September 2012 (UTC)

• • Criteria and subtypes
  • Rapid cycling
  • Differential diagnosis

See below. Fayedizard (talk) 20:01, 6 September 2012 (UTC)

• • Challenges

I'd like to suggest dropping the first two paragraphs there as either not-souced, or sourced to insufficiently good sources - then move the remaining paragraph into the 'Differential diagnosis' section above.Fayedizard (talk) 20:01, 6 September 2012 (UTC)

As there was no objection - I've done this...Fayedizard (talk) 15:50, 11 September 2012 (UTC)

• Comorbid conditions
• Management
  • Psychosocial
  • Medication
• Prognosis

I took a swing at this today and boldly dropped a paragraph - do let me know if this causes any problems... Fayedizard (talk) 15:50, 11 September 2012 (UTC)

• • Functioning
  • Recovery and recurrence
  • Mortality
• Epidemiology
• History

I'd like to propose dropping "The two bitterly disputed as to who had been the first to conceptualise the condition." as unsourced, and also to move the first paragraph down to the bottom under a heading of 'etymology' (I think it needs a bit of a rewrite as well, but it's probably GA-level already) - otherwise great... Fayedizard (talk) 09:27, 5 September 2012 (UTC)

agree with removing that bit and done Casliber (talk · contribs) 20:37, 6 September 2012 (UTC)

• Society and culture Although I suspect it cut be cut down a bit generally, I think it's fine for GA Fayedizard (talk) 09:27, 5 September 2012 (UTC)
• Specific populations
  • In children
  • In the elderly

It's not clear which parts of this are sourced - I'll have a look at the cited sources shortly and see if they cover more of the text... Fayedizard (talk) 09:19, 5 September 2012 (UTC)

• See also

should we have the category here? Fayedizard (talk) 09:19, 5 September 2012 (UTC)

• References

I will update refs and citations for consistency as necessary. --Mirokado (talk) 21:26, 6 September 2012 (UTC)

• Further reading - well arranged and complete, good variety and does not appear particularly promotional.Fayedizard (talk)
• External links - look clean and neat - can't see any problems. Fayedizard (talk) 09:19, 5 September 2012 (UTC)

...and it would be great if we can find anything within them that might cause a problem with the GA criteria (my point of view) or the, perhaps more important, medical project guidelines. Are there any things that pop up at people? Fayedizard (talk) 09:11, 5 September 2012 (UTC)

I've popped in a couple of early comments and struck out anything I felt really didn't need looking at... any takes to look at a section? Fayedizard (talk) 09:19, 5 September 2012 (UTC)

So to give a quick summary where we are - we've had some excellent work with people pitching in from all sorts of places, particularly on the referencing front - any there don't appear to be any red flags appearing on the medical front - I would suggest that the article as it is could probably pass GA - particularly if we keep and eye on it and give it a regular poke. Would anyone object to a nomination? (particularly given that the length of time we might be waiting for a review might be significant...) Fayedizard (talk) 15:50, 11 September 2012 (UTC)

Okies - if there is still no objection tomorrow I'll put it forward :) Fayedizard (talk) 18:44, 13 September 2012 (UTC)

I've been flat out with other things (sorry!). Still haven't looked systematically over this. Will try to do so in the next 48 hours. Put it up if you wish (I'm not stopping you). I will try to help fix stuff brought up at review. Casliber (talk · contribs) 20:03, 13 September 2012 (UTC)

I've just nominated - although looking at the queue, we may be waiting a while... Fayedizard (talk) 11:21, 15 September 2012 (UTC)

I've signed on for the GA review. I've made some small contributions to the article, but I think not enough to disqualify me. Looie496 (talk) 18:07, 15 September 2012 (UTC)

Prognosis

Fayedizard removed the following optimistic text regarding prognosis:

“ Prognosis depends on many factors such as the right medicines and dosage, comprehensive knowledge of the disease and its effects; a positive relationship with a competent medical doctor and therapist; and good physical health, which includes exercise, nutrition, and a regulated stress level. There are other factors that lead to a good prognosis, such as being very aware of small changes in a person's energy, mood, sleep and eating behaviors. — "Introduction". cs.umd.edu. Retrieved February 16, 2008. ”

Looking for something a bit better sourced, I have the following rather less optimistic sources from the BMJ Evidence Centre: [1] and the NHS: [2]. Do we have any other reliable evidence-based sources, that might perhaps reflect the balance between the optimistic "treat it, and you're golden", and the "sorry, you're screwed" positions? -- The Anome (talk) 16:03, 11 September 2012 (UTC)

Treuer T, Tohen M. Predicting the course and outcome of bipolar disorder: a review. Eur Psychiatry 2010. —MistyMorn (talk) 16:30, 11 September 2012 (UTC)

Missing controversy and criticism section and in lede per MOS (lede)

am placing a POV tag on the article until MEDRS and RS based material on this is added.

• 1. Criticism of out-of-control and lifetime antidepressant prescription based on hyper-easily-made auto-self confirming bipolar "disorder" diagnoses is lacking from the lede and article body, yet is all over the MEDRS at Google Scholar, and in the RS media.
• 2. "Bipolar disorder is defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or more depressive episodes.", yet the empirical evidence for attaching the term "disorder" to this of symptoms used to make a diagnosis is entirely absent from any publications I can find on the subject.
• 3 The diagnosis is so easy to make that forensic and geriatric psychiatrists can cite a single example of an investment that went south and declare bipolar "manic phase" -bipolar "disorder", and thereby take away assets (and sometimes home and even freedom) of the elderly, and what is not divied up among psychiatrist and attorneys, give the rest to the kids (or attorney) as conservators, selling the home to pay for forced internment in assisted living death camps.
• 4 I can find no RS on how to UN-diagnose someone, especially while on anti-depressants, and thereby shut off the drugging.
• 5 University campuses with insurance funded psych plans look like the set of Invasion of the Body Snatchers, with facial muscles drooping in places where emotions associated with joy have atrophied from long term "treated" "disorders".

Can anyone suggest the best of the RS on the first point? Does anyone have any sources as the latter points?

I ParkSehJik (talk) 02:37, 27 November 2012 (UTC)

Ok -each: Casliber (talk · contribs) 10:07, 27 November 2012 (UTC)

1. We need to stick to secondary sources - there should be some about controversies on diagnosis and overprescription of medication I agree.
2. standard DSM IV definition accepted worldwide - we should get DSM IV pages in I agree
3. ???
4. This type of material can be discussed in differential diagnosis
5. This type of material can be discussed in side effects of antipsychotics.

Please provide references for proposed changes. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:42, 27 November 2012 (UTC)

Where did the original poster get the impression that articles are supposed to have controvesy and criticism sections? Quite the contrary. Also, see WP:MEDMOS on sections in medical articles. SandyGeorgia (Talk) 19:51, 27 November 2012 (UTC)

Citation needed tags removed from medical claims statements requiring MEDRS

Since citation needed andc POV tags were removed as "pointy" from medical claims unsupported by MEDRS source (or even RS sources)[3], with an edit summary that they are sourced in the body, I am deleting all MEDRS violating unsourced statements from the body. I will then go back and verify the remaining statements by reading the sources, and delete any statements unsupported by the source, or where the source is primary, not secondary (e.g., where there may be a positive effect due to statistical fluctuation but no systematic review.) The version is preserved in the history tab and is here. If MEDRS or RS can be found, the content can be restored. ParkSehJik (talk) 05:58, 27 November 2012 (UTC)

The lead is supported by the body and does not need to contain references per WP:LEAD. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:37, 27 November 2012 (UTC)

NPOV noticeboard

ParkSehJik (talk · contribs) has added POV tags to this article, psychiatry and forensic psychiatry. I have made a post on the NPOV noticeboard to attempt to resolve this.

• Wikipedia:Neutral_point_of_view/Noticeboard#NPOV_dispute_at_Psychiatry_and_Forensic_Psychiatry

--Harizotoh9 (talk) 10:54, 27 November 2012 (UTC)

RS for WP:SPADE "a pseudoscientific trashcan diagnosis, to provide an FDA-approved “indication” for the prescription and marketing"

Does anyone know any RS for the exceedingly WP:Spade worded criticisms that is all over psychiatry webisites? For example, this one posted by a west coast clinical pscyholgist citing an east coast psychiatrist describing bipolar disorder as "a pseudoscientific trashcan diagnosis, to provide an FDA-approved “indication” for the prescription and marketing"[4].

The language would of course have to be drastically toned down, which is likely already done in some RS we can use for the upshot of the basis of these kinds of comments. ParkSehJik (talk) 01:38, 30 November 2012 (UTC)

Better would be one discussing controversies in bipolar disorder in particular, of which there are a few notable issues. I had intended looking into this and adding. Casliber (talk · contribs) 02:02, 30 November 2012 (UTC)

London Review of Books] is both reliable a tertiary source on bipolar history, and a reliable secondary source on Borch as criticisms. Borch's book is a reliable secondary on the history, but not as to his opinions, dcriticisms, or speculations, just those he describes of others. ParkSehJik (talk) 04:57, 30 November 2012 (UTC)

Admin noticeboard Incidents re COI re Bipolar disorder and Bipolar spectrum at WP?

Admin noticeboard Incidents re COI re Bipolar disorder and Bipolar spectrum at WP? ParkSehJik (talk) 04:05, 30 November 2012 (UTC)

There's a Conflict of Interest Noticeboard. Also note that the blog post you link to is from 2010, and merely says that "As a British blogger noticed recently, the Wikipedia entries ‘Bipolar Disorder’ and ‘Bipolar Spectrum’ were edited from a computer belonging to AstraZeneca, ensuring that everyone is on the same diagnostic page as the industry.”". It doesn't even say who reported this, when, whether it was even confirmed, how much was edited and so forth. These questions would have to be answered first.--Harizotoh9 (talk) 04:20, 30 November 2012 (UTC)

Thanks. I did not know of the COI noticeboard. I posted at admin notice figuring an admin might have tools to quickly find the area IP of the pharm company, then let their computer search for the edit. COI is allowed if properly sourced, so editors can work from the pharm co, but it stil should be verified. I am relatively new to all these boards, which seem to consume very much time better spent on articles and reading sources. I suppose with time and experience, my edits will need much less talk page discussion. ParkSehJik (talk) 04:41, 30 November 2012 (UTC)

Edit request on 4 December 2012

In the 'Environmental' Section of the article please change 'a third and a half of adults diagnosed with bipolar disorder' to '5 out of 6 adults diagnosed with bipolar disorder' because I believe that stating it this way would make the article flow better. I had to stop and think about what exactly a third and a half is to properly comprehend what I was reading. 1/3=2/6 1/2=3/6 2/6 + 3/6 = 5/6 This can be avoided for future readers by simply saying '5 out of 6' Dhenken (talk) 04:00, 4 December 2012 (UTC)

Not done: It says "between a third and a half" (my emphasis). In other words, between 1/3 and 1/2. Maybe that would be clearer expressed as percentages? I don't have access to the Lancet, so I don't know exactly what the source says, but it surely doesn't say 5/6. Rivertorch (talk) 06:26, 4 December 2012 (UTC)

Anyone have access to (the current) sources 36 and 37?

We could do with clearing up this citation needed tag -

"Other brain components which have been proposed to play a role are the mitochondria,[36] and a sodium ATPase pump,[37] causing cyclical periods of poor neuron firing (depression) and hypersensitive neuron firing (mania). This may only apply for type one, but type two apparently results from a large confluence of factors.[citation needed] Circadian rhythms and melatonin activity also seem to be altered.[38]"

But I don't have access to the sources myself right now to see how best to reword - anyone got something handy? Fayedizard (talk) 14:54, 16 December 2012 (UTC)

GA advice

This article needs to be referenced more to secondary rather than primary sources. Also a number of the references are rather old. We should be trying to use stuff from at least the 2000s or latter. Cheers Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:04, 15 September 2012 (UTC)

Three months later, this is still true. There are scores of free full-text reviews available, yet this article is cobbled together with primary sources and outdated reviews. Honestly the article should be tagged to somehow alert the reader to issues. SandyGeorgia (Talk) 01:46, 24 December 2012 (UTC)

GA Review

This review is transcluded from Talk:Bipolar disorder/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: Looie496 (talk · contribs) 18:01, 15 September 2012 (UTC) I'm happy to have the chance to review such an important article, and I'm willing to put up with an extended GA process if necessary -- my initial impression is that the article is within shooting distance of GA. I'll go over the article bit by bit, but let me start the review with what strikes me immediately. Forgive me for putting this strongly, but the lead really sucks. This article has a huge readership and the lead -- perhaps not the whole article but at least the lead -- needs to be accessible to a general audience. An ordinary person reading the current lead may not even grasp that BD is a condition in which people fluctuate between mania and depression. Much of the current lead needs to be simplified drastically.

I've been WP:BOLD and revised the intro to put that into the much simplified new first sentence. Does that help? -- The Anome (talk) 01:49, 16 September 2012 (UTC)

Yes, the first sentence is a big improvement, but there is still a long way to go. Think about it this way: suppose you are talking to a friend who doesn't know much about medicine, and he tells you that his cousin has been diagnosed with bipolar disorder, and asks you to explain what that means. You might start with something resembling the first sentence, but you probably wouldn't follow with anything like the second paragraph -- it's too abstract to be useful. What are "abnormally elevated energy levels, cognition, and mood"? From that description, would you recognize them if you saw them? This paragraph should try to describe the condition in a way that is concrete enough to be recognizable. Something like "hyper-energetic, excitable, impulsive, and erratic to a degree that interferes with the ability to lead a normal life" occurs to me -- I'm not suggesting that you use those words, just trying to convey the level of concreteness this should aim for. Looie496 (talk) 02:50, 16 September 2012 (UTC)

Note: I have removed some comments added here by Dnavarro (talk · contribs) which, while interesting, consist of personal opinions without reference to published literature, and therefore are not helpful in bringing this article to GA status. Looie496 (talk) 16:26, 24 September 2012 (UTC)

First of all, massive apologies for not realising that the GA review had started - I've been distracted by all manner of things both on-wiki and off. Following on from Anome's work I've just done some WP:BOLD condensing of the lede - including removing references - I hesitate to do much more without getting community consensus - but is that moving the the right direction? Fayedizard (talk) 05:53, 3 October 2012 (UTC)

That's again an improvement, but the real problem as I see it is that the lead is too abstract for our readership. It gives no real sense of what it is like to have bipolar disorder or to meet somebody who has bipolar disorder. Suppose you had a friend with BD, and you read the lead of our article -- would you recognize that the description there applied to your friend? I think there is a good chance that you wouldn't. Looie496 (talk) 16:37, 9 October 2012 (UTC)

I'm afraid I'm a little lost by the reasoning - would it help if we went though paragraph by paragraph to make sure we get to the bottom of your concerns? at the moment I'm not really clear on which direction to take the content in... Fayedizard (talk) 19:52, 10 October 2012 (UTC)

I'm thinking of something along the following lines: At the lowest level of mania, known as hypomania, individuals may simply appear energetic and excitable. At a higher level, individuals may behave erratically and impulsively, often making poor decisions due to unrealistic ideas about the future, and may have great difficulty sleeping. At the highest level, individuals can show psychotic behavior, including violence. Something that starts to paint a picture in the mind of the reader. Looie496 (talk) 15:39, 12 October 2012 (UTC)

Oooh sounds and looks good - I've adjusted the language slightly to fit, and found a place in the lead - how's it looking to everyone else? Fayedizard (talk) 21:03, 15 October 2012 (UTC)

Um, guys? Fayedizard (talk) 16:28, 2 November 2012 (UTC)

Resuming

Okay, back on track now, I'll try to get through this expeditiously. Looie496 (talk) 17:33, 12 November 2012 (UTC)

• There are lots and lots of wikilinks to redirects. They don't all have to be fixed, but it would be nice to reduce the number. Looie496 (talk) 18:38, 12 November 2012 (UTC)

• Isn't lithium important enough to be worth mentioning in the lead? Looie496 (talk) 18:38, 12 November 2012 (UTC)

I'm quite happy with the medication stuff as mentioned, but I think it's a good point and I'm interested to hear what other editors have to say - there is a notion that by giving too much promence to the medication stuff we really do change how readers percive the disorder (and arguably that's even a good thing) - so I think it's something to have a proper chat about. Fayedizard (talk) 19:51, 22 November 2012 (UTC)

• Last paragraph of lead: "German psychiatrist Karl Leonhard split the classification in 1957, employing the terms unipolar disorder (major depressive disorder) and bipolar disorder." Did Leonhard really use the term "major depressive disorder"? If not, this should be reworded. Looie496 (talk) 18:38, 12 November 2012 (UTC)

Good call - I've made a minor change to clarify (and I think it reads a bit better now as well). Fayedizard (talk) 19:51, 22 November 2012 (UTC)

Signs and symptoms

• I felt the need to do a substantial copy-edit of this section. Mostly I just moved material around and reworded things without major changes in meaning, but I also removed a good bit of material from the Hypomania subsection, which was wordy, poorly sourced, essayish, self-contradictory, and generally crap. I also removed the two pictures, neither of which shows bipolar disorder (one shows grief, the other a painting by van Gogh, who was not bipolar as far as I know). Please feel free to fix anything I may have broken. Also I'm starting to feel that I'm doing a little more than a GA reviewer ought to -- please comment if you have an opinion on this. Looie496 (talk) 18:38, 12 November 2012 (UTC)

Wow - lovely work on the copy-edit - the article is massively better for it. I don't see anything broken, and am suitably impressed with the dedication. For what it's worth - I certainly thing that the amount of work done there is well over and above the call of duty for a reviewer - personally I would have made a comment and the pictures and asked for the rewrite, but you've made it vastly easier for us. We're certainly happy to to have a reviewer willing to get their hands dirty. :) Fayedizard (talk) 19:54, 22 November 2012 (UTC)

Will this GA review be concluded soon? Been over two months and it's the oldest one under review by a lot. Wizardman 16:54, 30 November 2012 (UTC)

I'm a little worried about the fact that ParkSehJik has raised (possibly correctly) a bunch of issues on the talk page - I'd like to think this wouldn't affect the stability part of the article (getting to nomination was a long time more than two months - the project is about 10 months old) but I'd appreiate your take on it wizardman? Fayedizard (talk) 19:13, 1 December 2012 (UTC)

The concerns do seem noteworthy, and given how major the article is and how many changes it goes through, having it go through GA at all is probably not the best bet with the way it's run. Getting it towards FA with a peer review or two may be better. Wizardman 03:34, 8 December 2012 (UTC)

We're now at 90 days. Aside from the neutrality template, which seems to have no support on the talk pages (including at NPOV) aside from ParkSehJik who put it there, the article currently has three "citation needed" tags, one "clarification needed" tag, two bare refs, and a "full citation" tag for a ref that has authors but no article. If the tags aren't going to be taken care of, then the neutrality seems irrelevant: the article isn't going to cross the line. (And that doesn't address the idea of a new "controversies" section, proposed by Casliber.) The article's stability doesn't seem much affected by ParkSehJik's appearance; the most recent edits here were November 30. BlueMoonset (talk) 16:23, 15 December 2012 (UTC)

Thank you for your comments - I'll make the relevent changes over the next few days.Fayedizard (talk) 14:44, 16 December 2012 (UTC)

Now that ParkSehJik is no longer posting, I'm less hesitant to comment. This is nowhere close to GA-- there are numerous MOS issues (as one example, almost a dozen instances of "current", see WP:MOSDATE#Precise language), swaths of uncited text (which really should be tagged as cn), but most importantly, the article is incorrectly cited. There are numerous uses of primary sources to cite statements inappropriately (example: Alprazolam can trigger a manic episode.[80]), and there is not a single recent secondary review used to cite most of the article, while PubMed coughs up numerous 2012 reviews, and even scores of 2012 reviews where free full-text is available. We shouldn't cobble together medical articles from primary sources and a few old reviews when newer reviews are easily available. Even if the other deficiencies are corrected, this article needs to be rebuilt. I understand the delay because of the disruption ParkSehJik visited upon many medical articles, but this should have been closed long ago-- can't get there from here. Here's one example-- there are scores:

• The "Psychosocial" section in Treatment is now cited to a 2005 and a 2007 source. Yet there is a 2012 literature review, free full text available, found easily on PUBMED: Lolich M, Vázquez GH, Alvarez LM, Tamayo JM (2012). "Psychosocial interventions in bipolar disorder: a review" (PDF). Actas Esp Psiquiatr. 40 (2): 84–92. PMID 22508073.{{cite journal}}: CS1 maint: multiple names: authors list (link)

SandyGeorgia (Talk) 01:41, 24 December 2012 (UTC)

the second paragraph is regarding depression not bi polar — Preceding unsigned comment added by 99.229.54.131 (talk) 00:15, 27 October 2012 (UTC)

2012 review from the BMJ

[5] Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:40, 15 January 2013 (UTC)

• Another interesting review Mitchell, PB (2012 Nov). "Bipolar disorder: the shift to overdiagnosis". Canadian journal of psychiatry. Revue canadienne de psychiatrie. 57 (11): 659–65. PMID 23149281. {{cite journal}}: Check date values in: |date= (help) Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:38, 2 March 2013 (UTC)

Wikinews too new?

From Portal:Current events/2013 February 28 ... In The Lancet, genetics links between five major psychiatric disorders: autism, ADHD, bipolar disorder, depression, and schizophrenia per recent study.

• doi:10.1016/S0140-6736(08)61345-8

99.109.125.252 (talk) 01:35, 2 March 2013 (UTC)

Need a secondary rather than a primary source. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:28, 2 March 2013 (UTC)

Central contentious unsourced statement

The lede states without sources that - "Bipolar disorder is defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood".

"Bipolar disorder is a condition in which people experience abnormally elevated (manic or hypomanic) mood states, to a degree that interferes with the functions of ordinary life." is also in the lede unsourced.

"Bipolar disorder is a condition in which people experience abnormally elevated (manic or hypomanic) mood to a degree that interferes with the functions of ordinary life." was in the body unsourced, so I removed it per MEDRS.

The critical MEDRS secondary source not provided in this article, centrally related to the off-Wiki debate as to whether the list of bipolar symptoms indicates a "disorder", is that which empirically ties "one", or even "many episodes of abnormally elevated energy levels, cognition, and mood" to interference with functions of ordinary life, (or even that the set of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) symptoms resulting bipolar diagnosis is empirically correlated with "disorder" (assuming that is definted as "interference" with an "ordinary" life.)

Psychiatrists are free to go around making all the claims of "disorder" and "illness" they want, and associated claims of efficacy and healing, just like TCM doctors and Chiropractors, but their claims cannot go into WP unless there are MEDRS secondary sources. ParkSehJik (talk) 06:39, 27 November 2012 (UTC)

What are you talking about? DSM-IV-TR is a pretty standard consensus text with criteria used around the world. Casliber (talk · contribs) 09:52, 27 November 2012 (UTC)

I agree DSM is MEDRS. The content I cited above, and which I deleted, was not sourced by DSM or anything. It was restored withuot sources, makes medical claims, and so it violates MEDRS. "Prevalence of use" is no more indicative of scientific validity than it is in alternative medicine, which incessantly cites growing use and use in hospitals as "evidence" of its efficacy, and as evidence of existence of the supernatural energies it claims to work by. "Consensus" is not evidence of truth either. There is much controversy as to whether bipolar symptoms indicate "disease", or whether it has any more reality as a psycic category than penis envy. ParkSehJik (talk) 04:22, 28 November 2012 (UTC)

I'm sure there are bipolar wikipedians with far more patience to work on this article -- myself, I don't mess with the big articles, just stick with fixing small ones -- but you're biting more than you can chew here. I'd reconsider my participation if I were you. --201.19.96.195 (talk) 18:50, 13 December 2012 (UTC)

Look, this page is for discussing ways to improve this article; it is not a soapbox to promote anti-psychiatry ranting. There are other articles on wikipedia which serve that purpose quite well on their own. While there is a lot of criticism surrounding both the bipolar diagnosis and the medical model propagated by the psychiatric community (and sections of the wiki addressing them are necessary IMO), rants about death camp conspiracies have no place here. I strongly suggest you either cite your sources or recuse yourself from this discussion, as you clearly lack the ability to be objective.

As a bipolar wikipedian, I also don't particularly appreciate having a very real personal issue compared to disproven Freudian theories, thanks. — Preceding unsigned comment added by 99.9.199.149 (talk) 16:33, 26 December 2012 (UTC)

A doctors rant about how bad bipolar disorder disorder is is not how the beginning of this article should read. Only professional cited sources only! — Preceding unsigned comment added by 199.209.134.28 (talk) 12:32, 18 March 2013 (UTC)

Primary sources

I have reverted this edit [6] as it was based on this primary research article [7] per WP:MEDRS. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:32, 24 March 2013 (UTC)

Just one short comment-

In this statement here -

"Medications used to treat bipolar disorder are known as mood stabilizers; these work by reversing manic or depressive episodes and preventing relapses.[72] "

There are not a lot of long term studies on such medications, so far as I am aware, regarding long term efficacy for relapse prevention (especially ones that are fully controlled).

More importantly, I am aware of no study which compares long term medicated outcomes with non-medicated long term outcomes, which would be a properly controlled study of the sort you would want for such a statement as above (small or large scale, but ideally you would want large scale studies, and very long term). The long term studies I have reviewed, such as those with lithium, compare instead with pre-medicated outcomes, which isn't really proper study controlling per se, at least for purposes of higher certainty regarding relapse prevention qualities, especially long term.

Then again, I am not sure if wikipedia is supposed to be a scientifically evidence focused resource or not.

And, well probably a far more simple issue - at least according to the citation, that last "and", should be an "and/or", because only lithium did both in the citation, the others all did one or the other, according to the citation.

That's all, my 2c worth. — Preceding unsigned comment added by 203.100.215.200 (talk) 14:58, 28 March 2013 (UTC)

Wikipedia is indeed supposed to be scientifically evidence-focused, but our policy is to rely on review papers from highly reputable publications rather than trying to judge the primary literature ourselves. So the important questions here are: (1) Does the statement you cite correctly portray what the source says? (2) Is the cited source a good review paper? (3) Iis there a good review paper that supports the version you would prefer to see? Looie496 (talk) 16:02, 28 March 2013 (UTC)

The answer to "1" is really summed in the last paragraph of my statement, the source says that lithium is found to reduce episodes and stop them in progress, but most of the other drugs either do one or the other. So an "and/or" would reflect the source better.

In terms of whether there is a good individual review paper supporting the entirety of what I say here, I am uncertain if there is. The long term studies that exist tend to be only around 5 years long, and the vast majority of these compare pre-medicated episodes to medicated episodes, rather than control with non-medicated groups.

This paper suggests the following "Beyond the first few episodes, the evidence suggests an increased frequency of episodes, followed by a relative stabilization"

http://www.researchgate.net/publication/12490744_The_longitudinal_course_of_bipolar_disorder/file/d912f506ec57f73f4d.pdf

Which would seem to be at odds with using pre-medicated states as a control benchmark, given that most of the time, there is a relative stabilization anyway.

It also says "Some studies evaluating the efficacy of lithium in naturalistic settings have supported that many patients with initial good response do not have a sustained response, whether due to noncompliance or loss of efficacy of the drugs."

It goes onto to say in its conclusion section:

"As the range of treatments has expanded over the last 10 years, there has also developed an increased uncertainty of not only the critical role of medications but also the numerous factors that play into the development of new episodes and the impact of these factors on the overall course of the illness....an important advance is the increased inclusion of psychosocial therapies."

In general this review speaks to a mixed outcome in studies regarding long term medication, a wide variety of symptoms and forms of bipolar, as well as lifestyle factors and episode precipitators, and emergent evidence of the benefits of a psycho-social approach, or at least the benefits of combining both medications and psycho-social therapy approaches.

Given the emergent and pre-existing drug resistant bipolar phenomena, and the wide variety of presentations, and responses, also medication non-compliance, I think we are scientifically approaching a time where a one-size fits all approach is less warranted, and a multi-pronged, multi-disciplinary approach has more merits. Various research, some mentioned already in this article (such as the new research on nutritional influences, like choline and omega-3), and the review I have posted point in this direction, in terms of relapse prevention at least. I think there should be plenty of other reviews that support this kind of position, that medication while very very useful, is also not a be all and end all in terms of therapies.

http://www.madinamerica.com/wp-content/uploads/2011/11/Can-long-term-treatment-with-antidepressant-drugs-worsen-the-course-of-depression.pdf

This article discusses emergent evidence that long term use of anti-depressants (not mood stabilisers!) may have issues with desensitization, sensitization and tolerance - causing very long term, an increase in depression, and dependence on the medicine (ie more negative outcomes over the very long term). No studies of this nature have been really carried out on bipolar medicines, due to the both methodological and ideological framework that exists (as i pointed out, nobody really controls versus non-medicated groups, and certainly nothing for a period over about five years), but, all the same, medication resistant bipolar, and sudden medication resistance after a period of treatment (people stopping responding to a medication that once benefited them) are both very well agknowledged broadly within psychiatry, and this is something we might suspect, based on very simple neurobiology - up and down regulation are basic features of neuron and receptor actions. But...

I understand that it is wikipedias position to cite, and not interpret though!

In these terms, I think that an "and/or" would be a good substitution for the sentence in question, and PERHAPS a mention of the fact that there is "an increased uncertainty as to the critical role of medications, and increased inclusion of other therapies/modalities" or something suggesting the general move towards a more mixed modality approach - citing the 2000 review or some other reviews with a similar position? — Preceding unsigned comment added by 203.100.215.200 (talk) 02:57, 29 March 2013 (UTC)

Personality disorders

My sentence on BD being comorbid with cluster B PDs has been removed for being supported by a primary source. Does anyone have a reliable secondary source for this? Is it comorbid with any other PDs? Jim Michael (talk) 23:33, 27 April 2013 (UTC)

Time to Merge

{{mergefrom|Bipolar spectrum|discuss=talk:Bipolar spectrum#Merging w/ Main Bipolar Article.|date=May 2013}} johncheverly 22:35, 6 May 2013 (UTC)

Term for the normality between episodes?

What is the term for the state of having manic depression, but being neither manic nor depressive at the moment (for however long that "moment" lasts)? I had thought it was eurythmia, meaning "good or neutral rhythm", but it turns out that is actually the name of a kind of moth. Help? -96.26.108.183 (talk) 18:22, 12 May 2013 (UTC)

You might try asking here instead. This is the page for discussing improvements to the article. Rivertorch (talk) 18:57, 12 May 2013 (UTC)

Agree; but just to be nice, the answer is euthymia (medicine). You were close. Looie496 (talk) 19:23, 12 May 2013 (UTC)

Quite right. I would have been nice, too, but I couldn't think of the word :p Rivertorch (talk) 06:12, 13 May 2013 (UTC)

Edit request on 11 July 2013

The periods of mania/ depression lasting for days/months is not accurate. In my case it can last hours with no gaurantee which will prevail. The cycling can be very rapid. Imagine a day where one minute you feel you can fly and the next you dont want to exist any more, then an hour later its takeoff time again.... Please amend.. 86.170.173.139 (talk) 15:53, 11 July 2013 (UTC)

Not done: please make your request in a "change X to Y" format. Be sure to read the subsection entitled Rapid cycling (under Criteria and subtypes) first. You should also be aware that Wikipedia's policy forbidding original research prevents us from incorporating your personal experiences into the article. Rivertorch (talk) 16:34, 11 July 2013 (UTC)

I'm sorry to hear about your ultra-ultra-rapid cycling: it's not a pleasant experience. I'll add a cite to another article for ultra-ultra-rapid/ultradian cycling, just to make it clear that it's a real thing that's well-attested to in the literature: [8]. There are quite a lot of other references to it on PubMed: see http://www.ncbi.nlm.nih.gov/pubmed/?term=ultra-ultra+rapid+cycling and http://www.ncbi.nlm.nih.gov/pubmed/?term=ultradian+bipolar for more papers. -- The Anome (talk) 15:07, 12 July 2013 (UTC)

Light therapy

There is a light therapy box, but nothing in the article that mentions or cites it. It should be removed unless someone is willing to add text to the article itself with citations. --1000Faces (talk) 18:33, 13 July 2013 (UTC)

Reviews

• Geddes, JR (2013 May 11). "Treatment of bipolar disorder". Lancet. 381 (9878): 1672–82. PMID 23663953. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:28, 23 July 2013 (UTC)

Edit request on 9 October 2013

I would like to add a "Evolutionary" section under causes outlining the theories about how bipolar disorder may have evolved in humans. Cbfitzgerald (talk) 04:34, 9 October 2013 (UTC)

You can edit this and other semiprotected articles when your account becomes autoconfirmed which usually happens after your account is at least four days old with at least 10 edits. RudolfRed (talk) 05:05, 9 October 2013 (UTC)

Edit request on 9 October 2013

Please correct spelling mistake "zigotic twins" to "zygotic twins" in the "Causes" section. 194.103.189.41 (talk) 20:53, 9 October 2013 (UTC)

Done Thanks. --    L o g  X   20:59, 9 October 2013 (UTC)

Simple language

We should be writing the lead in simple language. "frenzied or euphoric mood" is a "very high mood". We can define this more specifically in the body of the text. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:10, 5 October 2013 (UTC)

I really don't think "very high mood" is sufficient to describe mania. To me, and I imagine most readers, "very high mood" conveys the sense of something similar to hypomanic euphoria. and sounds really quite pleasant for all involved. It does not even begin to describe how unpleasant mania can be, from the viewpoint of both the sufferer and those around them. There's no sense that irritability or agitation might be involved, either. The Mania article contains this:

“ Mania varies in intensity, from mild mania (hypomania) to full-blown mania with extreme energy, psychotic features, including hallucinations, delusion of grandeur, suspiciousness, catatonic behaviour, aggression, and a preoccupation with thoughts and schemes that may lead to self-neglect. ”

which I think is much more descriptive of the power and terror of full-blown mania. "Euphoric" and "frenzied" convey the full range described above, and are both well within the vocabulary of the average English language speaker. -- The Anome (talk) 10:24, 5 October 2013 (UTC)

We have linked to mania and people can click on it if they wish the full description. We can use "euphoric" and "frenzied" in the body of the text. It is very important to have the lead in simplified language. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:40, 5 October 2013 (UTC)

How about "extreme and sometimes uncontrollable high mood", then? Hypomania is a "very high mood": mania is way beyond that. -- The Anome (talk) 11:07, 5 October 2013 (UTC)

A high mood is hypomania, a very high mood is mania. Feel free to ask for further input at WT:MED Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:10, 5 October 2013 (UTC)

Those terms might well be accepted convention in medicine, and they certainly use plain English words, but I don't believe they are "plain English" in the sense of conveying the intended meaning to the common man: if you were to ask the man or woman on the street what a "very high mood" was, I believe they'd be imagining someone having a really wonderful day full of fun and happiness, possibly with their loved ones at a funfair; I don't think they'd have an image of full-on mania in their minds. -- The Anome (talk) 10:15, 6 October 2013 (UTC)

Have requested further input at WT:MED Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:44, 6 October 2013 (UTC)

(From WT:MED) The Anome's edit there and explanation makes sense to me. I wouldn't know what "very high mood" was trying to convey. Biosthmors (talk) pls notify me (i.e. {{U}}) while signing a reply, thx 21:51, 6 October 2013 (UTC)

The MS society describe it as "very very high" mood.[9] As does many books http://books.google.ca/books?id=mQMpCOVPmywC&pg=PA125] Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:56, 6 October 2013 (UTC)

(ec) If I saw that I'd think someone made an error by writing very twice. I especially wouldn't know what that meant. Biosthmors (talk) pls notify me (i.e. {{U}}) while signing a reply, thx 22:10, 6 October 2013 (UTC)

This book simply says "bipolar disorders are characterized by periods of high and low moods" [10]. I would have "severe" or "very" in there. Would "very elevated mood" be better? Just because all of us can write and understand complicated vocabulary does not mean all peoples of the world can. The lead especially needs to be keep simple. There is a new initiative to send out the first bits of Wikipedia articles by SMS. And we are also working to translate articles into other languages, in some languages this will just be the lead as the target languages vocabulary is limit, words like Euphoria and Frenzied makes this difficult. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:09, 6 October 2013 (UTC)

I would say "euphoria" is understood by the layman and regarded as common English (unlike, say "dysphoria"), and if not understood I still do not think it is an example of medical English. I don't think it's suitable to replace with "very high" as the meaning and connotations are quite different, "very high" is quite ambiguous (eg: does this involve dissasociation? a manic state? euphoria?) and also "very high" is quite informal in register. LT90001 (talk) 22:37, 6 October 2013 (UTC)

Euphoria in lay terms is a "feeling of great happiness or well being".[11] The psychiatric meaning is fairly different from the lay meaning and thus it is not a great term. Definitely no better than what we have now "an agitated or elevated mood". Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:57, 7 October 2013 (UTC)

I saw the note at WT:MED.

I'm not convinced that "euphoric" is within the range of all of our readers. We get a lot of traffic from non-English-speaking countries, and the lead will ideally be accessible to teenagers and English language learners. So I'm inclined to opt for "very high" or perhaps "very excited" over "euphoric". However, I appreciate the point about it not being all fun and games. So I would prefer to add another word, such as "extreme", or perhaps "frenzied" or "agitated".

You might look at http://www.readability-score.com/ It will give results for individual words, which is not especially accurate for absolute scores ("Euphoric" scores much, much higher than "She is euphoric"), but should give you an approximate handle for comparing them. Readability depends a lot on the number of letters and syllables in the words and the number of words in the sentences, rather than on whether the exact word is familiar. WhatamIdoing (talk) 16:12, 7 October 2013 (UTC)

• My view is that the word used in the first paragraph is not of critical importance, because the second paragraph explains what mania and hypomania are in a simple and concrete way. When I wrote that paragraph some time ago, my goal was to describe it in a way that ordinary people could understand. Looking at it again now, I see that it has been incorrectly modified to describe psychosis as a set of beliefs, but other than that it still seems to me to do the job. Looie496 (talk) 16:49, 7 October 2013 (UTC)

Yep, it's ultimately just a word. LT90001 (talk) 08:11, 8 October 2013 (UTC)

I'm happy with the words "elevated or agitated" in the current version. It's plain English, gets the two essential qualities of mania/hypomania right, and does not have the ambiguity of simply saying "very high". -- The Anome (talk) 14:16, 10 October 2013 (UTC)

Perfect we are all good than :-) Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:03, 10 October 2013 (UTC)

Edit request on 4 November 2013

change "dould" to "could" 62.249.238.250 (talk) 10:38, 4 November 2013 (UTC)

Done Thanks. Deli nk (talk) 11:19, 4 November 2013 (UTC)

Actually, I wish to make a correction to the pharmacology chapter. Lithium is a mood stabilizer. And it is not used to medicate only the manic episode. Also, it is not anymore the drug of choice. Quentiapina (Seroquel) is prescribed often, which is very expensive by the way but has less severe side effects as Lithium. — Preceding unsigned comment added by Archelaos2 (talk • contribs) 11:45, 15 November 2013 (UTC)

Edit request on 2 December 2013

There is a typo in the Evolutionary section:

... fitness of ancestral humans. . Being able to employ both ...

Replace it with the following:

... fitness of ancestral humans. Being able to employ both ...

174.101.63.152 (talk) 16:28, 2 December 2013 (UTC)

Done RudolfRed (talk) 06:02, 3 December 2013 (UTC)