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Tourette syndrome

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Myth and misinformation is the norm in most published literature about Tourette syndrome; I hope you will find this to be a well-referenced encyclopedic entry that helps clarify some of the common misconceptions about the condition. There is a very old peer review; the article is selected as one of the best at the medicine portal, conforms to the Manual of style for medical articles, has had several independent copy edits, and is extensively cited. The size is a respectable 66KB overall, with 37KB of prose. Self-nom, about 95% written by me, with lots of vandal patrolling by my Wikifriends (please help me watch for the expected coprolalia-related vandalism while it is here at FAC). Thanks in advance for your comments, Sandy (Talk) 20:01, 26 October 2006 (UTC)[reply]

  • In the introduction, why is a number of schoolchildren sufferers only given for America, which gives no information on incidence. The percentage mentioned later in the article would be more widely-applicable.
  • That is the only number (as opposed to prevalance est.) available anywhere in any literature I've seen, and I only found it in new reading this week: if estimates of school children in other countries (other than prevalance, already discussed) are available anywhere, I've never come across them. I wanted something to convey the idea of how "not rare" TS is; that's why I moved that number up. My thinking is that just including the prevalance in the lead wouldn't be "enticing" to the reader, as it wouldn't convey the magnitude of the number. Sandy (Talk) 04:36, 27 October 2006 (UTC)[reply]
Tried a formulation that adds both. Also changed half million to 500,000 as numbers with lots of zeros look larger!
Perfect! Thanks, Sandy (Talk) 13:53, 27 October 2006 (UTC)[reply]
  • You might add an image of the structure of the most-frequently used medication.
  • Some of these refs contain several papers, was this intended?
  • Yes, in cases where multiple (seminal or important) references were used to support one statement, I combined them into one ref tag (something I learned from the Daniel Boone nomination). I think I did that in 4 refs, rather than overburden the text with multiple tags.
  • Refs 70 and 71 are duplicates and could be merged.
  • Notes are specific inline citations; references are a listing of the broader sources used in researching the overall topic - seminal papers quoted often, reviews, and books on the entire topic - per WP:MEDMOS. References are also used for specific inline cites, but as MEDMOS was explained to me, and as I read it, the overall (general) research materials used are listed in References, while inline citations are at Notes. Those are the important Research works; they can't be listed as Further reading, as they are used as a source. Thanks for the help: going to make your changes now. Sandy (Talk) 04:36, 27 October 2006 (UTC)[reply]
Thanks. TimVickers 12:35, 27 October 2006 (UTC)[reply]
  • Support. Wow, comprehensive and well-written. Great work, Sandy! --Gzkn 09:13, 27 October 2006 (UTC)[reply]
  • Support' Etiology' could do with a link though. JMcC 10:01, 27 October 2006 (UTC)[reply]
  • Support - Great article. I learnt a lot reading through it. CloudNine 10:29, 27 October 2006 (UTC)[reply]
  • Support. Very nice indeed.--Yannismarou 12:48, 27 October 2006 (UTC)[reply]
  • Support Outstanding. Rlevse 12:49, 27 October 2006 (UTC)[reply]
  • Support – This article depresses me whenever I look at it and compare it to my own humble efforts. Something to aspire to. I have a few relatively minor comments. The words etiology and modality are a bit erudite for the lead and should be wiki-linked, or reworded. The word "should" is used a few times in the Screening section in a way that appears prescriptive rather than descriptive. I'm not convinced that the recently added image of the Haloperidol molecule is relevant or beneficial. That most people with TS require no medication is repeated a little too often. I appreciate it is difficult not to repeat somewhat, especially across sections. However, it is mentioned twice in the Management section. The second paragraph of Prognosis covers the life-span fact twice. The "the sickest of the sick" is mentioned twice in the Research section. This last section relies too much on one source, which is also perhaps over quoted (making the text harder to read). Are there no specific examples of ongoing or recent research to mention? Colin°Talk 13:03, 27 October 2006 (UTC)[reply]
  • Thanks so much for all of that, Colin; I'll get on all that after I've had several cups of morning coffee. (The final source used in Research controversies is so seminal and comprehensive it's hard not to use it all -- it covers all current controversies, but I'll see what I can do there.) Sandy (Talk) 13:28, 27 October 2006 (UTC)[reply]
  • Changes made, would appreciate a new set of eyes to have a look now at Research directions and controversies section. The Swerdlow paper is so comprehensive that there isn't much else to say, but I did add info from another source so as not to overly rely on one source. Thanks, Sandy (Talk) 18:13, 27 October 2006 (UTC)[reply]
I, for one, think it's relevant (the Arthur K. Shapiro article does state "a turning point in understanding of Tourette syndrome came...when Dr. Shapiro and his wife... treated a Tourette’s patient with haloperidol"), but as a "pharm guy" as Sandy put it I'm biased :) – Colin's concern (correct me if I'm wrong) may refer to the fact that lay readers may not associate a space-filling model of Haldol with Haldol (or may not recognize what it is). Perhaps linking to "space-filling model" or "molecular model" in the caption? Fvasconcellos 14:05, 27 October 2006 (UTC)[reply]
Pros and cons: I'm not happy having Haldol in there, since it really is a heavy-duty med, with major side effects, is used as a last resort in severe cases, and I don't want the article to appear to "encourage" its use. On the other hand, you are right that it was a turning point in the history. Maybe you can fix the caption? Another option I found, which I like better, is at Adderall: it's a very nice image, and it is important to convey that stimulants are underused in the treatment of TS because of old myths. But, I'm not sure about the licensing tag on that image? Anyone? Sandy (Talk) 14:11, 27 October 2006 (UTC)[reply]
As an image that is very similar to the one that is already used (generic medicine bottle and capsules). I think the Haloperidol image could stay but needs recaptioning. "Haloperidol is used to treat severe cases of Tourette's" tells us neither whether Haloperidol alone is used in this case nor whether it is the only treatment for severe TS. Perhaps even explaining that this is a representation of the molecule might help. Yomanganitalk 14:25, 27 October 2006 (UTC)[reply]
(dedenting)I'd be happy to amend the caption. As for the Adderall pic, I see no major problem with its copyright status. If you look closely, you can see personal details on the prescription bottle have been blanked with White-Out – an indication it is indeed someone's prescription, rather than a commercial image (is this much of a stretch on my part?) Either way, I'll wait for more opinions to emerge, or Sandy's choice. Fvasconcellos 14:29, 27 October 2006 (UTC)[reply]
[edit conflict] Yes, because pharmacological treatment is really an issue for the minority, I had left all of that detail in the daughter article, Treatment of Tourette syndrome; now the need for an image may cause med details to come back to this article. Maybe Fvasconcellos can explain better what that image represents - then I can adjust the wording, and later add the adderall image to the Treatment daughter article. (The images in this article have proven to be a bigger problem than the text :-) Sandy (Talk) 14:32, 27 October 2006 (UTC)[reply]
How about this? Fvasconcellos 14:51, 27 October 2006 (UTC)[reply]
Space-filling representation of a haloperidol molecule. Haloperidol is an antipsychotic medication sometimes used to treat severe cases of Tourette's.
Perfect, if Yomangani agrees that addresses the textual questions about its use, which I hope not to expand on in this article, rather the Treatment article. Thanks again, Fvasconcellos. Sandy (Talk) 14:54, 27 October 2006 (UTC)[reply]
Looks fine to me, now. Yomanganitalk 15:13, 27 October 2006 (UTC)[reply]
Great, thanks, will ask FV to add. Sandy (Talk) 15:16, 27 October 2006 (UTC)[reply]
Done. Sandy (Talk) 15:32, 27 October 2006 (UTC)[reply]
Sorry to have caused so much of an issue with the multi-coloured sex-toy / space-filling jobbie. Yes, I think most lay people reading this article won't appreciate the subtleties that such a model no doubt informs the pharmacologically minded around here. Given the overall impression regarding medication, I think the one photo of the pills is quite enough for this section. Colin°Talk 22:34, 27 October 2006 (UTC)[reply]


  • Support, though some techical jargon is a little difficult to follow. I noticed that "comorbid" is wikilinked quite a few times early on (twice in one paragraph) but not again in later sections. I wasn't sure what it referred to when reading the section on "Social impact". Gimmetrow 00:49, 29 October 2006 (UTC)[reply]
  • Support – I expected to be overwhelmed by medical jargon, but Sandy has made sure to explain the jargon in laymens' terms within the prose, which is very helpful. In response to the above post, I assumed that the repeated wiki-linking of the term comorbid was unintended and wiki-linked only the first instance of the term. I also noticed that the meaning of comorbid was not explained in the prose like other jargon. Overall, however, this article is very accessible and the quality of the prose is excellent; it seems like a reliable reference point. -- WGee 04:37, 29 October 2006 (UTC)[reply]
    • Based on further feedback from Gimmetrow, I moved up and included a brief definition of comorbid, provided an additional link to epidemiology in the Research section, and corrected some redundancy in the Research section. Thanks! Sandy (Talk) 04:58, 29 October 2006 (UTC)[reply]
  • Suggestion on an otherwise excellent article: either think of a better reason for retaining the picture of Mozart, or do away with it. If for example the article were to say The 1978 publication of a book by two eminent neurologists claiming that Mozart had Tourette's -- a claim largely based on a single source now thought to be fraudulent -- gave rise to the widespread belief that blah blah blah [NB this is entirely fictitious!], then Mozart would acquire a considerable (spurious) significance. But as it is, I can't help speculating that some previous editor at one point thought "Let's have a picture here. What can we use? Yes, Mozart! Let's stick in Mozart." -- Hoary 12:10, 29 October 2006 (UTC)[reply]
    • The lack of good images on the topic has been an ongoing problem, and that does occur/has occurred. On the other hand, google Mozart Tourette— you get 88,000 hits. The rumor is SO widespread that addressing it head on in the article does have a rationale. Comments ? Sandy (Talk) 14:29, 29 October 2006 (UTC)[reply]
      • I added a couple of sentences to the text: Hoary, the hypothetical scenario that you laid out above is very close to what did happen. See new text, thanks. Sandy (Talk) 14:59, 29 October 2006 (UTC)[reply]
        • Much better now. NB I didn't suggest that Mozart shouldn't be mentioned. Now he's not merely mentioned; as you say, the fuss over him is briefly discussed. Good, and now the Mozart pic doesn't seem absurdly out of place. But sorry, to me it still seems out of place. But I could be alone in seeing it this way. (Anybody else care to comment?) Meanwhile, the article is excellent and richly deserves effayfication. -- Hoary 15:06, 29 October 2006 (UTC)[reply]
          • Thanks, Hoary; if others concur, I'll gladly remove the image, but as you can see, finding images for the article has been a problem. The Mozart editors (several months ago) concurred to largely exorcise the TS text from *their* article — they don't want *that* there :-) There is another Mozart-TS project in the works (can't remember if it's a book, documentary, or what) in addition to the widespread claims furthered by a UK documentary, the work of one individual with TS with little medical input, and my hunch is that it's a frequent query worthy of dealing with seriously on Wiki, and would like to hear from others on the new text and image issue. Sandy (Talk) 15:58, 29 October 2006 (UTC)[reply]
  • Oppose. The article is 71kb long. Am I the only one who finds a problem with this? If I remember correctly, the criteria states that articles should be in summary style. Also, a tedious and exhaustive article cannot be considered "well written." Orane (talk • cont.) 06:32, 30 October 2006 (UTC)[reply]
    • Also, a tedious and exhaustive article cannot be considered "well written." Respectfully disagree there. Well written prose has little to do with how long an article is. From reading summary style, it seems the article meets that criteria. Note that a good chunk of that 71kb is probably in the references. In any case, I'll let Sandy speak to the article's length. Gzkn 07:20, 30 October 2006 (UTC)[reply]
      • First of all we should count prose length and not article length, because counting article length we also count notes, external links etc. (which is not correct). Second, 71 Kb is more than fine, in any case, since some of the recently confirmed FAs were way above 80 kb or even 90 and 100 kb. Comprehensiveness is above length.--Yannismarou 10:33, 30 October 2006 (UTC)[reply]
    • I'd certainly tend to agree that a tedious article isn't a good one. I'm also wary of exhaustiveness: comprehensiveness is a virtue, but comprehensiveness needn't and probably shouldn't imply exhaustiveness. Right then: How is this article tedious or [uncritically, tiresomely] exhaustive? -- Hoary 10:43, 30 October 2006 (UTC)[reply]
    • Sandy stated in the nom that the prose is only 37KB. Good referencing accounts for most of the rest. Yomanganitalk 11:58, 30 October 2006 (UTC)[reply]
      • Decided not to oppose based on Yomangani's point. I would just like to address a couple points however.
      1. "Well written prose has little to do with length?"--Gzkn. Are you serious? An article that is well written is conscious of the reader. No one wants to sit down for an hour sifting through an article that has 10,000 words. Good, clean prose is succinct and precise. Long articles are wordy, unfocussed and are symptomic of poor structure and organization. If length was not an issue, it wouldn't be in the criteria in the first place.
      2. "Comprehensiveness is above length." Again, that is a misconception. There are 4 FA criteria, none of which are more important than the other. To be comprehensive is to touch on all important areas, but a good writer omitts information that contributes nothing to the purpose of his/her writing. In other words, if a writer realizes that his article is too long, he is probably including more than he should, which resluts in a sloppy article. Orane (talk • cont.) 15:08, 30 October 2006 (UTC)[reply]
      • Well, I disagree with you, but this is not the right place to open this discussion. The adequate length for each article depends. An article with 100 kb can still be comprehensive and not lengthy for its subject.--Yannismarou 20:32, 30 October 2006 (UTC)[reply]
      • I guess my take on "well written prose" was just a little more general than yours, which is probably why we disagree. I was divorcing it from the concept of Wikipedia (novels can certainly feature "well written prose" no?). But that's neither here nor there. :) Gzkn 00:11, 31 October 2006 (UTC)[reply]
    • Thank you for the input, Orane. Extensively cited articles will have a large overall size, as citations count in the KB. We should avoid burdening the reader with too much prose, which is why prose size is calculated on most long FACs. When nominated, the article was 67 KB overall (not long by current FA standards), with 37KB prose. With the addition of two images and a few lines of text during FAC, the article is now at 71KB overall, with 40KB prose, still well within the norm for most FACs and the limits of readability. If you can point out any sections which you believe need to make better use of summary style, I will see what I can do. Thanks, Sandy (Talk) 15:30, 30 October 2006 (UTC)[reply]
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