Talk:Bipolar disorder

Cognitive Impairment

I think the balance is off for this section of the article. Maybe the title itself, it implies something along the line of mental retardation while the article says it is more along the line of a simple defect in thinking. Along the line of balance I think the other side of the point, creativity, is too small and also should be something else. The mania side can also account for hyper functionality, which is a term I probably made up to prove my point. Yes it can induce creativity, but I think there is also a link between bipolar and IQ, positively. I myself am not thinking clearly but I hope someone gets something out of this Chitchin13 (talk) 02:12, 21 May 2008 (UTC)

In general bipolar people are inteligent and when (hypo)manic quite creative as well, but there may be proverbial exceptions that prove this rule of thumb. I guess there are at least as much differences as with "normal" human beings, but who is able to give a full proof of this hypothesis? Patio (talk) 14:07, 29 May 2008 (UTC)

Cognitive deficit != mental retardation. Deficits like (for example) distractability, difficulty in everyday planning, and memory problems can coexist side by side with high intelligence, creativity and complex problem-solving ability. However, regardless of the many people who combine high IQ and bipolar disorder, and the clear positive correlation between bipolar disorder and creativity, there is no evidence of a positive correlation between IQ and bipolar disorder in the population as a whole, and some evidence of a negative correlation between IQ and bipolar disorder, although the cause-and-effect relationship, if any, is unclear. -- The Anome (talk) 01:14, 6 August 2008 (UTC)

Suggested section

A section on the geriatric care of manic depressive patients may also be useful. (Speaking as someone who is on the receiving end of between four and ten phone calls a day to get stream of consciousness monologues from my bi-polar 67-year-old mother.) —Preceding unsigned comment added by 69.157.187.222 (talk) 21:38, 13 September 2008 (UTC)

Good point. I started a subsection on it, based on a fairly recent review study. Added it after the children subsection for now, though it's not really specific to diagnosis (lot of overlap/unclearness with the sectioning, guess it's inevitable to some extent...) EverSince (talk) 12:31, 23 September 2008 (UTC)

To do

I thought I'd just note that there's now a to-do box at the top of this talk page that anyone can add to/act on/cross off. And also if I've removed/changed anything I shouldn't have in my hypomanic go at the article, please reinstate it of course. EverSince (talk) 16:55, 23 September 2008 (UTC)

Disorder?

Does 'disorder' have to be in the title? LamaLoLeshLa (talk) 20:08, 24 September 2008 (UTC)

Yes, that is its proper name. "Bipolar" on its own is merely an adjective. Cheers, Casliber (talk · contribs) 20:18, 24 September 2008 (UTC)

Definitions etc.

Caveat: being trained in maths and logic, I can be rather pedantic about details, but feel that in this instance the pedantry is justified.

I must praise the author(s) of the article for correctly (IMO) calling Bipolar disorder a 'psychiatric diagnosis' rather than a single 'disease'.

Anyway, the article uses the phrase 'abnormally elevated mood'. I struggle to find an adequate definition of mood, or what it means for mood to be abnormally elevated in this context (most google searches unearth university and other psychiatric pages that are happy to talk about mood disorders and mood stabilisation, but not what mood actually is.) For example, the Mood (psychology) page does not provide an adequate description in this instance and perhaps a separate Mood (psychiatry) page is justified. The Mood disorder page only indicates that mood/emotional disturbance (whatever mood means) is hypothesised as the underlying cause, and there is rather a lack of clarity. Maybe wikipedia is accurately reflecting a lack of clarity in psychiatric circles from which these terms are drawn, but this ought to be pointed out somewhere.

Any ideas? —Preceding unsigned comment added by Chalisque (talk • contribs) 13:55, 5 October 2008 (UTC)

I think this is very important but also that it does to some extent reflect a lack of clarity about the core constructs and cut-offs, and the blurry partitioning of the everyday and clinical usages. Some other pages touching on it also - Dispositional affect, Affect (psychology), Affective neuroscience and (barely) emotion. I agree it should be covered more...maybe here for now could include a bit more on the questionnaires/assessments used for conceputalizing/screening/diagnosing... EverSince (talk) 17:18, 18 October 2008 (UTC)

In true bipolar, it is pretty unmistakeable. There are problems, though, when you get to so-called milder forms and entities like ultra rapid cycling. Anyway, this will be another major overhaul at some stage. Cheers, Casliber (talk · contribs) 20:41, 18 October 2008 (UTC)

Intuitive recognition of stereotypes isn't quite the issue, though, and there is ongoing research/debate as to the psychological dimensions involved in mania, the extent to which it involves true "elevation", mixed states, underlying negativity etc. EverSince (talk) 22:08, 18 October 2008 (UTC)

One of the losses in the past 40 years has been psychological interpretation of manic episodes, however a full-blown episode is something to see and one where...anyway, they are pretty full-on. Cheers, Casliber (talk · contribs) 22:20, 18 October 2008 (UTC)

Well, I wasn't meaning "interpretation" particularly, and I don't think severity is again quite the issue (and you do'nt need to tell me how it can seem clinically); the query seemed to be about underlying construct definition/validity/assessment issues. Thanks EverSince (talk) 01:28, 19 October 2008 (UTC)

Psychosis Related to Bipolar Disorder

I noticed while reading the article that while many subjects concerning Bipolar Disorder were very detailed, there seemed to be little to no information concerning the development of psychosis during mood cycling. It might be helpful to give a brief explanation of this manifestation of the disorder with, possibly, a link to the article about psychosis. As well, information regarding the prognosis of those suffering from Bipolar disorder with psychotic features should be discussed in this article as well, along with any other relevant facts. That would be much appreciated.

99.255.70.39 (talk) 15:35, 8 October 2008 (UTC)

Good point, psychotic symptoms can be markedly florid in a full-blown manic episode, and I have just read that those who often get psychotic symptoms when manic often also do when in a depressive phase. Will add soon. Cheers, Casliber (talk · contribs) 22:18, 18 October 2008 (UTC)

Hgurling's edits

User:Hgurling, a well-intending new user and quite possibly an expert on the subject matter, has made significant edits to both Schizophrenia and Bipolar disorder. His edits to schizophrenia have been discussed at length, but a comparable discussion is lacking for bipolar disorder. Regardless of his actual identity, Hgurling appears to have significant knowledge about the subject, but he may be unfamiliar with policies such as WP:NPOV. Cosmic Latte (talk) 20:54, 1 November 2008 (UTC)

Erm, would be happy to look, but...erm.. am a little preoccupied at present. I think I will be stuck for a week or more. Cheers, Casliber (talk · contribs) 23:21, 2 November 2008 (UTC)

I've inserted templates for "bias" and "unreferenced" at the "Life events and experiences" section, since the 180° change of text seem to be confusing to readers (and, of course, that I think it's biased and unreferenced), and I don't feel confident to revert to the old version either, since I'm not sure that the sources used in that version really covers the claims made. I'll take a further look at this if I have the time, otherwise I'm hoping that someone knowledgable will come around. /skagedal^... 09:29, 7 November 2008 (UTC)

Childhood

I do remember this article saying something about how having a bad childhood or a life filled with abuse could contribute to becoming bipolar. I've never doubted that, but then it was suddenly removed and now it reads that "conflict contribute very little to the development of bipolar". So what does that mean? I'm just curious as if anyone could tell me the truth... because I have been bipolar since the tender age of twelve and my childhood was not that great. So I wanted to know if abuse really does contribute to developing this disorder or not. A Wikipedia talk page probably isn't the best place for this inquiry, but since it's been removed already... Lady★Galaxy 03:17, 4 November 2008 (UTC)

I think the view that stressful life events contribute to the development of a bipolar disorder is pretty much the "mainsteam view". This is what typical textbooks teach (e.g., Barlow & Durand 2005, Abnomal Psychology). (I can not, of course, say anything about what caused your problems; as you imply, this is not the place for that.) These recent changes to the article are what is discussed above under "Hgurling's edits". Specifically, this edit. Hopefully, someone will take a closer look at this. /skagedal^... 10:27, 4 November 2008 (UTC)

I have at times made controversial edits myself, but the stressful events view is not only mainstream, it is in the DSM IV. User:smkatz

Roller Coaster Picture

Is the picture of a roller coaster necessary? —Preceding unsigned comment added by 64.42.217.69 (talk) 15:39, 12 November 2008 (UTC)

Hi I added that, I was trying to find a picture that was an analogy of bipolar disorder, although it may be seen as a bit crude. Remove it if you find it offensive or think that it trivialises the illness or come up another image which is a better analogy (try searching thru wikipedia commons). I think the addition of images in general does add something to the article. What do others think? 194.83.141.120 (talk) 15:45, 17 November 2008 (UTC)

Yeah, I think the roller coaster pic is a bit over the top... Some of the other images on the page seem unnecessary, too, like the brain directly above "Starry Night." 152.3.65.140 (talk) 20:49, 18 November 2008 (UTC)

This following was left on the talk page of 194.83.141.120 by 72.189.98.222 "I feel the picture of the roller coaster is an excellent analogy of the emotions one experiencing the variances of bipolar disorder." 194.83.141.120 (talk) 12:20, 20 November 2008 (UTC)

While that may be true, it seems to me that analogies generally aren't encyclopedic. That image seems to detract from the encyclopedic tone of the page. 152.3.65.140 (talk) 18:48, 20 November 2008 (UTC)

I respect your point but I couldn't find anything on Wikipedia which disapproves of images representing analogies. Its important that while encyclopedic the article is also accessible to the general public and I think images like this help. Any others care to comment? 194.83.139.137 (talk) 11:31, 26 November 2008 (UTC)

Well, we could look at it another way: do we have one or more reliable sources that say bipolar disorder is comparable to a roller coaster? I'm removing the image; its inclusion suggests original research. (There are likely better reasons for removing it.) -- Gyrofrog (talk) 18:09, 4 December 2008 (UTC)

A search on Google Scholar for "bipolar disorder" + "roller coaster" get 575 hits, this being the first. Google Web gets over 41,000, and Google Books gets 251, at least two of which use the phrase in their titles, Bipolar and the Art of Roller-coaster Riding and Riding the Roller Coaster: Living with Mood Disorders. So it seems to be a pretty widely used metaphor. Looie496 (talk) 19:03, 4 December 2008 (UTC)

Abnormal Psychology by Barlow and Durrand third edition page 235 has a picture of a roller coaster in relation to bipolar disorder [1] so I'm putting the image back... —Preceding unsigned comment added by 194.83.139.137 (talk) 15:22, 5 December 2008 (UTC)

You seem persistent in keeping a picture you added on the page, when I saw it I didn't think it useful at all and I really find it unnecessary, sure the analogy is true but do we NEED a picture of a roller-coaster to "show" what bipolar is "like"? Earisu (talk)15:53, 23 February 2009 (UTC)

I have added a citation to the picture (one of the above-mentioned books, hundreds of other sources would be possible) so that if the issue arises again, it can at least be handled in a more informed way. Looie496 (talk) 17:42, 5 December 2008 (UTC)

The picture of the roller coaster appears juvenile and callous, I think it should be removed. I have a pretty serious case of bipolar I and I have extensively studied psychology before and after my diagnosis. I have to say that when I saw the picture of the roller coaster I burst out laughing. Using the analogy of a roller coaster to describe the mood swings of bipolar disorder is understandable when trying to bring information about the disorder to lay people, but I feel like the picture is absolutely useless in terms of educational value. After I finished laughing at the sheer frivolity of the picture I actually became offended by it. If this were a page on MS and one of the characteristics of MS was to initially have a feeling of pins and needles in one's extremities, would a picture of actual pins and needles be appropriate? I feel it makes light of a very serious disease that is often misunderstood. —Preceding unsigned comment added by 69.114.7.189 (talk) 04:10, 31 March 2009 (UTC)

Okay, that's a valid point of view, but I'm puzzled by "using the analogy of a roller coaster to describe the mood swings of bipolar disorder is understandable when trying to bring information about the disorder to lay people". Bringing information to lay people is exactly what Wikipedia is supposed to do -- students and professionals really ought not to rely on it. I don't have strong feelings about this myself -- it seemed to me that if books like this are published, then the metaphor is okay to use. Looie496 (talk) 16:27, 31 March 2009 (UTC)

In regards to you being puzzled, you cut off the rest of my sentence. Try reading it in its entirety.

I never said that students or professionals should rely on Wikipedia. I did say that the analogy is a good one for lay-people, but the picture is unnecessary for the various reasons I stated above.

There are plenty of books that are still in circulation today that have an antiquated or offensive view on sensitive issues ranging from history to art to science. Just because a handful of books regarding this topic use images that are offensive and simplistic does not mean that Wikipedia or anyone else should perpetuate the problem.

I think the image has proven to be offensive to many, and cheapens the integrity of the site. —Preceding unsigned comment added by 69.114.7.189 (talk) 19:14, 31 March 2009 (UTC)

Gosh I had not seen this debate before. I am a bit 'iffy' on the picture. To me (a psychiatrist) the analogy is wrong as a roller coaster more symbolises the mood swings from affect dysregulation of cluster B personality disorders such as borderline type (though I haven't seen it reported as such although many tempestuous biographies use teh term). Many well controlled bipolars would be a flat road with a few big rises and falls quite far apart. Thus, I am probably slightly happier without the image. Casliber (talk · contribs) 19:47, 31 March 2009 (UTC)

The only reason I'm not completely indifferent to this is that on the previous go-around I did the work of finding sources to justify the picture -- but I'll just say that if anybody feels bold enough to remove it, I won't complain or put it back. Looie496 (talk) 03:54, 1 April 2009 (UTC)

I fully understand - along with the annoying difficulties of getting pictures to decorate these mental health pages. Hopefully a few more folk will chime in with yea or nay. Casliber (talk · contribs) 04:18, 1 April 2009 (UTC)

Well, at least it's not The Scream, which used to adorn this page at one time. -- The Anome (talk) 08:54, 1 April 2009 (UTC)

Hi I originally added the picture mainly because some pictures were needed, and was supported by this by someone who had bipolar disorder saying they thought it was helpful, but I think there have been more negative responses to this than positive ones, so happy for this to go if this is the consensus. Any other users wish to comment on this so we get a good idea of the majority opinion? 194.83.139.177 (talk) 09:33, 21 July 2009 (UTC)

External Links

I Am Bipolar --Blakeisblake (talk) 00:23, 24 November 2008 (UTC)

This looks like a useful site. As the source for this article explains, the best thing to do is to submit it to the Open Directory project at http:www.dmoz.org , asking for the category Health/Mental_Health/Disorders/Mood/Bipolar_Disorder. Looie496 (talk) 19:11, 4 December 2008 (UTC)

Best site about depression

I was diagnosed with depression 5 years ago and a while ago I came across this site. I find it very useful and friendly.

You don't need to be a proffesional psychotherapist in order to understand it.An eye level information- just love it. I think many other readers can also benefit. —Preceding unsigned comment added by Sharon Kaplan (talk • contribs) 20:36, 4 January 2009 (UTC)

Forget it. That site would have to be way more informative and less spammy to be acceptable anywhere on Wikipedia. Looie496 (talk) 00:00, 5 January 2009 (UTC)

Helping Bipolar Children Grow I think that this is a site which could add to this page as all of the current external links are predominantly relating to bipolarity in adults whereas this site contains resources for parents that are dealing with bipolarity in children. Your thoughts? Ymsandweiss (talk) 18:33, 25 May 2009 (UTC)

Inositol

I am going to temporarily remove the material on inositol from the Alternative Treatments section, on the grounds that it is (a) completely unsourced, (b) partly tangential, and (c) partly doesn't make sense -- serotonin enhancers are generally not good treatments for bipolar disorder. (Unipolar depression yet, bipolar disorder no.) This may in fact be something valid to talk about, but go in it needs at least one source and a better explanation. Looie496 (talk) 17:16, 7 December 2008 (UTC)

In relation to

Nonverbal Learning Disorder.... I know patients with that disorder can develop GAD and Depression, but what about Bipolar Disorder?

I suffer from NLD, and also have a lot of mood swings... —Preceding unsigned comment added by 76.125.103.136 (talk) 06:49, 13 December 2008 (UTC)

Picture

I am bipolar and it's such an oversimplification to a complex thing, and that's just kind of offensive. When I see the picture, it minimizes my condition to a petty cliche. —Preceding unsigned comment added by 141.156.198.224 (talk) 09:37, 24 December 2008 (UTC)

I'm assuming the reference is to the roller coaster picture (which has been removed). I agree that this picture is insensitive; more importantly for wikipedia purposes, it adds nothing to the article. The concept of manic and depressive episodes is not easier to understand with it, nor does it illustrate a point well, etc. It should stay out of this context. LH (talk) 09:47, 24 December 2008 (UTC)

Actually, there's a pretty good consensus just above to have the picture in there. Moreover, the roller coaster analogy is well-sourced. And Wikipedia is WP:NOTCENSORED for purposes of "sensitivity." Cosmic Latte (talk) 09:56, 24 December 2008 (UTC)

I have, however, rephrased the caption so as to make clearer the (sourced) rationale for including the picture. Cosmic Latte (talk) 10:05, 24 December 2008 (UTC)

Regarding quality of article to date

Haven't been here in nearly a year (at least 9 months), and I am impressed at the growth of this article in scope and in the quantity of good citations, yet find that the description of Bipolar Spectrum disorders is sadly deficient to the point of conveying completely inaccurate understanding of what bipolar disorder is at all.

Not going to go on at great length for I am not the ones working on this article, parts of which are really great (the fact that bipolar is the most costly medical condition of those disorders of the brain that cause the patient to suffer often severe deficiencies in interpersonal relationships and also cause the bipolar population to most often have intelligent people with an incomplete higher education and a spotty job history. Bipolars often end up marginally employed and even homeless.

What most struck me was the absence of the present day recognition of the most predominant symptom of both Bipolar I and Bipolar II has not yet been included - that the emotional state that all bipolars spend most of their lifetime in is Depression, often a atypical depression often described vegetative depression. The depression has nothing to do with sadness as such, no common source of sorrowing triggers the depression, and the depressive periods can last continually, relentlessly, for a year or more of the retreat of incredible sleepiness with a near inability to stay awake UNLESS environmental influences intervene (such as family things like ferrying children about, shopping, holidays and trips).

Bipolar II is distinguished from what is presently called "Major Depressive Disorder" if even ONE episode of hypomania has occurred (usually a period of GREAT productivity and optimism without any sleepiness or sleeping for up to 3 days - after which, periodic brief naps (say maybe 3 hours) will keep the episode going for up to 5 to 7 days. The episodes can be triggered by such things as a great opportunity presenting itself, and the quality of work produced is high.

"Hypermania" produces such dysfunctional behaviors to the point of being quite seriously out of touch with reality and beyond the range of probable possibilities that the psychotic episodes are what first brought strong psychiatric attention to the disorder. For a long time, Bipolar II was not recognized for a considerable period of decades.

30 years ago, Bipolar "rapid cycling" was considered to be present when there was more than one mood swing during a year. More recently it has been recognized that multiple swings of mania or elevated "feeling great & optimistic" normal states, then back to depression could occur as frequently as several swings a month, week and even during the period of a single day.

I think it important to do a good, if snugly concise, section on the differential diagnostic confusions, especially since borderline personality disorder, CPTSD as well as ADD/ADHD are significantly found as existing as a co-diagnosis, while also having many similar symptoms and signs as Bipolar.

Next, even though it should have its own topic of bipolar disorder in children, since (as in autism, asperger's and others that attract emotionally involved parents and "politically active" patients), the mere inclusion of the sudden incredible popularity of the diagnosis - even in toddlers - along with the treatment with antipsychotic meds, along with the complications of high possibility of tremendous weight gain (and Diabetes, "adult" onset which does not even need weight gain to develop. Including more than a brief paragraph and a reference to a separate topic page is most definitely recommended as childhood mental conditions become battlegrounds of highly POV groups arguing regarding causation and treatment.

A mention needs to be made that the Health Service in England instructed all affiliated physicians to BEGIN bipolar treatment with lamitrogine, even tho it is vastly more expensive than lithium (tho safer). Only if lamitrogine fails to achieve a good response are they directed to add another medication or another change in treatment. Lithium carbonate and valproic acid (a rapid action form was first branded Depakene) and disodium ____ (?) my memory fails me (a slow release form of valproic acid, first branded Depakote) BOTH require careful monitoring of blood levels and regular blood tests to search for organ and/or system damage.

The other antiseizure meds do not need blood level monitoring and are far safer. Lithium and valproic acid are vastly cheaper than any of the others. However, Lithium and lamotrogine are the only two bipolar meds that control mania outbreaks PLUS serve as effective antidepressants.

As for antidepressants. The old-generation tricyclic desipramine and the "fits no other classification atypical AD" buproprion HCL (brand names Wellbutrin for depression and marketed under another name as the "stop smoking" drug aid) are the ONLY so-called "safe antidepressants" that provide a good response and are even capable of being sole medication control in some.

Otherwise, what is most important to know about antidepressants is that Prozac and all the rest that have followed it can trigger what is often a patient's first manic episode, with the patient sometimes ending up hospitalized (if not fired from their job or possibly even arrested). Most primary care providers have succumbed to demand and need to write prescriptions for depression, while being the least able to diagnose psychiatric illnesses. In addition, only a very tiny sliver of psychologists are adequately able to diagnose chronic depression and/or bipolar II, or even detect an emerging mania.

Well, that pretty much wraps it up. Great work, guys! Keep it up and this could eventually have a chance at FA status. Spotted Owl (talk) 03:15, 27 December 2008 (UTC)

Need to add that I feel it important to mention rage likely to manifest in hypermania, sometimes alongside grandiose ideation. In the psychosis, paranoia can emerge.

and (finally) I have found the most telling symptom for me of bipolar (I or II) is impulsiveness. During Bipolar I mania, the impulsiveness can extend to maxing out every credit card, borrowing to turn the fantasized future into reality. True, that is not in the DSM-IVR diagnositic criteria, but I have decades of up close and personal experience with both bipolar I's and bipolar II's. In diagnosis, there are symptoms (distress the patient experiences) and signs (what a psychiatrist can observe and test for). Impulsiveness is a behavior and it is thought by some that the reason anticonvulsants work is that they "calm" the brain, lessening acting impulsively, giving the patient time to think things over. (Wellbutrin is also used to treat ADD/ADHD as the drug calms down the propensity to act immediately on impulse).

Spotted Owl (talk) 03:32, 27 December 2008 (UTC)

Rage is better talked about as irritability or aggression. The impulsiveness was once described by a colleague as "increased goal-directed activity with impaired judgement". Not sure if that came from a text. I do plan to work on this next year when I have more time. Cheers, Casliber (talk · contribs) 12:48, 27 December 2008 (UTC)

I just have to correct Spotted Owl here in saying that with Carbamazepine/Tegretol you do need blood work once a year in the U.K. in America and Canada, however, it's once a month to start off with. Also, regarding Lamotrogine (thats the spelling I have on my old packet), it sent me extremely Manic, a trait which happens in many patients. It seems it either works for you or makes you incredibly sick. I think that doctors should evaluate the patient and decide individual treatment instead of being 'instructed' to hand out one medication to start. —Preceding unsigned comment added by Shoegalsho (talk • contribs) 10:55, 12 April 2009 (UTC)

Mixed bipolar

Isn't this missing? It is real, and is in DSM.

Best, Shlishke (talk) 04:21, 8 January 2009 (UTC)

bipolar is an extremely subjective thing, and i believe that people should only contribute unless they know a great deal about people actually diagnosed with it. Because even doctors can be wrong - BlueRedNathan Bear —Preceding unsigned comment added by BlueRedNathanBear (talk • contribs) 14:09, 2 February 2009 (UTC)

I think the original poster may have been referring to mixed states. -- The Anome (talk) 15:06, 13 February 2009 (UTC)

Proposed additional external links

I propose the addition of two more links to the "External links" section of this article:

• Bipolar Disorder page from the U.S. National Institute of Mental Health website
• NICE Bipolar Disorder clinical guidelines from the U.K. National Institute for Health and Clinical Excellence website

Both are detailed articles from major national government-run medical organizations that are widely recognized as among the leading authorities in their field. The first is aimed mostly at the lay reader; the second -- the full version of which is 592 pages long, and contains a systematic review of the entire topic -- is aimed at medical professionals.

At the same time, I would like to change the linking policy listed in the comment there.

I realize that the current restriction to the DMOZ link alone was intended to prevent the external links section silting up with competing links to personal and community bipolar sites, but either of these is far superior to the typical page linked from DMOZ, which is the only external link currently offered. If these links are OK with the community, I would suggest that the guidelines be altered to allow only links to sites operated by authoritative academic or governmental medical research bodies -- and also the present DMOZ link.

Does anyone have any objections to this change? -- The Anome (talk) 12:42, 12 February 2009 (UTC)

I have never seen those DMOZ links before and I have been around a while. Not thrilled about the links on the DMOZ page. I'd prefer the gov't links myself. Casliber (talk · contribs) 13:31, 12 February 2009 (UTC)

OK, given that the only comment made seems to be positive, I'm going to roll the change out now. -- The Anome (talk) 00:00, 13 February 2009 (UTC)

Associated Genes

I noticed that a citation was needed for the association of TPH1 with BP and went out looking for something. What I found here http://www.mememoir.org/e/gene/e/121278.html was that TPH1 is now deprecated in favor of TPH2. This site, interestingly, is a wiki. I don't have the technical expertise to judge its worth. Is it a worthwhile reference? --Halcatalyst (talk) 02:41, 24 February 2009 (UTC)

No, a wiki would not be a good reference. I did a bit of reading, and based on the most recent reviews, it seems that there is strong evidence for a role of TPH2 in unipolar depression, but the study implicating it in bipolar disorder has not been replicated. Looie496 (talk) 04:54, 24 February 2009 (UTC)

Bipolar II and full-on manic episodes

There has been a stream of edits regarding the frequency of manic episodes in Bipolar II patients, which is I think based on a confusion between retroactive and prospective frequency, because of the weirdness that the manic episode will effectively change their diagnosis retroactively. (Is this an example of Cambridge change[2], I wonder?)

To try to fix this, I've added the following text to the Bipolar II section, based on my (non-expert) interpretation of the diagnostic criteria:

"Patients with a Bipolar II diagnosis under the DSM IV criteria cannot, by definition, have had any history of full manic episodes, since the presence of even one such episode would have lead to their receiving a Bipolar I diagnosis. However, a Bipolar II diagnosis is not a guarantee that they will not eventually suffer from such an episode in the future."

That is to say: Bipolar II patients, looking retroactively, are certain to never ever have had manic episodes (i.e. a zero rate of occurrence), but, looking prospectively, sometimes may (i.e. a small but significant rate of occurrence).

-- The Anome (talk) 12:33, 29 March 2009 (UTC)

This is making something simple fairly complicated. In this clause:

Bipolar II disorder is characterized by hypomanic episodes rather than actual manic episodes, as well as at least one major depressive episode. Patients with a Bipolar II diagnosis under the DSM IV criteria cannot, by definition, have had any history of full manic episodes, since the presence of even one such episode would have lead to their receiving a Bipolar I diagnosis. However, a Bipolar II diagnosis is not a guarantee that they will not eventually suffer from such an episode in the future.

You could probably remove the need for the bolded bit with the handy adverb 'to date'. I am very tired at present and it will need some rejigging but can be done fairly readily. Casliber (talk · contribs) 13:01, 29 March 2009 (UTC)

I agree, it could be worded better. The possibly-redundant wording was intended to stop the to-and-fro edits between the viewpoints that Bipolar II patients never have (i.e. have had) manic episodes, and that they infrequently have (i.e. will have) manic episodes: althout apparently contradictary, both statements are true in their respective appropriate, but unstated, contexts. This definitely causes confusion in readers, because editors keep on making the same mistakes over and over again trying to "correct" the "false" statements they read. The confusion needs to be addressed somehow in the text, without relying on the reader to make the conclusion from logic alone. -- The Anome (talk) 13:07, 29 March 2009 (UTC)

Update: having written the verbiage above, I've had another hack at the wording in the article. Is that any better? -- The Anome (talk) 13:30, 29 March 2009 (UTC)

OK, I see where you are coming from and I was possibly suggesting a little too mch hacking. It is a little better now but I think can be improved. I am just swinging down my watchlist and will revisit this. Casliber (talk · contribs) 19:55, 29 March 2009 (UTC)

"Multidimensional" definition

Hi,

Towards the bottom of the article the word "multidimensional" is used as a term of art. I have also seen bipolar being discussed in terms of "axes."

Might these words have a quick parenthetical definition, i.e., clarification from plain meaning, when introduced?

Best, Shlishke (talk) 22:42, 1 April 2009 (UTC)

[Note: I'm not an expert, just an interested observer.] Regarding axes, you might want to take a look at Diagnostic and Statistical Manual of Mental_Disorders#Multi-axial system. In this terminology, bipolar disorder is an Axis I disorder, but it can often also be found associated with other less serious problems such as OCD or substance abuse. However, my understanding is that "multidimensional" is generally meant in the sense of bipolar disorder being complex and multifaceted, affecting every aspect of personality, rather than any formal idea of it inhabiting some kind of mathematical space. -- The Anome (talk) 11:06, 2 April 2009 (UTC)

It is not a word which means particularly much in psychiatry and we don't use it much these days - yes it is tied up with the multiaxial system of DSM but there are big issues there too. Casliber (talk · contribs) 11:35, 2 April 2009 (UTC)

Bi-polar disorder and manic depression are two different conditions

My sister has bi-polar disorder. I have been helping her deal with the therapy and everything else almost her entire life, and I believe this article is really good and goes into a lot of depth. However, the only reason I wanted to say anything is because I have been informed that Manic Depression is not the same thing as Bi-polar disorder, and it seems that as a result of referring to bi-polar as manic depression for decades up until about 20 years ago, a lot of people still believe it to be the same thing. The media, films and other forms, do nothing to help remove the misunderstanding. There is also a lot of stigma attached to it. My sister's psychiatrist has tried to explain things to me whenever I asked, and from my humble understanding, Manic depression and bi-polar are two different disorders in the same group of mood disorders, and I don't believe that Manic depression should redirect to bi-polar disorder, but should be directed to the manic depression disambiguation page or a separate article instead. Lyrical Israfel (talk) 20:39, 14 April 2009 (UTC)

[Note: I'm not an expert, just an interested observer] To the best of my knowledge, the terms are synonymous in modern usage in the UK and U.S. See the following:

• from the Royal College of Psychiatrists: [3] Quote: "Bipolar disorder used to be called ‘manic depression’"
• from the National Institute of Mental Health: [4] "Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in a person’s mood, energy, and ability to function."
• from the UK National Health Service: [5] "Bipolar disorder, previously called manic depression, is a condition that affects your moods, which can swing from one extreme to another."

Older terminology used the term "manic-depression" to mean the whole of what is now known as the bipolar spectrum: see [6] and [7] for more details. This is, as far as I know, no longer common practice.

-- The Anome (talk) 23:34, 14 April 2009 (UTC)

Oh thank you so very much for the references! I was unsure if people were still calling it that, though from what I'd gathered that was a previous name for it. Thanks for your reply! I feel better about it after reading what you recommended above. Lyrical Israfel (talk) 01:55, 15 April 2009 (UTC)

You're welcome. Please note again that I'm not a doctor and that nothing on Wikipedia should be taken as medical advice (or indeed as reliable or fit for any purpose; see the Wikipedia:General disclaimer and in particular the Wikipedia:Medical disclaimer.) If you need advice, please consult your doctor. -- The Anome (talk) 09:13, 15 April 2009 (UTC)

Request to add a new book on Bipolar Disorder

Hi, I was wondering if it is possible to add a new book to the "Further Reading" page? If so the information is as follows

"I just want my Daughter back - coming to terms with Bipolar 1" By B C Levinson ISBN number 144213979X EAN number 978144213979X Published April 2009 Available on Amazon.com

Description is as follows:

I JUST WANT MY DAUGHTER BACK is a powerful narrative of a mother who lives with the turmoil of having a child with Bipolar 1- and the wide range of emotions that consume her and her family as this illness takes over. Through trial and error, both mother and daughter discover how determination and love in spite of a surprising twist in the road; can give way to a hopeful new beginning. Families suffering through the effects of mental illness quickly find themselves identifying with the writer’s experiences, as they discover ways they, too, can come to terms with Bipolar 1.

Thank you for your time and consideration.  —Preceding unsigned comment added by Biploarsmom2 (talk • contribs) 02:21, 30 May 2009 (UTC)