Talk:Bipolar disorder

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 There are scores of free full-text reviews available, yet this article is cobbled together with primary sources and outdated reviews.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)

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)[1], 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)

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.

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"[2].

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)