Talk:Bipolar disorder/Archive 8

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Archive 9

Low-grade cycling

Ozzie10aaaa just put a {{cn}} tag on this sentence: There is a low-grade cycling of mood which appears to the observer as a personality trait and interferes with functioning, so I thought I'd google around to find a source and found that those lines were either taken verbatim from this neurocritic blog or the blog copied from wikipedia. Either way, the quote does not come from the source that neurocritic cited (PMID 10550853), so I don't think we should bother paraphrasing it unless we find a more reliable source, which I have been unable to do thus far. —PermStrump(talk) 17:27, 24 May 2016 (UTC)

agree (ill try to find a reference...)--Ozzie10aaaa (talk) 18:52, 24 May 2016 (UTC)

It's a highly controversial area. Essentially linked to discussion on bipolar II, which many psychiatrists are dubious about. Cas Liber (talk · contribs) 21:38, 24 May 2016 (UTC)

Here they tie it to cyclothymia [1], citing DMS-IV. Probably not MEDSR, but I just stumbled across it. Dennis Brown - 2¢ 21:43, 24 May 2016 (UTC)

It's weird that that's the same exact sentence again. It makes me think that wikipedia was the original source for it, especially since that book is self-published. —PermStrump(talk) 22:09, 24 May 2016 (UTC)

The author appears to be this person. So I guess let's do some reading. Commentaries and opinions can be risky as some doctors who are often published often have ideas that might not be backed up with peer-reviewed research or Review Articles. Not saying that's true in this case though as I don't know this person. Cas Liber (talk · contribs) 22:59, 24 May 2016 (UTC)

The blog that I linked above with the same sentence was posted in 2011 and the book is from 2013. I don't know how to tell when it appeared on the wikipedia page. —PermStrump(talk) 23:08, 24 May 2016 (UTC)

I'm wondering if DSM IV uses it, and that is the source. I don't have access, and some would argue that 4 is way out of date (I've heard that of 5 as well). If so, that would be one source, although I think we would all want something else to go with it as a source. Dennis Brown - 2¢ 23:11, 24 May 2016 (UTC)

I can access the DSM-IV and 5 online through work and just did Control F through both of them for "cyclothym" and "personality trait," and didn't find anything remotely similar to that statement. —PermStrump(talk) 23:21, 24 May 2016 (UTC)

I take it back. I took a closer look both the DSM-IV and the DSM-5 say something sort of similar in the differential diagnosis section of cyclothymic disorder: "Borderline personality disorder is associated with marked shifts in mood that may suggest cyclothymic disorder. If the criteria are met for both disorders, both borderline personality disorder and cyclothymic disorder may be diagnosed." If we were to paraphrase that (a) I think it belongs in the differential diagnosis section and (b) We should be more careful that the wording doesn't represent the source, because I don't think the original sentence is really on target. The article already talks about the differential diagnosis with borderline personality disorder anyway, so I think we can just scrap this unsourced, potentially WP:COPYVIO sentence. —PermStrump(talk) 23:37, 24 May 2016 (UTC)

Agree on scrapping the sentence - part of the problem is how and what folks mean by "mood swings", which varies between laypeople and therapists and even different therapists. Generally in borderline and antisocial personality disorder it relates to affect dysregulation and a person's impaired ability to self-soothe - e.g. if I go outside and I have a $120 parking ticket I will be mightily pissed off for a while but will get over it once my attention focuses elsewhere, "it's a nice day, it's only money etc.". With bipolar classically it refers to mood swings that are visceral and take place over weeks to months are are sustained over this period - i.e. a manic person will spend days or weeks on end in hyperdrive with lack of sleep, euphoria, irritability etc. Now problem is, if you're asking a person via questionnaire and they tick the "mood swings" box yes...how you gonna know what they mean unless you're a clinician who can talk to the person and figure it out (this is one reason why no questionnaire has been shown to be a valid substitute for a clinician actually interviewing a patient but hey...). More recently, psychiatrists have been diagnosing ultra-rapid cycling and bipolar II while other psychiatrists are dubious and feel that many of these are actually personality disorders. This is an area of some controversy and it would be good to see what discussion exists in the literature (hopefully a Review Article or more) Cas Liber (talk · contribs) 23:58, 24 May 2016 (UTC)

Psychiatric disorder

User:Motivação please come and explain the rationale for your changes. No one agrees, and you are not giving us a reason to. Pleese do. Jytdog (talk) 05:05, 28 May 2016 (UTC)

Motivação, I agree with Jytdog on the caption of the Infobox image, 'characterized' is a better choice than 'illustrates'. Reason: the image is a metaphor for bipolar disorder—'illustrates' treats the image as concrete; it is an illustration—'characterizes' is cues a deeper meaning. — Neonorange (talk) 00:34, 3 June 2016 (UTC)

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I fixed the citation, which had used a draft DSM term, rather than the final published one. Drdaviss (talk) 23:21, 23 July 2016 (UTC)

Semi-protected edit request on 9 August 2016

PLEASE CHANGE: Bipolar disorder, formerly manic depression, is a mental disorder

TO: Bipolar disorder, formerly manic depression, is a mood disorder

BECAUSE: Bipolar Disorder is a mood disorder, not a mental disorder. It is listed in the DSM V under "Mood Disorders" as evidenced by the article below.

SOURCE: http://www.ncbi.nlm.nih.gov/books/NBK64063/

Jennamokeefe (talk) 17:01, 9 August 2016 (UTC)

It is both a mental disorder and a mood disorder. Doc James (talk · contribs · email) 19:11, 9 August 2016 (UTC)

Differential diagnosis

This section has text that is incorrect: "It has been noted that the bipolar disorder diagnosis is officially characterized in historical terms such that, technically, anyone with a history of (hypo)mania and depression has bipolar disorder whatever their current or future functioning and vulnerability."

The DSM requires that, to have most diagnoses (including bipolar disorder), there must be "marked impairment of social or occupational functioning". Thus, this statement is incorrect. I checked the source and find no such statement there.

Frankly, this whole second paragraph does not address differential diagnosis, and I think it should be removed. There are other things that should be added to this section, however, including things like hyperthyroidism, stroke, brain tumor, epilepsy, drugs (cocaine, amphetamines), and medications (steroids, certain antibiotics, dopaminergic agents).

Thoughts? — Preceding unsigned comment added by Drdaviss (talk • contribs) 22:10, 7 August 2016 (UTC)

That's some serious editorializing. I'm pretty sure the editor who added that misunderstood (perhaps willfully) this paragraph from the source:

PMID 17825463

The defining features of mania are elevated, expansive or irritable mood, inflated self-esteem or grandiosity, decreased need for sleep (e.g. feeling refreshed after less than 3 h per night), pressure of speech, thoughts racing, distractibility, increased goal-directed activity and pleasurable risky activities (e.g. promiscuity, overspending). Many patients also experience psychotic symptoms such as delusions, thought disorder and hallucinations. Individuals with bipolar II disorder experience hypomania rather than mania. During hypomania, patients experience the same clusters of symptoms as a manic episode, but they fall short of mania in several ways. The symptoms do not include psychotic experiences, and last at least four days rather than over a week. Although other people notice that their behavior is clearly different from when they are in their normal state of mind, the symptoms do not lead to clinically significant social impairment or hospitalisation (APA, 2000). It is important to emphasis that hypomania is not a clinical condition on its own. Indeed, brief hypomanic symptoms are widespread in the nonclinical population (Udachina & Mansell, 2007; Wicki & Angst, 1991), and brief hypomanic episodes in the absence of a history of depression or treatment seeking have been reported in high functioning individuals (Seal, Mansell, & Mannion, in press). Thus, manic symptoms can be considered to lie on a spectrum, with increasing vulnerability to mania indicated by more pronounced, co-occurring hypomanic experiences, yet only mania represents the clinically significant extreme.

I went ahead and deleted it. That section just basically needs to be rewritten. I'll try to expand it a little later. —PermStrump(talk) 11:42, 8 August 2016 (UTC)

Thanks, Permstrump. I searched to find out more, and this language has been in the article [2008], when EverSince added it. I'll help with a rewrite. Drdaviss (talk) 17:46, 8 August 2016 (UTC)

It's sort of hard to believe it's been there like that for this long without anyone fixing the wording to match the source or a different source or to add material that actually has to do with differential diagnosis. (Well, it's not that hard to believe.) For some reason your last comment made me wonder what the original version of the article looked like... Here's a link to the oldest one available in the history if anyone else is interested. It's from Nov 2001 and it made me laugh a little. The first few sentences said: "Commonly called manic depression, bipolar disorder is a psychosis that manifests itself in cycles of mental ups and downs in a person; the cycles may be long or short, and the ups and downs may be of different magnitudes: for instance, a person suffering from bipolar disorder may suffer a protracted mild depression followed by a shorter and intense mania. The manic periods typically include euphoria, tirelessness, and impulsiveness; the depressed periods may seem much worse following a manic period." But I digress... —PermStrump(talk) 19:03, 8 August 2016 (UTC)

Regarding the bit I added in 2008, I'm bemused how you can quote from the source and make a possible accusation of willful misreading, without having apparently read the article properly enough to find the bit that actually says exactly what it was cited for:

It is also important to note that bipolar disorder, unlike most other psychiatric conditions, is characterised historically and therefore technically, anyone with a history of (hypo) mania and depression has bipolar disorder, whatever their recent functioning and future vulnerability. This is an ethical and methodological issue, as it means no one can be considered as being recovered from bipolar disorder, and that many studies could include individuals who, while having had (hypo)mania and depression in the past, no longer hold some of the key vulnerabilities to relapse that the studies are trying to identify.

Eversync (talk) 21:58, 8 August 2016 (UTC)

Actually, I'm thinking that having a section remain essentially unedited for 8 years is a good testament to staying power. Nonetheless, I do think that the original source overstated the lack of a requirement for recent (or current) functioning. Even DSM4TR required impairment to make a diagnosis, so for the source to say "whatever their recent functioning" is not consistent with the prevailing diagnostic criteria at the time (2005-ish article?), or now either.

So, I'm thinking we can get agreement that the differential diagnosis section should talk about the other conditions that can look like bipolar disorder, but are something else. Here's a starting point:

The main psychiatric differential diagnoses are schizophrenia, schizoaffective disorder and unipolar (major) depression, though some may include ADHD and borderline personality disorder.Nonpsychiatric diagnoses that overlap with symptoms of bipolar disorder are tabulated in this classic text, including seizures, multiple sclerosis, right hemisphere trauma, Huntington's disease, stroke, hyperthyroidism, dialysis, Addison's disease, Cushing's disease, infection, intracranial tumor, delirium, B-12 deficiency, and about 20 medications that can trigger mania or hypomania.

Drdaviss (talk) 02:53, 9 August 2016 (UTC)

References

A bit outdated but useful - large numbers of people with personality disorder are being diagnosed as bipolar II these days. I do need to stump up some refs on this....Cas Liber (talk · contribs) 03:12, 9 August 2016 (UTC)

EverSince: That's taken out of context and makes it sound like the authors were referring to bipolar diagnoses in general, when in reality they were talking about the limitations in the existing research. They were criticising bipolar studies which, more so than research on other disorders at the time, were largely based on self-report questionnaires that asked about historical symptoms and events as opposed to diagnostic evaluations with clinicians ("Even within the experimental literature, there is a predominance of neuropsychological tests and few paradigms from contemporary cognitive psychology, unlike the research base in many other disorders...". Here's more context from the source followed by the material that was previously in the WP article:

Extended content

Source: It is important to emphasis that hypomania is not a clinical condition on its own. Indeed, brief hypomanic symptoms are widespread in the nonclinical population...Thus, manic symptoms can be considered to lie on a spectrum, with increasing vulnerability to mania indicated by more pronounced, co-occurring hypomanic experiences, yet only mania represents the clinically significant extreme… One criticism of the above studies is that they rely on retrospective recall from multi-episode patients…Clearly however, retrospective studies are prone to a range of possible biases… Even within the experimental literature, there is a predominance of neuropsychological tests and few paradigms from contemporary cognitive psychology, unlike the research base in many other disorders...Maybe the biggest challenge is to try to integrate the diverse range of psychological assessments (e.g. self-report; cognitive; neuropsychological; real world monitoring) into a set of studies that provide a truly integrated picture of the development of mania… A key issue concerns the nature of the samples in the studies reviewed. While many used individuals diagnosed with bipolar disorder, others used screening questionnaires to identify at-risk populations, which while clearly important, only a subset will actually develop a clinical condition. It is also important to note that bipolar disorder, unlike most other psychiatric conditions, is characterised historically and therefore technically, anyone with a history of (hypo) mania and depression has bipolar disorder, whatever their recent functioning and future vulnerability. This is an ethical and methodological issue, as it means no one can be considered as being recovered from bipolar disorder, and that many studies could include individuals who, while having had (hypo)mania and depression in the past, no longer hold some of the key vulnerabilities to relapse that the studies are trying to identify Moreover, there appear to be a further group of individuals who have experienced hypomanic episodes and yet have high levels of functioning and do not develop bipolar disorder. Previous version of WP article: "It has been noted that the bipolar disorder diagnosis is officially characterized in historical terms such that, technically, anyone with a history of (hypo)mania and depression has bipolar disorder whatever their current or future functioning and vulnerability. This has been described as "an ethical and methodological issue", as it means no one can be considered as being recovered (only "in remission") from bipolar disorder according to the official criteria. This is considered especially problematic given that brief hypomanic episodes are widespread among people generally and not necessarily associated with dysfunction."

Drdaviss: I don't think the authors were claiming that a bipolar diagnosis doesn't require impairment in functioning and/or significant distress. I think they were saying that the studies that only used retrospective self-report measures likely captured false positives of participants that only had subclinical manic/hypomanic symptoms and never actually met the full criteria for bipolar disorder. I'm having a little trouble articulating what I'm trying to say. Does this make sense give the context above? —PermStrump(talk) 03:37, 9 August 2016 (UTC)

Yes, I have seen some really crappy self-report studies used as "evidence" to support secondary sources claiming ten year delay in diagnosis Cas Liber (talk · contribs) 03:41, 9 August 2016 (UTC)

Permstrump & Casliber: I see that now. I was thrown by their use of technically to indicate that these are people who meet criteria. I would insist that, technically they don't. There are certainly better secondary sources to be used. Drdaviss (talk) 13:50, 9 August 2016 (UTC)

Suddenly I remember why I quit Wikipedia. The source clearly turns to making a statement about bipolar disorder in general, explicitly calling the historical basis for the diagnosis an "ethical" as well as a technical issue. Drdaviss originally implied there was nothing in the source saying anything like this, but I now realise they apparently subtly meant it didn't specifically say 'current and future functioning and vulnerability'. Ok. But then quickly Permstrump deletes the paragraph on the basis of quoting the wrong section of the source while alleging bad faith, for which there's been no acknowledgement let alone retraction - instead changing to claiming the relevant section was taken out of context. But the thing is, you're all talking as if genuinely unaware that a diagnosis of bipolar disorder can indeed be applied during the euthymic periods where by definition there doesn't need to be clinical distress/impairment, and e.g. a quick random search suggests "The duration of the euthymic interval varies from as little as a few weeks or days to as long as years, or even decades." Eversync (talk) 20:20, 9 August 2016 (UTC)

I've now retracted the the part of my first comment that implied bad faith and I am genuinely sorry to have assumed that, because I hadn't seen the section later on that really isn't worded clearly. First of all, I'm not, and I don't think anyone else is, taking issue with the part about a bipolar diagnosis still applying in between episodes. Secondly, now I can see how you might have taken away what you did from the article, and in isolation, your paraphrase looks accurate to the source, but it draws a conclusion the authors weren't drawing and leaves out the important context clues as to what the authors' main point actually was. They were specifically talking about how the methods used to identify study participants with bipolar disorder skews research, specifically research in the area of their review, which was looking at studies on the progression of symptoms leading up to full blown manic episodes. From a research perspective, the fact that bipolar is considered a lifelong illness and includes people with bipolar II who have had major depressive episodes and hypothetically only one hypomanic episode, means that study data include people across the bipolar spectrum, some of whom will never have manic episodes and aren't representative of the severe end of the spectrum, which makes it difficult to find relevant data in the specific context of the "ascension towards mania" that would ideally help direct treatment to potentially be able to preemptively intervene and stave off full blown manic episodes if they could be caught in an earlier stages. That's what the entire review is about and that's the point the authors were making in the paragraph you're referencing. —PermStrump(talk) 19:59, 10 August 2016 (UTC)

Sincere thanks for acknowledging that about my original edit and your prior comment; I would guess the original comment here led to it by misleadingly suggesting the source said nothing about it, for reasons I'm not sure of. Regarding what the source says, I take the point that it was in the context of research technicalities, but it does also seem to be stated in general terms - and a later article by the same first author supports this clearly: http://www.ncbi.nlm.nih.gov/pubmed/19523280 First paragraph: "Bipolar I disorder is defined by a history of mania and depression... Because the diagnosis of bipolar disorder is based on historical information, the diagnosis is lifelong." I'm not entirely sure if this is from an explicit official statement, but it does appear to be the case logically per the DSM criteria: "At least one lifetime manic episode is required for the diagnosis of bipolar I disorder" / "Criteria have been met for at least one manic episode", or "For a diagnosis of bipolar II disorder, it is necessary to meet the following criteria for a current or past hypomanic episode" but only when "There has never been a manic episode" (not caused by a substance) at any time in the person's life. There is a bit in the DSM-IV intro that talks about coding Full Remission and it gives an example of Bipolar Disorder treated with lithum for three years, and the next sentence says a clinician could decide after some further time to stop coding a condition at all - 'recovered' - but that's apparently a different sense of the term. Eversync (talk) 08:06, 11 August 2016 (UTC)

Gender differences in bipolar disorder

Zuormak left this comment below on my talkpage and I'm responding here since other editors might have opinions about it. —PermStrump(talk) 23:13, 10 August 2016 (UTC)

You're wrong, gender differences are not covered in the 'Epidemiology' section. Bipolar disorder is generally evenly distributed by sex, however, it's clearly detailed that Bipolar type I is more common in men, Bipolar type II and Cyclothymia is more common in women. Again, this is not detailed in this 'Epidemiology' section.

Furthermore, I had good information and studies, sourced from the NCBI that you deleted - I would recommend reading the studies and reconsidering.. — Preceding unsigned comment added by Zuormak (talk • contribs) 12:58, 10 August 2016 (UTC)

Zuormak: See my response at at Talk:Bipolar disorder. —PermStrump(talk) 23:13, 10 August 2016 (UTC)

In reference to my revert here that removed this content from the lead: "There has also been studies linking bipolar disorder to criminality, especially in individuals with early onset bipolar and poor impulse control."[2][3][4][5][6][7] All 5 of the sources cited (#2 and #5 are duplicates) are primary sources, so they don't meet WP:MEDRS standards. This "critical review" might be MEDRS (I'm not sure how a critical review differs from other types of review articles, so maybe another editor can weigh in on that). But it should go in the body, not the lead, at least for now until editors can evaluate it in the context of the entire article, because the lead is supposed to be a summary of the main ideas from the body. Also, this is a sensitive, nuanced topic that needs more thoughtful wording and explanation than what it said before, because it was too vague and could be interested different ways by anyone who reads it.

In reference to this revert that said: "Although Bipolar disorder is equally common in men and women, Bipolar II and Cyclothymia appears more often in women than in men."[8][9] Neither of those sources support the statement about cyclothymia. The epidimiology section already says, "The incidence of bipolar disorder is similar in men and women[109] as well as across different cultures and ethnic groups." This is a more recent review from 2014 (as opposed to 2003-2004) that supports the statement that women are more likely to have bipolar II, but doesn't support women having higher rates of cyclothymia or men being more likely to have bipolar I. One of the older sources said men had higher rates of mania, but the other one said men and women have the same rate of mania, and the most recent review doesn't address it, so it seems like could make sense to include somewhere about women having higher rates of bipolar II, but I don't think the rest of it should be added back, at least until there's clarity on what the mainstream view is from recent high quality sources. —PermStrump(talk) 23:13, 10 August 2016 (UTC)

A large meta-analysis of 29 epidemiological studies of bipolar disorder, covering 20 countries, concluded that there was no significant difference in gender prevalence of bipolar spectrum disorders. I added this reference to the Epidemiology section. Drdaviss (talk) 04:32, 18 August 2016 (UTC)

Added a top-tier assessment instrument for bipolar disorder

Hello all, I added the General Behavior Inventory, a top-tier assessment instrument for bipolar disorder for adults. There are multiple existing measures that have been adapted from this measure, and are currently in use in clinical settings. Here's a review on the strong support of the GBI in an academic textbook (can be found under Self-Report Measures). Happy to hear any comments on this. Thanks! Ongmianli (talk) 18:18, 12 August 2016 (UTC)

I'm sure it's a fine tool. There are tons of measures though and this can't be an exhaustive list. The 3 that are already mentioned were listed together in the source, which is a review of rating scales for bipolar, as the 3 most extensively researched for accuracy, so as far as due/undue weight, I think it makes sense to just include those 3. I don't see a reason to include more than 3. Other editors might feel differently, but that's my opinion. —PermStrump(talk) 06:13, 13 August 2016 (UTC)

I agree that this isn't the place to make an exhaustive list, and GBI is not one of the more commonly used tools, in part because of its length (! 70 items). The Carvalho 2015 reference does a nice job of reviewing bipolar tools and does not mention GBI, though these are all bipolar-specific tools. It appears that the GBI is a broader, multidimensional tool, like M3 and PRIME-MD. If mentioned here, I'd support doing so if calling this differentiating factor out, especially given the textbook reference (MEDRS). The 1989 Depue article has 35 Pubmed Central citations, adding support to some degree of weight. That being said, the use of top-tier to describe the GBI seems like a superlative that I've not found WP:MEDRS support for. Drdaviss (talk) 05:02, 18 August 2016 (UTC)

I'd just add that no-one really uses these tools for clinical purposes - no tool has been found to replace assessment by a clinician. There are a whole bunch of them and none really stands out as more common or signficant than others. Cas Liber (talk · contribs) 05:18, 18 August 2016 (UTC)

Unfortunately, I agree with Cas. The reality is that primary care clinicians treat most people with mental health conditions, and they, for the most part, are not using structured assessment tools at all. When they are, they use the PHQ-9 and, to a much lesser degree, GAD-7. It is uncommon for PCPs to use MDQ or other tools for bipolar. Given that we know that 15-20% of people positive for depression on PHQ-9 in fact have bipolar disorder, this means that about 15-20% of people with PCP-diagnosed depression are being treated inappropriately.

In the US, multiple forces are pushing for more use of measurement tools. The Joint Commission has proposed requiring behavioral health clinicians to use measurement-based care principles (structured instruments) for outcomes monitoring. So has the nonprofit mental health advocacy org, Kennedy Forum. NCQA is expanding its mental health requirements for PCMH to go beyond just depression. And the Depression and Bipolar Support Alliance, in their comments on pending MACRA regulations, stated:

"If a depression diagnosis is made then further testing should be done for bipolar disorder. We request that NQF‐0109 (Bipolar Disorder and Major Depression: Assessment for Manic or Hypomanic Behaviors) be added to TABLE A: Proposed Individual Quality Measures Available for MIPS Reporting in 2017 and that it also be added to TABLE E: 2017 Proposed MIPS Specialty Measure Sets."

It seems clear that more of these tools will be used in the future. While I agree with Cas that they will not replace assessment by a clinician, they will be used to determine which people may benefit more by such an assessment. Hopefully, people with unrecognized or mismanaged bipolar disorder will benefit from these changes.

Drdaviss (talk) 16:38, 20 August 2016 (UTC)

Useless image in infobox

File:BiopolarCoverNIHcrop.jpg

Current image

Possible replacement image

The current image in the infobox is merely decorative and does not illustrate the information in the article in a useful way. I had replaced it with an image based on historical depictions of mania/"melancholy", one of which was already in use further down in the article. However, this was reverted with the message "This isn't an ideal image and goes back to Bedlam stereotypes". Is there a better image available? If not, we should probably have no image since the current one is just a waste of space and detracts from the encyclopedic nature of the article. Augurar (talk) 19:43, 23 July 2016 (UTC)

It's worth noting that the article on Mania uses a similar lithograph in the infobox, and both Mania and Major depressive disorder articles use the proposed lithographs further down in the body. Perhaps a better caption would suffice to indicate the historical nature of the depictions, if the concern is about perpetuating historical stereotypes? Augurar (talk) 19:51, 23 July 2016 (UTC)

This was discussed in the talk page archive and the current image is the result of a consensus being achieved. One of the things that emerged during the discussion is that mental health advocacy groups and charities have asked the media not to use Bedlam era images to illustrate modern concepts in mental health. Paintings and drawings of inmates in 19th century lunatic asylums are fine for showing what 19th century lunatic asylums were like, but things have moved on since then. There is a tendency to overuse this type of image because it is so old that it is out of copyright. On a personal level, I'm not a great fan of the NIH brochure image, but I'm even less of a fan of the proposed replacement.--♦IanMacM♦ ^{(talk to me)} 19:54, 23 July 2016 (UTC)

How about a more abstract image, or a symbolic one? The tree image doesn't really cut it, as the green "spring" image is normal, not manic. Perhaps a rollercoaster, or a public domain donated lifechart image? Or hold a little contest for people to donate artwork that represents their view of living with bipolar disorder. Does wikipedia ever hold contests? Drdaviss (talk) 23:48, 23 July 2016 (UTC)

I think the current image of the tree was selected because A) we had permission to use it and B) it comes from an NIH brochure about bipolar disorder. I said essentially what Drdaviss just said during the last RFC, but at the time, the tree was the best alternative suggested compared to the previous image of something like a Greek comedy/tragedy mask (I don't know what to call it and can't figure out how to link to it). I like this one Augurar suggested of two women (the same woman?) since the description says they had been diagnosed with mania and depression. I think it's worth discussing again with these new suggestions, but we should probably do an RFC since the lead image for this article has come up a number of times in the past. —PermStrump(talk) 02:18, 24 July 2016 (UTC)

I'm on the fence about the new suggestion now that I read ianmacm's comment. Somehow I missed it before. But I don't love the current image either way and would be open to discussing again with some better options proposed. —PermStrump(talk) 02:22, 24 July 2016 (UTC)

Support keeping the current one as it is a classic depiction. Doc James (talk · contribs · email) 06:20, 24 July 2016 (UTC)

There is another obvious problem, because the women on the left and right hand side of the proposed new image do not seem to be the same woman. This means that neither of them has been diagnosed with a bipolar condition, and the image has been stitched together as a form of WP:SYNTH.--♦IanMacM♦ ^{(talk to me)} 06:37, 24 July 2016 (UTC)

The tree hasn't been diagnosed with a bipolar condition either.  :) Augurar (talk) 21:11, 21 August 2016 (UTC)

• I'm not a fan of the two woman image. It isn't obvious that "mania" and "depression" are represented, nor that the expressions are polar opposite from each other. They are only different states. The tree (while imperfect) is more expressive than the human in this case. Dennis Brown - 2¢ 22:00, 15 November 2016 (UTC)

Prefer the tree to the woman but not hugely fussed. Cas Liber (talk · contribs) 05:29, 16 November 2016 (UTC)

"among bipolar people"

I would have made this a quick edit but the article is semi-protected. It should be re-worded as people with bipolar disorder, not bipolar people. "bipolar people" is otherising and without any consensus or cited accreditation. 47.33.200.43 (talk) 05:34, 11 December 2016 (UTC)

agreed. I'll change that. Cas Liber (talk · contribs) 06:56, 11 December 2016 (UTC)

Formerly "manic depression"?

Many people still use this terminology so it is still known as "manic depression" IMO. Yes it is not longer the official term.

The more correct term is substance use disorder rather than substance abuse.

Emotional neglect is a type of child abuse and IMO does not need to be singled out.

Makes sense to talk about bipolar one before bipolar two as that is how the numbers naturally go. Doc James (talk · contribs · email) 05:56, 16 December 2016 (UTC)

The term "manic depression" is becoming antiquated. The term bipolar is pretty much used everywhere now, and has taken over in lay-speech. This is why I think "formerly" is more accurate than "also". I do agree that better to talk of BAD I before BAD II, particularly as the first was/is the more established diagnosis. There are still a significant number of psychiatrists that question the existence of bipolar II as well. Cas Liber (talk · contribs) 13:47, 16 December 2016 (UTC)

Agree we should speak about the more confirmed one before the less accepted one.

Here is the Ngram of these two terms in lots of books[10] only goes up to 2007.

"bipolar" is used about twice as often as "manic depression" Doc James (talk · contribs · email) 23:39, 16 December 2016 (UTC)

• Manic depression is antiquated and it use is dwindling, but yes, it is still used a great deal, particularly among laymen, including our readers. We need to explain (and source) why it is considered outdated, even while accepting it is still common among laymen and in older literature. Dennis Brown - 2¢ 01:44, 17 December 2016 (UTC)

@Dennis Brown: O-kay, but which adverb would you use in lead? "also" or "formerly"?

"(often referred to by the archaic term manic depression)" is how I would phrase it. It uses a few more words but establishes that the name is still somewhat common, but is considered archaic. Dennis Brown - 2¢ 16:25, 17 December 2016 (UTC)

What about: "(sometimes referred to by its former name "manic depression")"? —PermStrump(talk) 19:38, 17 December 2016 (UTC)

That accomplishes the same thing, so I'm fine with that. I'm not stuck on exact wording, just the desire to convey the idea. Dennis Brown - 2¢ 19:50, 17 December 2016 (UTC)

Not trying to be nitpicky, but I wasn't sure if "archaic" might be too big a word for the lead. If other people think it's a common enough word, I'm fine with it. —PermStrump(talk) 19:54, 17 December 2016 (UTC)

• Again, I'm fine either way. Archaic is probably more precise and most would get it from the context, but your version is more accessible in some ways. Dennis Brown - 2¢ 20:03, 17 December 2016 (UTC) Dennis Brown - 2¢ 20:03, 17 December 2016 (UTC)

Agree "archaic" is to complicated for the lead. IMO the discussion that manic depression is no longer the prefered term belongs in the body of the article not the first sentence. It is still known as "manic depression" by many. If people are really set on "formally" IMO that is the best of the options presented so far. Doc James (talk · contribs · email) 20:23, 17 December 2016 (UTC)

I am not a fan of "archaic" - makes me think of archaic period in ancient Greece or something that disappeared in the 1890s or earlier...not within the last 20 years. Cas Liber (talk · contribs) 22:42, 17 December 2016 (UTC)

I'm not arguing that any such word is needed in the lead, but if a word is used, it should be "obsolete" rather than "archaic". Looie496 (talk) 15:00, 2 January 2017 (UTC)

Abbreviation

Bipolar is almost always abbreviated BP. BD usually refers to borderline personality disorder, an entirely different thing. — Preceding unsigned comment added by 2602:306:35C6:DF80:7947:94:CE46:5F78 (talk) 19:19, 10 January 2017 (UTC)

I've never seen bipolar abbreviated as BP. I've seen BPAD or BD and BPAD is old fashioned. The abbreviation for borderline personality disorder is BPD. —PermStrump(talk) 20:04, 10 January 2017 (UTC)

I've never seen the 'P' used in an acronym for this either. In Oz we'd have said BAD or BD Cas Liber (talk · contribs) 20:16, 10 January 2017 (UTC)

The most common abbreviation for borderline is BPD, BD is common for bipolar.Petergstrom (talk) 20:29, 10 January 2017 (UTC)

Yup BPD is most common. Doc James (talk · contribs · email) 10:55, 11 January 2017 (UTC)

will not very well studied

I spotted a typo: the phrase "will not very well studied" should be "while not very well studied". (I cannot edit the locked page, would someone with access please correct? Thanks!) Lplatypus (talk) 12:41, 3 March 2017 (UTC)

Done Doc James (talk · contribs · email) 15:10, 3 March 2017 (UTC)

Addition to "Causes: Physiological"

I suggest to amend the section "Causes: Physiological"

The last sentence of the first paragraph currently reads: "Functional MRI findings suggest that abnormal modulation between ventral prefrontal and limbic regions, especially the amygdala, are likely contribute to poor emotional regulation and mood symptoms.[45]"

My suggestion is to update this sentence to include more recent research that shows that abnormal amygdala regulation is also a risk factor for bipolar disorder. The same deficit in amygdala regulation is present in patients with bipolar disorder and healthy individuals at increased genetic risk to develop bipolar disorder. The amended sentence could be: "Functional MRI findings suggest that abnormal modulation between ventral prefrontal and limbic regions, especially the amygdala, are likely contribute to poor emotional regulation and mood symptoms, also increasing the risk to develop bipolar disorder.[45][46]"

[46] Kanske P, Schönfelder S, Forneck J, Wessa M (2015). "Impaired regulation of emotion: neural correlates of reappraisal and distraction in bipolar disorder and unaffected relatives". Translational Psychiatry. 5:e497. doi: 10.1038/tp.2014.137. PMID 25603413.

Oregonensis (talk) 19:33, 14 May 2017 (UTC)

With respect to refs please read WP:MEDRS Doc James (talk · contribs · email) 22:19, 14 May 2017 (UTC)

Thanks a lot for the reference information. Oregonensis (talk) 13:41, 15 May 2017 (UTC)

Hyphen needed

A hyphen is needed between "self" and "harm" when there is a wikilink or merely when the expression self-harm is listed (the title of the wikilinked page is "Self-harm" and it has a hyphen in between "self" and "harm"). One-state solution (talk) 14:00, 22 May 2017 (UTC)

• It was hyphenated in all but one place, but I did correct the one. Dennis Brown - 2¢ 00:59, 23 May 2017 (UTC)

Image

Well the image at the commons was deleted for stupid fucking made up reasons. So we are back to square zero on the image. Jytdog (talk) 04:53, 2 January 2017 (UTC)

Sigh....Cas Liber (talk · contribs) 05:09, 2 January 2017 (UTC)

Yes one needs to be careful with NIH images. Doc James (talk · contribs · email) 11:50, 2 January 2017 (UTC)

Re this edit: The image isn't fine, it is silly and clichéd and reeks of desperation because the old image was deleted from Commons. It is another example of "We must have an infobox image even if it is a load of rubbish and fails WP:PERTINENCE." As its name suggests, Teatro.svg was intended to show the masks used in drama, not mental illness.--♦IanMacM♦ ^{(talk to me)} 18:37, 2 January 2017 (UTC)

Old image was replaced as a different one was found. Now that the new one has been deleted I have replaced the old one which is extensively used to indicate this condition by a large number of medical organizations. Doc James (talk · contribs · email) 12:40, 3 January 2017 (UTC)

@Doc James: Thanks for restoring the old image. -- The Anome (talk) 15:55, 3 January 2017 (UTC)

I've now removed the glowing red ellipse from the old image, leaving only the masks, and re-balanced their positions within the image. -- The Anome (talk) 16:55, 3 January 2017 (UTC)

@Doc James:The image you reinstated is a good stopgap (the modifications by The Anome help). I think an image in an infobox helps set the reader to better absorb the article's content. This article is about a concept, a condition that is internal and that has few external, concrete aspects (note the complexity of diagnosis). The NIH image, as a metaphor, fulfilled its tasks well. Removing color from the masks image helps indicate the metaphorical nature. — Neonorange (talk) 17:55, 3 January 2017 (UTC)

Happy with the changes. Doc James (talk · contribs · email) 01:19, 4 January 2017 (UTC)

The current image is inappropriate for this article. The comedy and drama masks convey an ignorant simplification of bipolar states as happy and sad. Stigmatisation and trivialisation of the disorder aside, the comedy and tragedy masks have no clinical or historical relevance to bipolar disorder. While this depiction may be used by some medical organisations, that is a marketing decision on their part. Furthermore, this is a Wikipedia article, not a website for a medical organisation. In contrast, the article on anxiety displays an illustration from a historic medical journal of a woman experiencing anxiety (panaphobia), the depression article has a similar illustration, and the schizophrenia article displays a self-portrait by an individual with the disorder. Please find a new, more appropriate image. Alternatively, the absence of an image would be more appropriate than the current image. — Preceding unsigned comment added by Jmercer127 (talk • contribs) 04:59, 17 April 2017 (UTC)

I can only repeat the view that the happy/sad masks are silly and unnecessary per WP:IMAGERELEVANCE. However, some users have insisted that the infobox must have in image, even if it means trawling around Commons for unsuitable images. I've removed the masks again, let's see how long it lasts.--♦IanMacM♦ ^{(talk to me)} 05:28, 17 April 2017 (UTC)

You can try another RfC suggesting we replace them with nothing or something else. These types of images are very commonly used both in the academic and lay press. Doc James (talk · contribs · email) 20:12, 17 April 2017 (UTC)

Yup, like the proverbial rubber ball, it has come bouncing back to the article. But at least I tried.--♦IanMacM♦ ^{(talk to me)} 05:45, 18 April 2017 (UTC)

Yup you did. Doc James (talk · contribs · email) 07:28, 18 April 2017 (UTC)

• I still have issue with the current photo for reasons I already explained in the previous RFC. Dennis Brown - 2¢ 01:02, 23 May 2017 (UTC)

Semi-protected edit request on 19 June 2017

§2.5 ¶3 (Causes>Neurochemical>"Medications...")
Please change "Medications use..." to "Medications use[d]"
Thank you! Diamonds and Crust (talk) 16:56, 19 June 2017 (UTC)

•  Done Thanks for the heads up. Dennis Brown - 2¢ 17:02, 19 June 2017 (UTC)

Lead Picture

Hey everyone, I know the lead picture has been discussed before and it's been there a long time but what do you think about using this picture [11] instead to depict depression and mania instead? I think both pictures do a good job of conveying the difference in mood but perhaps a picture with human faces might be preferred. Thoughts?— Preceding unsigned comment added by TylerDurden8823 (talk • contribs) 04:53, 28 July 2017 (UTC)

This has been suggested before, and it's even worse because a) there is no evidence that either of the women depicted has bipolar disorder, b) it is a composite image and it doesn't appear to be the same woman in both images, and c) it is using an old asylum stereotype to depict modern mental illness.--♦IanMacM♦ ^{(talk to me)} 04:59, 28 July 2017 (UTC)

Fair points. I wasn't sure if this specific picture had been suggested before but it sounds like it has. Regarding your second and third points, which I think are reasonable, some of these images are already used elsewhere in the article so perhaps they should be replaced with better/more modern images. TylerDurden8823 (talk) 05:42, 28 July 2017 (UTC)

The current one is a commonly used representation of the dichotomy found in bipolar. Doc James (talk · contribs · email) 18:54, 28 July 2017 (UTC)

Edit Request for the Causes Section

There is a hypothesis already supported with scientific evidence that bipolar disorder might be caused by the dysfunction of mitochondria (or Mitochondrial disease) and it is hypothesized that mitochondrial modulators might be a new line of treatments that need more evidence and clinical trials to support their use and prescription. A few basic references including two reviews are below.

[1] Experimental and Molecular Pathology 83 (2007) 84–92 Mitochondrial dysfunction and molecular pathways of disease Steve R. Pieczenik, John Neustadt⁎ Received 30 August 2006 Available online 18 January 2007 Link to article

[2] Mitochondrial modulators for bipolar disorder: A pathophysiologically informed paradigm for new drug development Andrew A Nierenberg, Christine Kansky, Brian P Brennan, Richard C Shelton, Roy Perlis and Dan V Iosifescu Australian & New Zealand Journal of Psychiatry 47(1) 26–42 Link to article

[3] Neurosci Biobehav Rev. 2016 Sep;68:694-713. Epub 2016 Jul 1. Mitochondrial dysfunction in bipolar disorder: Evidence, pathophysiology and translational implications. Scaini G1, Rezin GT2, Carvalho AF3, Streck EL4, Berk M5, Quevedo J6. Link to article

[4] Bipolar Disorders 2000: 2: 180–190 Hypothesis Paper Mitochondrial dysfunction in bipolar disorder Tadafumi Kato and Nobumasa Kato Link to paper

[5] Molecular Psychiatry (2005) 10, 900–919. doi:10.1038/sj.mp.4001711; published online 12 July 2005 Mitochondrial dysfunction in bipolar disorder: evidence from magnetic resonance spectroscopy research C Stork1 and P F Renshaw1 Link to paper

[6] Neurochemical Research June 2009, 34:1021 Mitochondrial Dysfunction and Psychiatric Disorders Gislaine T. RezinGraziela Amboni Alexandra I. Zugno João Quevedo Emilio L. Streck Link to paper

[7] Experimental and Molecular Pathology 83 (2007) 84–92 Mitochondrial dysfunction and molecular pathways of disease Steve R. Pieczenik, John Neustadt Link to article in PubMed

Two blog posts on the same topics Mitocondrial Modulators and Mitocondrian dysfunction as a cause of disease — Preceding unsigned comment added by Alucarbon (talk • contribs) 09:08, 1 October 2017 (UTC)

These are all primary sources yet to be reviewed in secondary sources. Once there is some ongoing discussion in Review Articles we can think about including. Cas Liber (talk · contribs) 13:41, 1 October 2017 (UTC)

Re Cas Liber comment: Secondary sources already discuss this cause of BD. For example, The Bipolar Boook is a reference concerned with the neurobiology of BD and discusses mitochondrial dysfunction. A review by Nature Magazine published in 2005 and a second review by Nature Magazine published in 2001 (Nature Magazine is the highest ranked magazine in science!) provide evidence and discussion that supports this cause of BD. A few blog posts discuss mitochondrial dysfunction and they are a secondary source.

All other causes of BD are as well hypotheses and there might be even weaker evidence for them than the evidence for mitochondrial dysfunction. This topic would be a great addition to the causes section and there is enough scientific support and discussion for it to be included. Reference [6] above is a review and discusses even more broadly the implications of mitochondrial dysfunction for psychiatric disorders. Reference [7] above is a review article in the PubMed archives and it list bipolar disorder among several other diseases possibly caused by mitochondria disease. The search term "mitochondrial dysfunction bipolar disorder" has 26,000 results in Google Scholar and 89 articles in PubMed some of them reviews. — Preceding unsigned comment added by Alucarbon (talk • contribs) 16:26, 2 October 2017 (UTC)

Alright then, phrase in 1-2 sentences what you think should be added. I am mindful of the fact that even though this has been talked about for almost twenty years, it has yielded nothing effective clinically. At all. Cas Liber (talk · contribs) 20:31, 2 October 2017 (UTC)

Rfc Request for comment on bipolar disorder causes

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

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The causes section of the bipolar disorder makes very brief mention of mitochondria but not mitochondrial dysfunction or mitochondrial disease as a possible cause. Would it be good to add more on mitochondrial dysfunction to the causes section on the topic? This addition would make Neurobiology role as a cause more prominent on the article. Alucarbon (talk) 20:17, 2 October 2017 (UTC)

In current treatment and management of bipolar, none of this comes up at all - it is all still in research and theory stage. Hence I feel it does not warrant more than a couple of sentences. Still, why not discuss what you think should be added here? Cas Liber (talk · contribs) 10:15, 3 October 2017 (UTC)

Thanks! I would add something like: Neurobiology might play a role in the development of bipolar disorder and its treatment and there is evidence that mitochondrial disease or mitochondrial dysfunction might be a cause of bipolar disorder. Mitochondria function is essential for the energy production of the cells, called ATP, and for regulating cellular metabolism. --Alucarbon (talk) 18:20, 3 October 2017 (UTC)

I'd leave out the last sentence with the explanation of what mitochondria do. A link suffices. Other than that, do we have consensus now? PizzaMan ♨♨♨ 20:44, 6 October 2017 (UTC)

• This ref says "implicate mitochondrial dysfunction as an important component of the pathophysiology" So belongs in the pathophysiology section not the cause section. Doc James (talk · contribs · email) 22:44, 6 October 2017 (UTC)

Doc James makes an important point - agree with pathophysiology and not causes as a destination for this extra material Cas Liber (talk · contribs) 23:20, 6 October 2017 (UTC)

The cause is mithocondrial dysfunction and the pathophysiology would tells us how precisely the mythochondria malfunctions. I would add a couple of sentences on this to both sections. --Alucarbon (talk) 19:53, 20 October 2017 (UTC)

"MtDNA/nDNA mutational damage, failure of endogenous antioxidant defenses, hormonal mal-function, altered membrane permeability, metabolic dysregulation, disruption of calcium buffering capacity and ageing have been found to be the root causes of mitochondrial dys- function in psychatric and neurodegenerative diseases." Please see this reference and review article because it explains the ways mithocondria mal-functions and thus can enrich the pathophysiology section as well. --Alucarbon (talk) 23:34, 23 October 2017 (UTC)

• Too many "might" and "possible" phrases to list as cause. Bipolar is poorly understood to begin with, we need better research before we have better sources, certainly before making a claim as to cause. Dennis Brown - 2¢ 10:42, 7 October 2017 (UTC)
• Comment Agree with PizzaMan and Doc James. I propose a slight adjustment of wording, something like:
  Evidence suggests that neurobiology is relevant both to the development of bipolar disorder and to its treatment. There also is reason to believe that mitochondrial disease or mitochondrial dysfunction can be important in the development of bipolar disorder. JonRichfield (talk) 06:45, 9 October 2017 (UTC)

Yes, JonRichfield wording is better! --Alucarbon (talk) 19:53, 20 October 2017 (UTC)

• Comment The phrase "mitochondrial disease as a possible cause" is confusing. It sounds as if mitochondrial disease means "a disease of the mitochodria". It doesn't mean that. It means a disease caused by defective mitochdria. Bipolar disorder is (maybe) a mitochondrial disease. Maproom (talk) 16:28, 12 October 2017 (UTC)
• Comment Many genes have been claimed to play a role in bipolar disorder. Most are chromosomal, at least one is mitochondrial. Do we have any reason to single out mitochondrial genes for special mention? Maproom (talk) 16:28, 12 October 2017 (UTC)

References

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The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Semi-protected edit request on 9 May 2018

Please change

"Bipolar disorder is the sixth leading cause of disability worldwide and has a lifetime prevalence of about 3 percent in the general population.[5][137] However, a reanalysis of data from the National Epidemiological Catchment Area survey in the United States suggested that 0.8 percent of the population experience a manic episode at least once (the diagnostic threshold for bipolar I) and a further 0.5 percent have a hypomanic episode (the diagnostic threshold for bipolar II or cyclothymia). Including sub-threshold diagnostic criteria, such as one or two symptoms over a short time-period, an additional 5.1 percent of the population, adding up to a total of 6.4 percent, were classified as having a bipolar spectrum disorder.[138] A more recent analysis of data from a second US National Comorbidity Survey found that 1 percent met lifetime prevalence criteria for bipolar I, 1.1 percent for bipolar II, and 2.4 percent for subthreshold symptoms.[139]"

to

"Bipolar disorder is the sixth leading cause of disability worldwide [137] and has a lifetime prevalence of 1.02%. There are several different types of bipolar disorder with type I [link to https://en.wikipedia.org/wiki/Bipolar_I_disorder] accounting for 0.62%, type II [link to https://en.wikipedia.org/wiki/Bipolar_II_disorder] for 0.36%, and “Not Otherwise Specified (NOS) [link to https://en.wikipedia.org/wiki/Bipolar_disorder_not_otherwise_specified]” for 0.96%. () Other studies have suggested a lifetime prevalence of about 3 percent in the general population (). Including sub-threshold diagnostic criteria, such as one or two symptoms over a short time-period, an additional 5.1 percent of the population, adding up to a total of 6.4 percent, were classified as having a bipolar spectrum disorder.[138]" A1moreira (talk) 12:03, 9 May 2018 (UTC)

Bipolar I disorder is already linked higher up in the article. So no need to link again.

Which ref supports "has a lifetime prevalence of 1.02%" Doc James (talk · contribs · email) 13:42, 9 May 2018 (UTC)

These results are from a recent meta-analysis ref Moreira ALR, Van Meter A, Genzlinger J, et al. Review and meta-analysis of epidemiologic studies of adult bipolar disorder. J Clin Psychiatry. 2017;78(9):e1259–e1269. Changes to the text with the inclusion of prevalence rates for bipolar type I, II, and NOS from this recent meta-analysis add to completion and updating of the text. That ref concludes prevalence rates are not increasing over time and vary by geographic region, further research could help unpack specific risk factors at play. — Preceding unsigned comment added by A1moreira (talk • contribs) 15:47, 14 May 2018 (UTC)

 Not done for now: I am very hesitant to add any study proposed by its primary author, particularly a new study by a new editor which proposes substantial re-analysis. If other studies present similar findings, then we can add it at that time. Eggishorn (talk) (contrib) 04:18, 21 May 2018 (UTC)

It is a decent ref. Have adjusted to "Bipolar disorder is the sixth leading cause of disability worldwide and has a lifetime prevalence of about 1 to 3 percent in the general population." User:A1moreira your thoughts? Doc James (talk · contribs · email) 05:14, 21 May 2018 (UTC)

References

Semi-protected edit request on 21 July 2018

Remove dramatic mask symbols as representation of a disease. It's offensive. 78.147.181.186 (talk) 13:07, 21 July 2018 (UTC)

 Not done for now: This image has been a point of contention in this article for many years. I see discussions about the infobox image going back to at least 2012, and I haven't looked that hard. As such, this can't be considered an uncontroversial improvement per WP:EDITREQ#General considerations and would need consensus before being changed. It may be worth holding another RFC at this point - the last RFC in 2016 doesn't look like it was open for very long, and I don't see it being closed at all. ‑‑ElHef (Meep?) 14:35, 21 July 2018 (UTC)

See Talk:Bipolar_disorder/Archive_7#RfC: Is the happy/sad mask in the infobox section appropriate? Looie496 (talk) 16:23, 21 July 2018 (UTC)

Semi-protected edit request on 20 July 2018

please, in history section, of the origin of melenchoni, it is around the word milan not melas of greek word. i think milan can be found in ancient greek otherwise it is latin(i consider latin language & sanskrit same). milan means socialising or matching. 117.197.16.161 (talk) 18:41, 20 July 2018 (UTC)

 Not done: please provide reliable sources that support the change you want to be made. I see that Melancholia and wikt:Melancholia agree with this article on the word origin. ‑‑ElHef (Meep?) 18:52, 20 July 2018 (UTC)

i will return on it in a year or 2, i just don't want to consume time in this right now. — Preceding unsigned comment added by 117.197.24.2 (talk) 21:36, 21 July 2018 (UTC)

Semi-protected edit request on 26 July 2018

Hi,

I am not experienced with editing code and am writing my request here. Hopefully, someone gets it. :)

As someone with bipolar disorder, I find the page's main image of the Comedy and Tragedy Masks offputting. As we become more accepting and less stigmatizing of mental health disorders, I believe it would be best if the accompanying image where people come to learn about bipolar disorder not be the evil looking mask of tragedy.

Thank you for reading and let me know if you have any questions.

Best, Jeremy

JeremySamson (talk) 14:38, 26 July 2018 (UTC)

 Not done: please establish a consensus for this alteration before using the {{edit semi-protected}} template. - FlightTime (open channel) 14:43, 26 July 2018 (UTC)

And here we go again. I've yet to fathom why some people like this image so much despite repeated criticism.--♦IanMacM♦ ^{(talk to me)} 18:25, 26 July 2018 (UTC)

Semi-protected edit request on 30 July 2018

Hi, I apologize that I do not understand how to use code. It was confusing to me on how to respond.

I respect that others like the image. I just feel if it has been brought up multiple times, does it really hurt not to associate this image with the posting?

Thanks, Jeremy JeremySamson (talk) 00:05, 30 July 2018 (UTC)

Please could you comment in the request for comment section titled "New RfC on the mask image" above. If I removed the image with the masks from the infobox now, one of its fans would put it back again, saying that there was no consensus to remove it. Realistically, the only way forward is to find a new image which has a consensus and is copyright free. The article cannot use a copyrighted image in the infobox.--♦IanMacM♦ ^{(talk to me)} 05:14, 30 July 2018 (UTC)

Please Remove "BPD" From this page

Hi,

While 'Bpd' is used as an abbreviation for bipolar, the abbreviation "BP" is more clear, as "BPD" is frequently used for "Borderline Personality Disorder".

"BP" is just as accepted, but is more clear. Eswales (talk) 11:29, 9 September 2018 (UTC)

•  Done This was added recently in this edit in late August 2018. There is a risk of confusing it with Borderline personality disorder which is the more usual acronym, and it isn't a WP:COMMONNAME for bipolar.--♦IanMacM♦ ^{(talk to me)} 12:28, 9 September 2018 (UTC)

New RfC on the mask image

The following discussion is an archived record of a request for comment. Please do not modify it. No further edits should be made to this discussion. A summary of the conclusions reached follows.

(non-admin closure) Closing without a decision on account of the wording being vague and open to many different responses. WP:RFC and WP:WRFC demand that the opening statement should contain a straightforward question which is as specific as possible. This has been a discussion, incidentally a very informative and productive one, IMVHO, but it cannot be assessed as an RfC. -The Gnome (talk) 07:40, 16 September 2018 (UTC)

---

Bearing in mind the two edit requests above, who actually likes this image? Should we look for another one?--♦IanMacM♦ ^{(talk to me)} 19:00, 26 July 2018 (UTC)

Well, I have bipolar disorder, and I like the image. I think the solution is not so much to delete the image, as to replace it with a better image. Something like an image of a tree in summer in full leaf and bearing fruit alongside the same tree in winter with its branches bare would seem good to me, (perhaps something like this or this) but I have not yet found such an image with appropriate use rights. File:Four Poplars in four seasons.JPG, and its source images, also on Commons, seems to be suitable source material for creating such an image. -- The Anome (talk) 10:28, 27 July 2018 (UTC)

I think that File:Four Poplars in four seasons.JPG has problems with WP:IMAGERELEVANCE, which says "Images must be significant and relevant in the topic's context, not primarily decorative". The trees image doesn't convey much of value.--♦IanMacM♦ ^{(talk to me)} 14:15, 27 July 2018 (UTC)

I wasn't thinking of that image itself: I was thinking of a graphic, using it for reference, symbolizing the stark contrast between the extreme plenitude of mania and the extreme paucity of depression. -- The Anome (talk) 12:23, 29 July 2018 (UTC)

Older readers may remember when this image was in the infobox, which I thought was OK and had some sort of consensus. Unfortunately it was deleted because of WP:NFCC concerns, leaving some users scraping the barrel over at Commons because the article must have an infobox image. Actually, WP:IMAGERELEVANCE says "not every article needs images".--♦IanMacM♦ ^{(talk to me)} 13:11, 29 July 2018 (UTC)

• What do you all think about a graph such as these? I think it would be possible to make them with English labels.

The theatre masks could be moved to the 'Society and culture' section, with a properly sourced explanation of the symbolism and its relative accuracy. (If you don't like the exact image used in this article, then there are many more at c:Category:Comedy and tragedy mask icon.) WhatamIdoing (talk) 05:53, 1 August 2018 (UTC)

• I am happy with the current mask. This is a commonly used image for this condition. I am also happy with the prior tree image but their was copyright concerns. I am not a fan of the graphs. Doc James (talk · contribs · email) 09:34, 1 August 2018 (UTC)

• I can see how the masks would be considered offensive. I really like the prior image noted by IanMacM that had copyright issues. If that was acceptable to everyone in the past, maybe we can find someone to create a similar image and submit it to CC. I'd be willing to give it a shot if everyone here agreed to use it. § Music Sorter § (talk) 04:29, 4 August 2018 (UTC)
• I would prefer a suitable "trees" image - or one showing a wheatfield in summer and in winter. The masks image doesn't seem quite right, the tragedy part is near enough, but comedy doesn't really align with mania. The graphs convey nothing that isn't better conveyed by text. Maproom (talk) 07:02, 9 August 2018 (UTC)
  • For someone who sees people with mania fairly frequently, yes they often smile or grin excessively.
  • The APA uses a similar image but with images of a real person.[12] NAMI also uses this type of image[13] as do multiple university sites.[14]
  • It is the most common method of illustrating the condition in fact. Doc James (talk · contribs · email) 08:12, 9 August 2018 (UTC)

agree w/ doc James, it is the most common manner...IMO--Ozzie10aaaa (talk) 11:18, 9 August 2018 (UTC)

If it's kept, I think the caption should be expanded a little to explain that this is frequently-used imagery. -165.234.252.11 (talk) 19:10, 13 August 2018 (UTC)

Having said that, though, my gut reaction is that it's pretty weird to present a stylized logo for a mental disorder. -165.234.252.11 (talk) 15:43, 14 August 2018 (UTC)

• Tree image is a better representation. Not a fan of the masks. That they are often used isn't a good reason to use them here as I'm sure the reason many articles use them is simple laziness. It can be used lower in the prose and explained, but I don't really see the need and that would be beyond the scope of this RFC anyway. Don't like the graphs at all. Way too simplistic of a representation, to the point of being misleading. Dennis Brown - 2¢ 20:28, 13 August 2018 (UTC)

To add, I know more than a couple of people who are bipolar and would consider the idea of using masks to be just a little offensive. That doesn't stop the press from using them, but using representations of Comedy and Tragedy to demonstrate (hypo)mania and depression is rather crass and should not be done in an encyclopedia. Having no image is infinitely better than using the masks. Dennis Brown - 2¢ 20:50, 14 August 2018 (UTC)

• I think the mask image should be removed, regardless of whether another image is put in its place. I'd also like to throw in the idea of using an image of Kraepelin (e.g. File:Emil Kraepelin 1926.jpg) or someone else relevant to the discovery of the disorder. — Bilorv_(c)(talk) 18:51, 16 August 2018 (UTC)

@Dennis Brown (to others)—I agree that the bifurcated tree image is better—in my opinion, a pefect metaphor for the bipolar spectrum. The Comedy/Tragedy mask as now used are just crude knockoffs of the classical representations and show the typical limitations of clip art whose only virtue is being free. Ib this case it's not even decorative(as it might be at the bottom of a high school play program. This article deserves a better effort—it deserves an image that serves as in introduction to bipolar spectrum itself, not just one of the first medical professional to describe it. The bio is the place for that.

Of the three images DocJames mentioned, the APA image is ok. The image with the mirror is lit too much like part of an ad. The capering figures image is perhaps ok for a brochure cover aimed at a child with a bipolar parent, but not for an encyclopedia article that gets pretty technical.

I suggest no image until a properly free and expressive image can be found. — Neonorange (Phil) 07:31, 17 August 2018 (UTC)

The image of Emil Kraepelin does not clue one into what this page is about and therefore IMO would be inappropriate.

If the image was so controversial as some are claiming than why would so many medical organizations be using it? Doc James (talk · contribs · email) 23:57, 19 August 2018 (UTC)

Not every design decision is made by a doctor, and not every bipolar person is going to make an unsolicited comment about it. Bipolar diagnosing and treatment is still way behind the times, I don't find it shocking that some are using images that really aren't appropriate, even if they mean well. Dennis Brown - 2¢ 23:01, 4 September 2018 (UTC)

• Not every article needs an image, and its better to have none rather than the mask which some people find offensive or disrespectful. (Also, I think the current image is simply not encyclopedic and sets a wrong tone.) Lack of consensus what should the replacement be should not hinder simply removing the mask image. I agree with points made by Neonorange. — bieχχ (talk) 19:00, 3 September 2018 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Antidepressants

I don't know why antidepressants for associated symptoms was removed from the infobox, as atypical antipsychotic medication, such as risperidone, olanzapine, quetiapine, or aripiprazole, are typically augmented to enhance the effectiveness of the SSRI antidepressant, including sertraline, fluoxetine, paroxetine, or fluvoxamine, especially in the treatment of bipolar disorder. ATC ^{. Talk} 08:35, 10 November 2018 (UTC)

Ref says "A recent meta-analysis of 15 RCTs found no significant benefit for antidepressants over placebo in the treatment of bipolar depression"

What ref were you using? Doc James (talk · contribs · email) 07:18, 11 November 2018 (UTC)

That's because there has been little research on combining the SSRI antidepressant with the antipsychotic but psychiatrists frequently prescribe antipsychotics to enhance the effectiveness of the antidepressant. See this article here: https://www.ncbi.nlm.nih.gov/m/pubmed/12392350/ ATC ^{. Talk} 04:49, 12 November 2018 (UTC)

That source is from 2002 and thus too old. A discussion of antidepressants belongs in the body of the article not the infobox. Doc James (talk · contribs · email) 02:12, 13 November 2018 (UTC)