Talk:Bipolar disorder/Archive 7

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Semi-protected edit request on 15 December 2013

Currently there is a void on the page for causes of Bipolar Disorder due to neuroendocrinology. Below is an edit I would like to submit to be put under Causes with the heading of Neuroendocrinological with the following:

Neuroendocrinological

Dopamine, a known neurotransmitter responsible for mood cycling, has been shown to have increased transmission during the manic phase. The dopamine hypothesis states that the increase in dopamine results in secondary homeostatic down regulation of key systems and receptors such as an increase in dopamine mediated G protein-coupled receptors. This results in decreased dopamine transmission characteristic of the depressive phase. The depressive phase ends with homeostatic up regulation potentially restarting the cycle over again .

Two additional neurotransmitters, gamma-Aminobutyric acid (GABA) and glutamate, have been found to cause elevated mood states. Glutamate is significantly increased within the left dorsolateral prefrontal cortex during the manic phase of bipolar disorder, and returns to normal levels once the phase is over 2 . GABA is found in higher concentrations in people with bipolar disorder, overall leading to a decrease in GABA (B) receptors. 3,4 . The increase in GABA is possibly caused by a disturbance in early development causing a disturbance of cell migration and the formation of normal lamination, the layering of brain structures commonly associated with the cerebral cortex 5 .

Research shows that a dysregulated hypothalamic-pituitary-adrenal axis (HPA axis) plays a role in the pathology of major depression 6. Recently there has been additional research showing that the HPA axis also contributes to the pathology of bipolar disorder. One study found an increase in cortisol in major depression patients and in bipolar patients in both manic and depressed phases 7. An additional study found that there were increases in cortisol in both active bipolar patients and remissive bipolar patients indicating an overall deficit in HPA axis functioning in people with bipolar disorder 8.

Sources:

 1Berk, M., Dodd, S., Kauer-Sant'Anna, M., Malhi, G. S., Bourin, M., Kapczinski, F., & Norman, T. (2007). Dopamine dysregulation syndrome: implications for a dopamine hypothesis of bipolar disorder. Acta Psychiatrica Scandinavica, 116, 41-49. doi: 10.1111/j.1600-0447.2007.01058.x

2 Michael, N., Erfurth, A., Ohrmann, P., Gossling, M., Arolt, V., Heindel, W., & Pfleiderer, B. (2003). Acute mania is accompanied by elevated glutamate/glutamine levels within the left dorsolateral prefrontal cortex. Psychopharmacology, 168(3), 344-346. doi: 10.1007/s00213-003-1440-z

3 Brady, R. O., McCarthy, J. M., Prescot, A. P., Jensen, J. E., Cooper, A. J., Cohen, B. M., . . . Ongur, D. (2013). Brain gamma-aminobutyric acid (GABA) abnormalities in bipolar disorder. Bipolar Disorders, 15(4), 434-439. doi: 10.1111/bdi.12074

4 Fatemi, S. H., Folsom, T. D., & Thuras, P. D. (2011). Deficits in GABA(B) receptor system in schizophrenia and mood disorders: A postmortem study. Schizophrenia Research, 128(1-3), 37-43. doi: 10.1016/j.schres.2010.12.025

5 Benes, F. M., & Berretta, S. (2001). GABAergic interneurons: implications for understanding schizophrenia and bipolar disorder. Neuropsychopharmacology, 25(1), 1-27
6 Vreeburg, S. A., Hoogendijk, W. J., van Pelt, J., Derijk, R. H., Verhagen, J. C., van Dyck, R., . . . Penninx, B. W. (2009). Major depressive disorder and hypothalamic-pituitary-adrenal axis activity: results from a large cohort study. Arch Gen Psychiatry, 66(6), 617-626. doi: 10.1001/archgenpsychiatry.2009.50

7 Cervantes, P., Gelber, S., Kin, F., Nair, V. N. P., & Schwartz, G. (2001). Circadian secretion of cortisol in bipolar disorder. Journal of Psychiatry & Neuroscience, 26(5), 411-416. 

8 Watson, S., Gallagher, P., Ritchie, J. C., Ferrier, I. N., & Young, A. H. (2004). Hypothalamic-pituitary-adrenal axis function in patients with bipolar disorder. British Journal of Psychiatry, 184, 496-502

Wipayners (talk) 23:30, 15 December 2013 (UTC)

Done with some punctuation fixes ~ Boomur [☎] 23:15, 19 December 2013 (UTC)

Diagnostic Categories

This article lacks any discussion of the various diagnostic categories (type 1, type 2, cyclothymia, etc.). That seems pretty important. The DSM has changed, but not so much that these categories don't apply.Ctnelsen (talk) —Preceding undated comment added 15:22, 15 January 2014 (UTC)

Main templates

Have reverted [2] as the previous wording was more to the point. We link to these subpages already and main templates not really needed. Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:47, 15 February 2014 (UTC)

No Criticisms Listed?

I dread the idea of someone with undiagnosed, severe bipolar disorder perusing this page, finding a 'criticisms' section, and dissuading themselves from seeking help when they truly need it-- however, it seems strangely amiss that no criticisms section/page for the topic exists, especially considering that a few obvious ones are implicit from just the information given here. Example: does conventional diagnosis of bipolar disorder suffer from the Forer effect, given its large number of innately human symptoms? What about the perverse incentive that exists to diagnose people purely for monetary gain, in combination with the aforementioned problem? Just playing devil's advocate (ignorantly I might add), but it seems clear that a list of educated criticisms/rebuttals should exist in some capacity, even with a warning dissuading curious, in-denial sufferers from rationalizing their way out. EDIT: And, given that adequate rebuttals should exist, the case for conventional diagnosis should only be stronger for having listed the criticisms. 162.239.166.17 (talk) 08:12, 20 February 2014 (UTC)

Yes there is stuff out there - the supposed incidence is much higher than it used to be. Needs to be in a good secondary source though. Cas Liber (talk · contribs) 08:51, 20 February 2014 (UTC)

Manic Episodes Section Changes

Hi! Under the section Manic Episodes I propose the addition that these symptoms must interfere with the individual's daily functioning. This addition clarifies the main difference between Manic episodes and Hypomanic episodes giving readers a better understanding between the two.Shreeya06 (talk) 20:49, 18 April 2014 (UTC)

It does already say this in the manic episodes section. TylerDurden8823 (talk) 20:57, 18 April 2014 (UTC)

Lithium Citrate graphic vs. Lithium Carbonate graphic

Why is the image of Lithium Lithium Citrate? Certainly it is more interesting (complicated) than Lithium Carbonate but Lithium Carbonate is prescribed more frequently. (Lithobid and Eskalith are Lithium Carbonate.) Also, the image isn't labeled as Lithium Citrate until you open the large view of the chemical. SesquiZed (talk) 02:32, 28 March 2014 (UTC)

That's a fair point. I admit I hadn't paid much attention to that. I'll see what I can do about getting some high-quality images of lithium carbonate's chemical structure on here to replace the lithium citrate. If you can, please provide some to the Wikimedia Commons. They have very few entries about lithium carbonate but many more images of other lithium compounds. TylerDurden8823 (talk) 02:54, 28 March 2014 (UTC)

This issue has now been resolved. A 3-D picture of lithium carbonate (credit goes to Benjah-bmm27) has now replaced the picture of lithium citrate. TylerDurden8823 (talk) 17:29, 14 May 2014 (UTC)

Removed primary study

I removed an inappropriate source, that failed MEDRS, as it was too old per WP:MEDDATE, and is a primary study and we should be using secondary studies like reviews. The source also does not support the quoted sentence, and is a study of only the Swedish population so cannot be used to generalized about all people about bipolar disorder. Discussion of suicide already takes place with better sources two sections down, so this is largely redundant as a discussion of suicide. Yobol (talk) 19:36, 15 May 2014 (UTC)

Agree with removal - sorry Dennis. This topic is a fiddly one. Probably need to check the whole article at some point. Cas Liber (talk · contribs) 19:43, 15 May 2014 (UTC)

Not a problem. As unusual as it might sound, I had sent a "thanks" notification for the last revert, as Yobol's summary was a solid policy based rationale, which persuaded me that he was right and I was wrong. Dennis Brown | 2¢ | WER 17:37, 16 May 2014 (UTC)

Semi-protected edit request on 25 May 2014

removed Philsmartsyd (talk) 22:44, 25 May 2014 (UTC) Philsmartsyd (talk) 22:44, 25 May 2014 (UTC)

• Withdrawn, but wouldn't be happening anyway. Dennis Brown | 2¢ | WER 22:58, 25 May 2014 (UTC)

Semi-protected edit request on 25 May 2014

Causes. Does not indicate misadventure through medication. I know of a case that was brought on by a severe reaction to a medication. Risks to patients and scope for prevention. Please. Philsmartsyd (talk) 22:44, 25 May 2014 (UTC) Philsmartsyd (talk) 22:44, 25 May 2014 (UTC)

• "Knowing of a case" is called WP:Original research, which isn't allowed. You might want to get familiar with WP:MEDRS to know which kinds of sources are appropriate to source new info. Dennis Brown | 2¢ | WER 23:00, 25 May 2014 (UTC)

bipolar help

I am scared i am suffering from this. How can this be detected and cured? Do i need to submit myself to the doctor? Is means to self-test/examine this? — Preceding unsigned comment added by 196.11.134.77 (talk) 13:08, 7 August 2014 (UTC)

You should talk to your local doctor - no self-test, web-page or book is a substitute for talking to a clinician. Take care and good luck, Cas Liber (talk · contribs) 14:26, 7 August 2014 (UTC)

Emil Kraepelin, M.D. was a Psychiatrist, not a Psychologist as the picture of him in this article indicates.

Emil Kraepelin, M.D. was a Psychiatrist, not a Psychologist as the picture of him in this article indicates.

You are, of course, correct, as Emil Kraepelin article documents. I'll make correction. Paulscrawl (talk) 19:36, 14 August 2014 (UTC)

Intro wordings

- "The elevated mood is significant and is known as mania or hypomania depending on the severity." Misleading to state that the only difference between mania and hypomania is severity of elevated mood. Firstly with regard to symptoms as per the DSM, psychosis of any severity mandates that it is mania. Secondly, with regard to life course, BPII is in some ways the more severe condition (suicide rates etc).

- "Typically many genes are involved." is misleading because it could make it sound like many genes of large effect have been identified, when in reality we are talking about a hypothetical heterogenously varying mixture of genes of small effect.

- "If due to drugs or medical problems it is classified separately" - misleading because in some cases it would still be classed as bipolar disorder but just a different type (so mania due to antidepressants wouldn't be BPI but could still be BPII).

Regards, FinalAccount (talk) 21:21, 24 August 2014 (UTC)

Yes I do not see a problem with these clarifications. User:The Anome? Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:54, 24 August 2014 (UTC)

Previously we'd have called it an organic mood disorder - now apparently antidepressant-induced BAD is bipolar III - need to check this. Cas Liber (talk · contribs) 14:33, 25 August 2014 (UTC)

You're not a psychiatrist are you? FinalAccount (talk) 16:24, 25 August 2014 (UTC)

DSM 5 is slowly creeping into use - not really lingua franca as yet, so am a bit rusty on some fine-tuning bits. I wrote that last night just before going to sleep as it popped up on my watchlist. Given this is text and I can't tell the difference between a straight out comment/question/sarcasm, I can't tell the intention of that sentence. Cas Liber (talk · contribs) 21:34, 25 August 2014 (UTC)

My initial comment was not very clear, as the text in the aricle is not very clear. My point is it's misleading because there's a longstanding problem with e.g. antidepressants causing hypomania/mania and it's not as simple as saying the person's condition is therefore classified separately. But since you said "we'd have called it", I do ask you, are you saying you're a psychiatrist? FinalAccount (talk) 08:58, 26 August 2014 (UTC)

Yes I am a psychiatrist. Busy articles such as these erode over time with large numbers of edits. This has been on my 'to do' list for ages...but editing psych articles is a bit like....ummm.....work. Still it might be good to overhaul this damn thing sooner rather than later. DSM is also interpreted subjectively by many people. We've made a chores list before...will take a look in archives once I've finished editing something else I was going to do. Cas Liber (talk · contribs) 10:46, 26 August 2014 (UTC)

History

Just noting that:

It's a bit misleading regarding Kraepelin since his manic-depressive category included depression alone, it was all one mood condition, unlike later use of the term manic-depression.

Says Karl Leonhard was the "first to introduce the terms bipolar (for those with mania) and unipolar (for those with depressive episodes only)" However several expert sources state that it was Karl Kleist or his other student Edda Neele, or the 'Kleist-Leonhard school'. Also mania alone appears to have been excluded from that bipolar concept, and cycloid psychoses included, unlike today.

There is no mention that the more current bipolar concept originated by research from Angst, Perris, Winokur. Oddly there is no mention whatsoever of anything about when and how the major subtype of 'Bipolar II' came into things - apparently since the 1970s with research by Goodwin et al., adopted by the Research Diagnostic Criteria but not included in the DSM proper until 1994 version IV. FinalAccount (talk) 14:14, 25 August 2014 (UTC)

Be nice to get some good secondary sources.....will try to get for BAD II Cas Liber (talk · contribs) 14:34, 25 August 2014 (UTC)

In fact it appears that Lithium populariser Ronald Fieve credits David Dunner while at NIMH as the namer of Bipolar II in 1976, perhaps referring to the research article I tried to put in by Dunner, Gershon & Goodwin. FinalAccount (talk) 14:37, 25 August 2014 (UTC)

Quotes from an interview with David Dunner:

DD: We identified that group around 1969 and presented the data at a meeting in San Francisco in 1970. It took forever to get that paper published because I do not think people were quite ready for a subtype of bipolar disorder. TB: Was that before or after Angst and Perris published? DD: Angst and Perris had written their reports around 1966, but they had bipolar and unipolar patients. We were interested in replicating bipolar versus unipolar, and found this bipolar II group. TB: Could you tell us something about the place you worked at NIMH? DD: blahblah TB: By that time you did this research you had discovered bipolar II? DD: By that time I had discovered bipolar II.

.....

TB: Could you mention some of your important papers? DD: I mentioned the rapid cycling paper and the paper on bipolar II. It was written with Elliot Gershon and Fred Goodwin, and took forever to get published. We presented that data in 1970 at APA and it was turned down by a couple of journals for reasons nobody really understood. People did not recognize bipolar and unipolar, let alone bipolar subtypes. It was a very good paper and was finally published in Biological Psychiatry in 1976.

FinalAccount (talk) 14:56, 25 August 2014 (UTC)

(belatedly) thanks for the leads - will look into it soon. Cas Liber (talk · contribs) 14:41, 14 September 2014 (UTC)

Mood swings

The use of the term mood swings is problematic, as mood swings are usually described as rapid, whereas mood changes in bipolar disorder generally occur over weeks or months.--Jack Upland (talk) 09:39, 14 September 2014 (UTC)

• Some mood changes takes days but most take a few hours, then the mood may last days or weeks. Or symptoms may be absent altogether for days, weeks or months. Mood cycling doesn't really happen over "months". Even weeks is pushing it. The "swing" is the period that they go from one emotional state to another, the transition period itself between "regular" and "hypomanic/manic" or "depression". Or in some cases, or skipping from manic to depression (or vice versa), or in mixed episodes, from any state to both. This transition period tends to be shorter rather than longer. The duration of the current emotional state isn't part of the "swing". Dennis 13:33, 14 September 2014 (UTC)

• It is true there are two distinct meanings muddled together. Jack Upland is correct in what I end up explaining to people and clarifying what they mean. The lay term essentially means mood variation to mood over seconds to hours - this usually means dysregulated affect that is symptomatic of personality disorder or just stress making someone regressed. This gets confused with the term "mood swings" that psychiatrists use in bipolar disorder. The episodes usually do last weeks to months, though the change between can be rapid (days). I've seen the term used to mean the episode pretty often - much more often than to mean the shift between mania and depression. To complicate things, someone who is manic or hypomanic can have labile mood, with exaggerated changes between happy, sad angry etc. Cycling (between mania and depression) more than a few times a year is pretty rare. To sum up, the term is ambiguous and needs to be clarified or avoided where used to avoid confusion.....Cas Liber (talk · contribs) 14:39, 14 September 2014 (UTC)

• I'm all for clarity, however it is termed. Recent studies are showing, however, that cycling more than a few times per year is more common than previously thought, as is mixed episodes. It is amazing how little quality research has been done into bipolarism until recently. Most of the knowledge before 20 years ago was primarily anecdotal and flawed/small studies. Dennis 17:13, 14 September 2014 (UTC)

• There are problems with this though. I need to find some RS to add on this...in fact this article has been on my 'to do' list for about seven years.....Cas Liber (talk · contribs) 20:55, 14 September 2014 (UTC)

• Hagop S. Akiskal is a good place to start, including [3]. I've read several of his papers and he tends to be a bit more on the cutting edge of research, in particular, outpatient care and research. I know one of his previous fellow researchers, Dr. James Sloan Manning, who is also fairly published and up to date on the subject. Dennis 12:54, 16 September 2014 (UTC)

• I know his work - my observations and feelings on the illness probably don't align with his too much, though he's made some good points from time to time. However, my feelings should be irrelevant and it'd be what material has gained general acceptance really, so I'll start reading.....Cas Liber (talk · contribs) 21:02, 24 September 2014 (UTC)

• I thought this was interesting from U of CT, [4], which deals specifically with geriatric onset bipolarism. I will leave to your discretion as to quality. Dennis 17:17, 25 September 2014 (UTC)
• Another interesting read re: Dendritic spines is at [5] and backed up by JAMA Psychiatry, which I assume you have access to (I don't). Anything tying physiology to BP is always going to be interesting. Dennis 2¢ 17:39, 4 October 2014 (UTC)

• The bummer would be if another factor was responsible...say, prescription of antipsychotics.(which they discuss and dismiss but I would say prematurely).I've read the article. Wish they could have got more participants. I can send the fulltext to you. Cas Liber (talk · contribs) 20:06, 4 October 2014 (UTC)

• Sounds good. Much of this gets over my head pretty quickly, but I've been interested in several topics like this for some time, so moderately read up. Dennis 2¢ 20:23, 4 October 2014 (UTC)

publication is primary with small N - paper is here "study used postmortem human brain tissue from individuals with schizophrenia (n = 14), individuals with bipolar disorder (n = 9), and unaffected control participants (n = 19)." not useful for generating WP content. we are so, so limited in our ability to see into the living brain with high temporal and spatial resolution. until we solve that we are going to continue having little to say about physiology. ... Jytdog (talk) 20:24, 4 October 2014 (UTC)

Use of antidepressants in bipolar disorder

Hello all, I'm new to Wikipedia, so I cannot edit this article directly. I do have a suggestion regarding the medications used to treat bipolar disorder. I noticed that there is currently not much information regarding the use of antidepressants. I think it would be helpful to point out that antidepressants are sometimes still used to treat bipolar disorder, even though mood stabilizers are preferred for maintenance treatment. If possible I would like to add the following after the sentence "Antidepressants have not been found to be of any benefit over that found with mood stabilizers.[103]":

Some studies have shown that the use of antidepressants in bipolar disorder may trigger manic episodes and may cause bipolar disorder to worsen in the long run. This is not to say that antidepressants should not be used at all in bipolar disorder. It can be useful in the treatment of “severe cases of acute bipolar depression” but should not be “routinely used in mild to moderate cases”. While studies support the discontinuation of antidepressants after recovery from depressive episodes in most patients, some studies show that the continued use of antidepressants may actually benefit bipolar patients who repeatedly relapse into depressive episodes.

Please tell me what you think and what I can improve on. Thank you! Aylees (talk) 08:43, 3 November 2014 (UTC)

It is certainly an area where opinion is divided among psychiatrists. Need to look at the papers and there might be some others too. Hang on.....Cas Liber (talk · contribs) 19:54, 3 November 2014 (UTC)

It looks like an area where there is not enough expert consensus to be appropriate for a wikipedia article. See the WP:MED Manual of Style on audience. Your writing is more appropriate for medical researchers or clinicians. You might consider contributing to the WikiDoc project. See this link. Carlos Rivas (talk) 01:18, 10 November 2014 (UTC)

A new study

Primary sources are not allowed as references, but I think that editors watching DSPD, Non-24 and/or Bipolar will be interested in seeing this paper Just FYI. --Hordaland (talk) 12:25, 17 December 2014 (UTC)

Neurological

Add to the end of the Neurological section. (Samiam809 (talk) 15:17, 1 December 2014 (UTC))

An analysis completed after Leibenluft and Rich's study in 2008 concluded that the level of dopamine effects bipolar disorders.

References:

I doubt that you mean "effects" although that is grammatically possible. You probably mean "affects". --Hordaland (talk) 12:34, 17 December 2014 (UTC)

Suicide rates

Statistics about suicide seems to be wrongly cited in the source in this article. Information on the cited article here is a secondary source and according to the original paper, more than 6 % suicide rate is only true for males. Females have a cumulative suicide rate of 4.78 % in a period of 36 years, never getting close to being more than 6 %. I believe this calls for a correction --OganM (talk) 21:25, 16 December 2014 (UTC)

Ref says "Although it has been associated with creativity, it has a negative impact on the lives of most patients and more than 6% die through suicide in the two decades after diagnosis.1""The completed suicide rate in a recent

large prospective study was 7.8% in men and 4.8% in women over a median 18 year follow-up after first psychiatric contact, higher than for depression or schizophrenia.1" So the 6% is a combination of both genders i guess.Doc James (talk · contribs · email) 22:58, 22 December 2014 (UTC)

DSM-5

This is outdated: what was the outcome in DSM-5?

The DSM-V has proposed a new diagnosis which is considered to cover some presentations currently thought of as childhood-onset bipolar.[150]

Because I'm unclear why we need to have a ton of duplicated text at Bipolar disorder in children. SandyGeorgia (Talk) 15:51, 8 January 2015 (UTC)

OK, I found this source, freely available, which should be useful in updating both articles, and convinced me we should have a separate article for pediatric.

• "Bipolar disorder in children". Psychiatry J. 2014: 928685. 2014. doi:10.1155/2014/928685. PMC 3994906. PMID 24800202. {{cite journal}}: Cite uses deprecated parameter |authors= (help)CS1 maint: unflagged free DOI (link)

SandyGeorgia (Talk) 16:00, 8 January 2015 (UTC)

Hmmm, I'll take a look today. Cas Liber (talk · contribs) 21:06, 8 January 2015 (UTC)

Semi-protected edit request on 11 February 2015

A medical device that uses H-coil for deep transcranial magnetic stimulation (Deep TMS) as a noninvasive treatment. Brainsway conducted its first clinical Deep TMS trials at Tel Aviv University in 2005.[3] It obtained European Union CE mark approval to treat manic depression (2009).[10] https://en.wikipedia.org/wiki/Brainsway Germanbrother (talk) 08:28, 11 February 2015 (UTC)

Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format. — {{U|Technical 13}} (e • t • c) 11:37, 11 February 2015 (UTC)

Environmental

Add this at the end of the environmental section under causes.

One environmental factor that can trigger bipolar disorder is the loss of a loved one. The death of a loved one causes the patient to go into depression, and then mania phase soon after.

References

'Guide to Depression and Bipolar Disorder', DBSA. Retrieved 19 March 2015.

Nipatel95 (talk) 22:18, 19 March 2015 (UTC)nipatel95

Semi-protected edit request on 5 April 2015

'Treatment in hospital against a person's wishes may be required at times as people may be at risk to themselves or others yet refuse treatment' should be changed to 'treatment in hospital against a person's wishes may be required at times as people may be a risk to themselves or others yet refuse treatment.' FlameLightFleeNight (talk) 16:43, 5 April 2015 (UTC)

Done Alakzi (talk) 17:08, 5 April 2015 (UTC)

Semi-protected edit request on 5 April 2015

'The death of a loved one causes a peron to become depressed' should read 'The death of a loved one causes a person to become depressed'. FlameLightFleeNight (talk) 17:17, 5 April 2015 (UTC)

Done Also see WP:RFP/C - no harm in asking. Alakzi (talk) 17:24, 5 April 2015 (UTC)

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Can we talk about...

Can we talk about the nine year premature death rate studies and the immune system problems that lead to double or triple the death due to pneumonia, heart disease, cancer, etc. This is arguably as important as the excessive and ad nauseum discussion of mood, which is only a symptom and not the cause. If you get diagnosed with cancer and get depressed, is cancer then a mood disorder and will treating the depression cure the cancer - no. http://psychcentral.com/news/2013/07/20/bipolar-patients-die-nearly-a-decade-earlier-than-others/57421.html — Preceding unsigned comment added by 75.166.217.165 (talk) 09:50, 23 September 2015 (UTC)

Image removal

@Doc James: Would you please comment on how this - clip art - image is not just as inappropriate as the one we just discussed at Schizoaffective disorder where there was a very clear consensus that the image must have a direct relationship to the topic [6]. This does not even have the fig leaf of being by someone who might have had the condition. Jbh^Talk 01:30, 27 October 2015 (UTC)

It has been in the article a long time. I did not add it. This condition is exemplified by very positive and very negative emotions so yes I think their should be discussion before it is removed. Doc James (talk · contribs · email) 02:40, 27 October 2015 (UTC)

This particular piece of clip art, at best, illustrates a popular conception of the disorder - happy! HAPPY! Yay!!!<flip> ho hum blahhh whahhh blaahhehh which is far from accurate or even representative. We are not going to put that in the text, why are we going to use a picture that makes the same ignorant representation. In the cases of mental disorders a piece of art by a diagnosed individual illustrating their state is about the only thing that is acceptable per WP:IMAGE RELEVANCE ("...significantly and directly related to the article's topic") and WP:LEADIMAGE ("Lead images should be images that are natural and appropriate visual representations of the topic; they not only should be illustrating the topic specifically, but should also be the type of image that is used for similar purposes in high-quality reference works")emp. mine. This would not even be used in an undergrad ab-psych text. Such works exist cf the lead image in Schizophrenia. Jbh^Talk 03:23, 27 October 2015 (UTC)\

Also many others use similar images to illustrate the condition [7], [8], [9], [10], and many more.

The condition is very much very happy and very sad. Doc James (talk · contribs · email) 03:28, 27 October 2015 (UTC)

(edit conflict) The proliferation of similar imagery tells me more that it is very hard to come up with an image when you must, for whatever reason, have a graphic not that the graphic is appropriate for a reference work. In our case we have no requirement for an image. I am open to the possibility that the iconography is so pervasive that it has become standardized but I would prefer something to document that beyond 'lots of stuff'. Jbh^Talk 03:50, 27 October 2015 (UTC)

"The condition is very much very happy and very sad." Except Bipolar II disorder or the people who float around in 'mixed affect' or the people who have only one manic episode and then present as major depression or the people who meet the criteria but present as psychotic or a plethora of other clinical presentations which meet the diagnostic criteria for bipolar disorder but not the 'very happy' - 'very sad' popular conception. Jbh^Talk 04:03, 27 October 2015 (UTC)

It requires one manic or hypo-manic episode and a depressive episode. Of course not at the same time.

Here is that textbook you requested [11]

Even the NIH uses them [12]

The APA also uses masks [13] Doc James (talk · contribs · email) 04:18, 27 October 2015 (UTC)

It is less clear cut than the way off-topic painting at Schizoaffective disorder. What other websites do or do not do is not relevant here, as MOS:IMAGE is the guideline to follow. I don't really think that the infobox image here is ideal, but would stop short of getting into an edit war over it.--♦IanMacM♦ ^{(talk to me)} 06:42, 27 October 2015 (UTC)

the clip art does seem to interpret the disorder --Ozzie10aaaa (talk) 09:04, 27 October 2015 (UTC)

It looks like the image is a widely used icon. I withdraw my objection to its use. Thank you all. Jbh^Talk 12:37, 27 October 2015 (UTC)

I'm not entirely satisfied with the clip art. "Manic" isn't "very happy". It can be wild, angry, anxious, or easily irritated. I recognize that this clip art is common, but I think that it might tend to promote a common misconception. WhatamIdoing (talk) 15:58, 27 October 2015 (UTC)

We just had an MD describe bipolar disorder as "...very much very happy and very sad" so I do not have much hope for avoiding the promotion of simplistic stereotypes. Unfortunately the imagery has become iconic so those who want to include it have a strong case based in policy and I do not see enlightenment dawning. It seems the desire for lead pictures is pretty strong. My strong personal preference is that it is removed but I have no argument in policy and I am not here to right the great wrong of stereotypical labeling of the mentally ill. Although I am very happy someone else thinks it is a less than ideal illustration. Jbh^Talk 16:22, 27 October 2015 (UTC)

Yeah, and that of course is a generalization, but without generalizations we can't begin to explain anything. It also happens to be a fairly accurate generalization. CFCF 💌 📧 23:14, 27 October 2015 (UTC)

I have no problem with generalizations, in general. I would have much less of an issue, not enough to count, if the image were not in the infobox/lead. Putting it with Bipolar I might be OK but the presentation of BPD, in general, is so varied that without a long term history it can be hard to differentiate from schizophrenia, other forms (organic, chemical or other mental) of psychosis, major depression etc. Or the patient may be BP II, in which case hypo-mania may be what they see as 'normal' vs depressed or the manic phase may have occurred only once in their clinical history with other symptoms predominating - none of these present as "very happy - very sad".

As WhatamIdoing said above, "happy" often never enters into it. Manic euphoria is possible but 'racing thoughts', another symptom of mania, is far from being happy for the one experiencing it and they will not present as such. Sometimes you just see a cognitive decline and complaints of 'confusion' and 'being unable to concentrate' or you can see hyper-focus and increased productivity in the 'manic' phase. Your typical Type A personality who 'has some bad days every few weeks' can be shoehorned into a BPD diagnosis if a couple of the 'bad days' effect their ability to work. BPD can present all over the place and even though we are not a clinical reference (Thank whatever god you thank!) we do no service to our readers sticking happy/sad theater masks in their head as the image to bring to mind when the disorder is mentioned.

The lead pic is meant to summarize/illustrate the whole article and sticks in the mind of a reader even more than the lede text. This does a very poor job of it and in fact perpetuates an, incorrect, generalization of the condition. That is where my objection is coming from but, as I said, since it seems to be a prevalent iconic image I have no policy position to stand on so even though I think it is a crappy image my opinion is not what matters. Cheers. Jbh^Talk 23:58, 27 October 2015 (UTC)

The led image is not required to perfectly describe every aspect of a disease that can possibly present. These sorts of high bars would require the removal of nearly all images from the leads of our articles.

Not all cases of Psoriasis present like this seeing that their are multiple types. But that does not mean it is not a suitable image.Doc James (talk · contribs · email) 00:40, 28 October 2015 (UTC)

Missing the point so very badly. Maybe this will illustrate.

Is that a proper illustration for the psoriasis infobox/lede? That is using an icon to represent a disease. Better to use nothing? Anyway, as I have said, the masks are iconic and my personal preferences are not material except in so much as they inform my editorial judgement. Most of you disagree so unless others show up who think nothing is better or propose a better image, there is no point continuing. Cheers. Jbh^Talk 01:38, 28 October 2015 (UTC)

Hi there. Just to give you a data point: I have bipolar disorder (specifically Bipolar II), and I (a) am not at all offended by this image and (b) regard it as a perfectly reasonable visual shorthand for the twin conditions of mania and depression. I appreciate the effort to be sensitive on behalf of people with bipolar disorder, but this image is a non-issue in this regard. -- The Anome (talk) 11:32, 28 October 2015 (UTC)

I didn't really think about whether it might be offensive to people with this condition, so thank you for sharing that perspective.

But do we really need this image? WhatamIdoing (talk) 15:47, 28 October 2015 (UTC)

It has been shown previously that readers find our encyclopaedia more professional when we include images, so when we have an acceptable image we should use it. Also thanks for the pointer The Anome, I think causing offense with this image would be very rare indeed.CFCF 💌 📧 21:22, 28 October 2015 (UTC)

• Note there is an RfC on Talk:Schizoaffective disorder about the appropriate use of lead images. [14] Jbh^Talk 21:35, 28 October 2015 (UTC)

The RFC is about specific images on a specific page not about appropriate use of lead images. Doc James (talk · contribs · email) 23:15, 29 October 2015 (UTC)

I guess I could have worded it better - use of images there - although I doubt anyone reading the RfC would be confused as to its purpose due to my ambiguity. It is similar enough to the issue that was discussed here that this seemed to be a good place to go for additional input. Jbh^Talk 23:39, 29 October 2015 (UTC)

Adding Bipolar medications

Can we include the new Atypical Antipsychotics under the medications heading for treatment of Bi-polar? "If symptoms of depression or mania persist in spite of treatment with other medications, adding an antipsychotic medication such as olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris) may help. Your doctor may prescribe some of these medications alone or along with a mood stabilizer." http://www.mayoclinic.org/diseases-conditions/bipolar-disorder/basics/treatment/con-20027544

Atypical Antipsychotics for Bipolar Disorder http://psychcentral.com/lib/atypical-antipsychotics-for-bipolar-disorder/

ABSTRACT STUDY CONCLUSION: "Emerging data suggest that the atypical antipsychotic agents have a role in the acute and long-term treatment of bipolar depression." http://www.ncbi.nlm.nih.gov/pubmed/16420074 11/7/2015 Ajbajr (talk) 21:05, 7 November 2015 (UTC)Ajbajr

Antipsychotics are already mentioned in the article. We use secondary sources (Review Articles) not articles of single studies. Agree section needs updating and will check latest literature. Cas Liber (talk · contribs) 22:05, 7 November 2015 (UTC)

"bipolar affective disorder"

Is the ICD10 term and therefore I would ask people to stop removing it [15] Doc James (talk · contribs · email) 04:38, 10 November 2015 (UTC)

False evidence - misreading source material

The source material for the evolutionary basis of Bipolar Disorder hypotheses that Africans are less like likely to be Bipolar, but this is in no way a proven fact and the article doesn't make that claim. It is a proven fact that mental illness is under diagnosed in minority populations making these racial claims even more harmful when stated as fact instead of merely hypothetical arguments that need follow up. The data for Asians and Latinos is ignored. This article on the illnesses evolution is not scientifically worthy of inclusion. It's just conjecture and hypothesis with no real science to support it. — Preceding unsigned comment added by 71.215.67.109 (talk) 01:08, 11 November 2015 (UTC)

I've removed the part referring to prevalence among African Americans: the single source was an article from Medical Hypotheses. The entire "evolutionary" subsection should be reviewed to see if it's sourced according to WP:MEDRS. Update: and, pending that review, I've removed the entire subsection. -- The Anome (talk) 13:12, 11 November 2015 (UTC)

"Evolution" subsection

I've removed the entire evolution subsection. There were two reasons for this. Firstly, it was placed under "Causes". While evolution may be the ultimate cause for the persistence of bipolar disorder, it's certainly not a proximate cause for the disease itself in individuals, which is what these sections should be about. Secondly, it was almost entirely speculative, some of it drawn from press sources that don't meet WP:MEDRS. I'm not at all against a subsection on the possible evolutionary reasons for the continued prevalence of bipolar disorder in the population, but I believe it needs to be really well sourced to multiple peer-reviewed sources that meet the relevant RS standards. I think it's well worth a review, to see what can be salvaged from it, and might be worth incorporating in the article. -- The Anome (talk) 13:27, 11 November 2015 (UTC)

Semi-protected edit request on 6 December 2015

Paragraph for minor editing: Several rating scales for the screening and evaluation of bipolar disorder exist, such as the Bipolar spectrum diagnostic scale.[61] The use of evaluation scales can not substitute a full clinical interview but they serve to systematize the recollection of symptoms.[61] On the other hand, instruments for the screening of bipolar disorder have low sensitivity[clarification needed] and limited diagnostic validity.[61]

Comments: I am a new editor and these are minor but significant editing suggestions. I hope I am submitting them correctly. If not, please advise on how I should do such things in future. This last sentence in this paragraph simply calls for clarification of statistical/methodological terms. As a psychologist (not a clinician, however), as a methodologist [and as a lifelong but fairly recently diagnosed bipolar], I believe (1) you are referring to statistical reliability instead of low sensitivity. Low or high reliability refers to whether a measure of a trait (in this case, a measure of bipolar characteristics) yields a dissimilar or similar result each time that test (or another statistically valid version of the test) is taken by a sample of individuals drawn from the same population of patients. In simple terms, someone who is bipolar should have about the same score on the test each time he/she takes it. Low reliability refers to a measure that yields inconsistent results; high reliability clearly refers to a test that produces consistent results across testings.

[This is no doubt difficult to measure given the fluid nature of mood swings.] However, from personal experience, after being given one of these measures I could distinguish actions that were typical of the "trait" aspects of my bipolar disorder vs. the "state" aspects. This is likely to be part of the measurement reliability problem. I would suggest you refer to a section on "measurement reliability" or "personality measurement" to explain this issue further.

The other measurement problem is validity and there are four types: face validity, criterion validity, statistical validity, and construct validity. The latter is relevant here since I assume you are using "limited diagnostic validity" to refer to low construct validity. Construct validity simply refers to whether an instrument measures the underlying theoretical idea that it purports to measure. I think it might be best to just expand that part of the sentence to "limited diagnostic or low construct validity" with a link to a section on "construct validity" or on the four types of validity. DrSatine (talk) 02:26, 6 December 2015 (UTC)

Please change:

Several rating scales for the screening and evaluation of bipolar disorder exist, such as the Bipolar spectrum diagnostic scale.[61] The use of evaluation scales can not substitute a full clinical interview but they serve to systematize the recollection of symptoms.[61] On the other hand, instruments for the screening of bipolar disorder have low sensitivity[clarification needed] and limited diagnostic validity.[61]

to

Several rating scales for the screening and evaluation of bipolar disorder exist, such as the Bipolar Spectrum Diagnostic Scale.[61] The use of evaluation scales cannot substitute for an in-depth clinical interview but they serve to help systematize the recollection of symptoms.[61] On the other hand, instruments for screening bipolar disorder have low reliability [link] and low construct validity [link] and are therefore of limited diagnostic value.[61] DrSatine (talk) 02:38, 6 December 2015 (UTC) DrSatine (talk) 02:26, 6 December 2015 (UTC)

• Not done: According to the page's protection level you should be able to edit the page yourself. If you seem to be unable to, please reopen the request with further details. --Stabila711 (talk) 08:37, 6 December 2015 (UTC)

General comments on medications and treatment

In my opinion, and as a bipolar patient, I believe too much emphasis is given to lithium as a drug of choice for mood swings. I was unable to tolerate lithium the several times that it was prescribed for me. Also, topiramate should be added as one of the anti-epileptics that can be effective for many bipolar patients.

I would also like to see a section on medication side effects. Theses are not insignificant and restrict medication choices for many bipolar patients. I cannot tolerate most of the anti-epileptics (lamictal, depakote, trileptal, etc.) due to problems with edema, rash, and hair loss. There also are age-related problems with the atypical anti-psychotics including dystonic reactions and increasing chances, as with schizophrenia, of tardive dyskinesia (although the atypical antipsychotics are safer than their predecessors). Ongoing medication management is absolutely essential for bipolars; a drug combo that works at time A may become ineffective at time B. Time B may be just the next mood swing, which may be as soon as a few weeks down the road. Individuals with rapid cycles or mixed moods need much more frequent attention to medication changes than individuals with "classic" bipolar mood swings. Living with bipolar disorder is a full-time job.

Some reference should be made to just how much of a disruption this disease can make of someone's life which I assume can be connected to a page on how difficult it is to manage one's life, marriage, family, and work with chronic illnesses, including mental illness, physical illness, and etc. Resources available to bipolars at the community, state, and national level also might be mentioned. Treatment modalities include more than just meds, private care, and inpatient treatment. Family education is also extremely important.

Just my 6 cents worth.... DrSatine (talk) 02:52, 6 December 2015 (UTC)

We based on content on high quality sources generally. Doc James (talk · contribs · email) 08:47, 6 December 2015 (UTC)

@DrSatine: I am a psychiatrist - you are right about ongoing medication and there should be a secondary source available for that somewhere. We go on secondary sources (review articles) for content to give us the best chance of consensus - I have not heard nor seen of material that supports the idea that medication may be effective at different times. If you have seen that please post. Agree about hte impact, again there should be sources that cover that. Cas Liber (talk · contribs) 09:45, 6 December 2015 (UTC)

• The amount of quality literature on the subject is surprisingly low considering the number of people with bipolar disorder. Having lost more than one friend who had bipolar disorder to suicide, I've put some serious time into studying it, searching for support groups (there are none where I live, a metro area of over 1 million people), and the like. While we know it is genetic, but it hasn't been studied enough. Like virtually all mental disorders, the average general practitioner is often obvious to the symptoms, which is why most bipolar patients go undiagnosed and untreated. It's a catch 22 for Wikipedia, as we can only publish what has been researched and written about. Dennis Brown - 2¢ 12:36, 6 December 2015 (UTC)

• works both ways. I spend a significant amount of time taking folks off medication too (i.e. folks wrongly diagnosed with an Axis I illness). Cas Liber (talk · contribs) 12:15, 7 December 2015 (UTC)

Semi-protected edit request on 20 December 2015

The caption "Bipolar disorder is characterized by transitions between depression and mania" is inaccurate. Bipolar disorder isn't characterized by the transitions, but by the episodes themselves, which do not necessarily immediately follow one another, as stated in the article. I'd say "Bipolar disorder is characterized by episodes of depression and mania interspersed with normal periods." ClaudiaCrowley (talk) 20:11, 20 December 2015 (UTC)

Agree thanks User:ClaudiaCrowley Doc James (talk · contribs · email) 23:33, 20 December 2015 (UTC)

Adding to the History. Melanie Klein on Manic-Depressive States

The Manic-Depressive Psychosis had "splitting" as a defense mechanism, or "cleavage" as Melanie Klein referred to it. She noticed this mechanism as a normal part of the human mental growth. But when "reparation", the next defense mechanism in the mental development, was not achieved, the person could suffer from the most severe mental illnesses such as psychopathy, autism and schizophrenia. M.P.L.P.H. (talk) 14:55, 6 January 2016 (UTC)M.P.L.P.H. 14:55, 6 January 2016 (UTC)

References

Wording

I do not see this as an improvement

"Bipolar disorder, also known as bipolar affective disorder, or less formally as manic depression, is a mental disorder characterized by periods of disordered mood involving alternating, or co-occurring elevated depressed moods."

The lead is a summary. Thus the addition of "less formally" can go in the body of the text.

I do not know what "co-occurring elevated depressed moods" means Doc James (talk · contribs · email) 06:18, 31 December 2015 (UTC)

I agree. The current wording of the first sentence is more clear. Your comment called my attention to this article though and now I'm noticing that I don't love the simplified explanation of mania in the lead, "During mania an individual feels or acts abnormally happy, energetic, or irritable." To me, that perpetuates the common misconceptions of bipolar d/o. People often confuse it with MDD and this sounds more like a description of a brief period of remission from MDD or irritability that's a symptom of depression and there's nothing there that illustrates how a manic episode is significantly different from MDD or even a normal range of emotions. I know the clinical terms can get stuck in my head, like I can't move on from "expansive" at the moment, so I'm bringing it up here for suggestions of alternate wording that would be simple, but also more more accurate. Permstrump (talk) 10:00, 31 December 2015 (UTC)

Right now we say "During mania an individual feels or acts abnormally happy, energetic, or irritable" The ref says "elevated, expansive, or irritable mood, increased activity that is good directed, reduced need for sleep..." I guess we can changed happy to elevated but not sure what is wrong with "abnormally happy". NIH uses similar language [16]. I agree we should use more complicated terms in the body but IMO we should try to keep the lead easy to understand. Doc James (talk · contribs · email) 06:53, 1 January 2016 (UTC)

@Doc James: I think the original was missing the word "and". In which case, "alternating, or co-occurring elevated and depressed moods" would then cover all three cases of (hypo)manic, depressed, or mixed episodes. -- The Anome (talk) 14:37, 31 January 2016 (UTC)

What does "co-occurring elevated and depressed moods" mean? Doc James (talk · contribs · email) 02:37, 1 February 2016 (UTC)

Presumably they mean a mixed affective state such as dysphoric mania or agitated depression. Please note that I'm not personally defending the wording in question: I'm just trying to elucidate what the original author of those words may have intended them to mean. -- The Anome (talk) 22:57, 1 February 2016 (UTC)

It means a mixed affective state - dysphoria in mania is not uncommon...and is still considered mania. Agitated depression is depression. Cas Liber (talk · contribs) 01:46, 2 February 2016 (UTC)

Image of Margaret Trudeau

Margaret Trudeau

This was added as the main image and IMO is inappropriate. Also per WP:MEDMOS we do not typically use the term "surfer" Doc James (talk · contribs · email) 10:04, 2 February 2016 (UTC)

Semi-protected edit request on 7 March 2016

I request that the Teatro.svg image by the title on the right side of the page be REMOVED. It is a horrible connotation to have such imagery applied to a serious mental illness. As a sufferer of bipolar disorder, imagery such as this relating to the disease in a informational setting such as wikipedia is harmful, embarrassing, destructive and further stigmatizing.

58.108.249.116 (talk) 06:07, 7 March 2016 (UTC)

Hmmm, worth an RfC to gain broad opinion. Cas Liber (talk · contribs) 10:33, 7 March 2016 (UTC)

I agree that image was inapt. That image has always bugged me, and I just removed it. I searched on the commons for a better image and didn't find one. I also did a google image search (with reuse filter) and searched on NIH websites, and found nothing that seemed reasonable to me. Jytdog (talk) 20:06, 7 March 2016 (UTC)

Note prior discussions:

• 2008 over former Munch/The Scream image - see version with that image here
• 2008-2009 over roller coaster image - see version with that image here - as far as I can tell this was never in the infobox
• June 2012 and July 2010 over van gogh image - see version with that image here
• Oct 2015 over this image. see version with the teatro image here
• the article has gone for long periods with no image in the infobox, btw

- Jytdog (talk) 20:12, 7 March 2016 (UTC)

@Jytdog: vote below then. Cas Liber (talk · contribs) 09:47, 8 March 2016 (UTC)

RfC: Is the happy/sad mask in the infobox section appropriate?

• Archive 7: Discussion about Happy/Sad Mask image
• Archive 6: Discussion about Van Gogh image
• Archive 5: Discussion about irresponsible captioning on Van Gogh image
• Archive 4: Discussion about roller coaster image
• Talk:Schizoaffective disorder#Inclusion of painting
• ~Permstrump (talk) 21:31, 7 March 2016 (UTC)

Yes

1. I have bipolar disorder, and I don't find this image offensive in any way. It's a neat way of symbolizing the moods in question. -- The Anome (talk) 10:15, 8 March 2016 (UTC)
2. Yes This image and images like it appear in peer-reviewed literature, on government pamphlets, in patient advocacy material etc. This discussion is absurd and the image should most definitely not be removed — it is strongly (and has for the longest time been strongly) associated with bipolar disorder. Pertinence arguments carry no weight in this discussion whatsoever! CFCF 💌 📧 11:27, 9 March 2016 (UTC)
3. Support use This is a frequently used image to represent bipolar in the academic press. The NIH uses similar images [17] as does veteran affairs[18] and the Royal College of Psychiatrists in the UK.[19]. Images also frequently used by the psychology popular press.[20] etc. The image rapidly clues people in to the fact that this article is about a mood disorder. Doc James (talk · contribs · email) 19:58, 9 March 2016 (UTC)

Note - I see the teatro-like image at veterans affairs and the similarity of the image at Psych Today. i do not see it at the NIH or the Royal College of Psychiatrists. in my view the Royal College of Psychiatrists' image here is great. Perhaps we should ask them to release it. Jytdog (talk) 20:09, 9 March 2016 (UTC)

I agree that it is a better image, if you can get them to release it I would support that over the current image. CFCF 💌 📧 20:24, 9 March 2016 (UTC) \

Would be perfectly happy with that one too. With respect to the NIH I was referring to the happy tree sad tree at the top. Larger image here [21] and it is likely under an open license. Doc James (talk · contribs · email) 20:32, 9 March 2016 (UTC)

Oh! I like the tree too. Jytdog (talk) 21:05, 9 March 2016 (UTC)

agree it would be better--Ozzie10aaaa (talk) 22:48, 9 March 2016 (UTC)

Sure. Doc James (talk · contribs · email) 05:03, 10 March 2016 (UTC)

I also much prefer the NIH happy/sad tree image -- let's go with that! -- The Anome (talk) 08:03, 18 March 2016 (UTC)

Would an article ever have a main image like this? If you do a google image search for "bipolar disorder," a lot of the images involve happy/sad faces in some way, so something like this infographic could be a way to get away from that. I like the one Jytdog linked to too though. PermStrump talk 05:21, 10 March 2016 (UTC)

No

1. - 58.108.249.116 (talk)

• Comment 58.108.249.116 says in the section above: "I request that the Teatro.svg image by the title on the right side of the page be REMOVED. It is a horrible connotation to have such imagery applied to a serious mental illness. As a sufferer of bipolar disorder, imagery such as this relating to the disease in a informational setting such as wikipedia is harmful, embarrassing, destructive and further stigmatizing.--♦IanMacM♦ ^{(talk to me)} 09:53, 8 March 2016 (UTC)
• I also have concerns about this image, which is more usually associated with Greek drama. It has problems with WP:PERTINENCE here and could easily be removed without any loss of context for the reader. Images in Wikipedia articles are not decorative.--♦IanMacM♦ ^{(talk to me)} 09:53, 8 March 2016 (UTC)
• it might have problems w/ WP:PERTINENCE--Ozzie10aaaa (talk) 11:24, 8 March 2016 (UTC)
• I find it a bit offensive actually, as it oversimplifies the disorder. More importantly, that mask is designed for theatre, not mental disorders, so it seems to trivialize. As this is a medical article, the lede photo should be medical in nature. Dennis Brown - 2¢ 15:05, 8 March 2016 (UTC)
• no - images aren't required and the teatro image has always bugged me for being tacked on and somewhat trivializing. Jytdog (talk) 15:30, 8 March 2016 (UTC)
• No: Perpetuates misconception that bipolar disorder = being happy one minute and sad the next. Would be better to have no image at all than the current one, but it would be cool to agree on a nice new one. Permstrump (talk) 15:43, 8 March 2016 (UTC)
• No While the image is used often in other sources the masks are more caricature than it is informative. I prefer no infobox pictures for psychiatric disorder articles but if we must have one the NIH one [22] is aesthetically better than the masks. Jbh^Talk 13:11, 10 March 2016 (UTC)

Discussion

Commonly used symbol for bipolar disorder.

• Discuss away. I am undecided myself....Cas Liber (talk · contribs) 10:33, 7 March 2016 (UTC)

We could have another RfC if people wish. Doc James (talk · contribs · email) 02:45, 8 March 2016 (UTC)

It has problems with WP:PERTINENCE. It is bordering on decorative. I don't think it is necessary or ideal. At best, there is no consensus to include this image, as various people have expressed concerns that it is unsuitable.--♦IanMacM♦ ^{(talk to me)} 05:59, 8 March 2016 (UTC)

Can we try again and this time we'll leave the discussion open for longer than a minute? I wanted to respond when I got home from work tonight, but it was already closed by the time I saw it. I thought it was closed by mistake at first, because the RFC had just opened this morning and only one person had commented... Now I'm totally lost. Can we just create a new section or is an RFC essential? Permstrump (talk) 09:09, 8 March 2016 (UTC)

@Permstrump: unarchived then. Cas Liber (talk · contribs) 09:46, 8 March 2016 (UTC)

• I don't think an RFC is needed, this is a local concern, local consensus is all that is needed. I do think medical articles shouldn't have theatrical imagery in the lede, if anywhere. It might seem "convenient", but it borders on insulting. Dennis Brown - 2¢ 15:07, 8 March 2016 (UTC)
  • I made a quick image, which is actually one of the most common symbals used for bipolar disorder, a two sided emoticon. Whether anyone wants to use it or not, I'm fine either way as I'm not sure it is fully appropriate either, but it is fairly common in social media, inoffensive, and shows the duality of the disorder. Dennis Brown - 2¢ 15:17, 8 March 2016 (UTC)
    • Given that there are a number of archived discussions above which deal with previous rejected images for this article, I'd ask why does this article need an image (any image) anyway? Chuntuk (talk) 15:39, 8 March 2016 (UTC)
      • Valid point. My thinking was if you are going to use one, find one that is accepted (or at least common) as representing bipolar disorder OR use a generic image for "medical articles". Dennis Brown - 2¢ 16:03, 8 March 2016 (UTC)
        • I made the RfC as I saw there are folks who feel strongly on both sides and a broader consensus is needed rather than a half dozen folks or so. And it keeps popping up. Cas Liber (talk · contribs) 18:42, 9 March 2016 (UTC)
          • I consider images useful as they clue the reader into the general subject matter of the article in visual form. I do not consider the punctuation marks as good but do consider them better than nothing. Doc James (talk · contribs · email) 20:00, 9 March 2016 (UTC)
• CFCF can you please provide refs to support your statement here? Jytdog (talk) 16:20, 9 March 2016 (UTC)

• so... this is not actually an RfC - there is no tag and it is not being broadcast. Casliber do you really want an RFC or not? Jytdog (talk) 19:00, 9 March 2016 (UTC)
  • I set it up as one before but was reverted. I feel it would be better as one than not to get a wider audience and broader consensus. Cas Liber (talk · contribs) 20:21, 9 March 2016 (UTC)

• so i downloaded the NIH brochure and uploaded the cropped cover of the "tree" image, and replaced the image. Thoughts? Jytdog (talk) 23:46, 9 March 2016 (UTC)

good image--Ozzie10aaaa (talk) 23:58, 9 March 2016 (UTC)

Is there a worry that it overidentifies wuth one particular organisation..? Cas Liber (talk · contribs) 02:37, 10 March 2016 (UTC)

There is always a tendency to bias towards the free images on Commons. The use of Teatro.svg is a good example of this. Wikipedia is an encyclopedia, not a newspaper, magazine or organization, and its content should be encyclopedic. Mental health is a difficult subject to illustrate and the media has been advised about this by patient advocacy groups.[23] Although Teatro.svg is not spectacularly bad, it is not adding greatly to the article and could easily be removed without the article falling to pieces. As WP:LEADIMAGE says: "Lead images are not required, and not having a lead image may be the best solution if there is no easy representation of the topic."--♦IanMacM♦ ^{(talk to me)} 05:29, 10 March 2016 (UTC)

• Re this edit: I was going to say earlier that BiopolarCoverNIHcrop.jpg is a big improvement on Teatro.svg, which as its name suggests was designed with illustrating some form of drama at a theatre. At least the BiopolarCoverNIHcrop.jpg image was designed with bipolar in mind.--♦IanMacM♦ ^{(talk to me)} 16:19, 10 March 2016 (UTC)
  • I like it better because it's not as juvenile, but I dont love it. I assume winter represents depressive episodes and spring/summer is supposed to the manic episodes? That makes it seem like they're a good thing. If we get rights to the one Jytdog posted above ("in my view the Royal College of Psychiatrists' image here is great.") IMHO we should us it. That was one of the only ones that does make manic episodes seem like it just means being really happy. Any word on the rights? I thought someone said they were asking. PermStrump(talk) 15:38, 11 March 2016 (UTC)

It looks like someone was aping Pablo Picasso with the Royal College of Psychiatrists' image (according to my amateur art critic's skills). However, if it is WP:NFCC it may be unlikely that they would release for free use.--♦IanMacM♦ ^{(talk to me)} 16:30, 11 March 2016 (UTC)

Opening sentence

The opening "characterized by periods of depression and periods of elevated mood" looks too generic, as healthy people also have them. While subsequent sentences clarify that, I think more specific opening sentence (possibly containing peculiar signs of BD) would look better. Brandmeister^talk 21:12, 30 March 2016 (UTC)

That is why "periods of depression" was linked to "Major depressive episode" Doc James (talk · contribs · email) 21:20, 30 March 2016 (UTC)

I'd say "periods of depression" are not the same as "Major depressive episode" and in common parlance that may be confusing. Perhaps just say plainly "major depressive episode". Brandmeister^talk 21:32, 30 March 2016 (UTC)

No one says you have "major depression disorder" we all say you have "depression" when we mean MDD. So I would say in common parlance they are the same. When people mean a depressed mood they usually say "sad" or "blue" or "feels down". Doc James (talk · contribs · email) 22:08, 30 March 2016 (UTC)

Brandmeister, I've been bothered by that same sentence for a while now too. My issue is that it minimizes manic episodes though. I'm actually fine with the casual description of depression because I think, in general, people are aware there's a difference between the colloquial and clinical use of the term "depression," even though they usually aren't aware of what exactly that difference is (at least they know enough to know what they don't know). Whereas they're 100% certain that they know "bipolar manic depression" is when you're happy one minute and then angry and flipping out the next minute. Or they repeat the cliché about extreme highs and lows, but they're imagining "highs" to be more like hyperactivity or an unexpectedly bright mood shortly after a good cry. "Elevated" has a similarly misleading, positive connotation and IMHO, that's exactly why so many people these days insist they have bipolar disorder when they're actually reporting textbook symptoms of a major depressive episode and zero symptoms of a manic episode. I'm at a loss for a better alternative to the current version though. Everything I come up with is too jargony or uses words that have multiple definitions and would be equally confusing. PermStrump(talk) 09:57, 31 March 2016 (UTC)

We describe the "elevated mood" as "The elevated mood is significant and is known as mania or hypomania depending on its severity or whether symptoms of psychosis are present." And link to both those terms. Doc James (talk · contribs · email) 10:29, 31 March 2016 (UTC)

I'm partially fine with the current version, but my impression is that we're still approaching WP:EGG. I think "major depressive episode" is understandable to general public, so there's no need to WP:PIPE it for simplification. Especially since "periods of depression" could be short and relatively minor, while we're talking about "major depressive episode". Brandmeister^talk 10:42, 31 March 2016 (UTC)

I know elevated mood is explained later, but people are lazy readers. I just want them to get it already. Ya know? I don't really have a good sense if most people would have a different connotation to hearing major depressive episode vs periods of depression. I bet they'd lump them together anyway. What about any of these options...

• Bipolar disorder is a mental illness characterized by periods of clinically significant depression and periods of unrestrained and inappropriately elevated moods.
• Bipolar disorder is a mental illness characterized by significant periods of depression and periods of pathologically elevated moods.

• Bipolar disorder is a serious and rare mental illness characterized by clinically significant periods of depression and elevated moods.

PermStrump(talk) 12:45, 31 March 2016 (UTC)

It is the very next sentence. Doc James (talk ·

contribs · email) 17:52, 31 March 2016 (UTC)

• I think saying "significant periods of depression" or "periods of clinically significant depression" would be incorrect from a medical point of view. Many people with bipolar disorder have very mild or virtually no depression and the primary symptom is regular hypomania, which is why it is so underreported, as a someone with hypomania generally doesn't feel like anything is wrong, and in fact, may feel that everything is great. Another problem is that many people with BP disorder mainly have depression and very little hypomania/mania, so they end up getting misdiagnosed as simply being depressed, and of course, regular depression medications can be detrimental to someone with BP disorder. Depression depth and length varies wildly among those with BP, so you can't get very specific in the lede or you risk misleading the reader. BP is a very broad spectrum. As for "rare", some estimates claim up to 1 in 20 people have some level of BP disorder (with over half undiagnosed), so I'm not sure that word is accurate either. I think we have to start broad in the lede. BP simply isn't binary enough to be so specific. Dennis Brown - 2¢ 01:52, 1 April 2016 (UTC)

I've reverted "major" back out. Again, not every person with bipolar disorder has major depression. This isn't new information and the sources simply do not support the notion that all people with BPD have "major" depression. Type Is, yes, but not all Type II nor many NOS. Dennis Brown - 2¢ 11:12, 1 April 2016 (UTC)

Agree it is a spectrum. We have cyclothymia which is a type and does not include major depression episoids. The exact paraphrased definition is long and complicated and belongs in the body. Agree it is common in the US affecting 3% of people at some point in their life. Doc James (talk · contribs · email) 11:24, 1 April 2016 (UTC)

That is what "periods of depression" is currently linked to, if it's indeed incorrect then it should be unlinked from Major depressive episode. The first source says: "Depression is usually more common and longer lasting than elevated mood, and—together with inter-episode milder symptoms—contributes most to overall morbidity". Thus it's also possible to say "lasting" or "significant depression", to distinguish it from depression in healthy people. If major depressive episode is correct, it's possible to just plainly write so, as I noted above. Doesn't look like rocket science. Brandmeister^talk 11:32, 1 April 2016 (UTC)

Have adjusted the link to clinical depression depression (mood). Doc James (talk · contribs · email)

The point being that "major" isn't correct. It is for most, but it isn't required to be diagnosed, so it isn't accurate for all people with BPD, thus you can't define BPD as such. Depression of some kind is, but not "major". Dennis Brown - 2¢ 11:43, 1 April 2016 (UTC)

Yes was just coming around to that when I realized that clinical depression links to MDD. Doc James (talk · contribs · email) 11:47, 1 April 2016 (UTC)

Mania-induced euphoria

Does anyone know of a MEDRS-quality reference that covers this topic (i.e., something more than a trivial level of detail like a single passing mention)? I need a medical reference to cite and possibly revise Euphoria#Mania. Seppi333 (Insert 2¢) 17:35, 11 April 2016 (UTC)

Doh. I dropped the ball. I swear it's still on my to-do list. :) I'll respond/start a thread with some ideas on Talk:Euphoria. PermStrump(talk) 19:18, 11 April 2016 (UTC)