Talk:Bipolar disorder/GA2

GA Review
The edit link for this section can be used to add comments to the review.''

Reviewer: Ajpolino (talk · contribs) 16:17, 2 February 2020 (UTC)

Hi I'll take this review on. It's a long article, so it might take me about a week to make my first pass through. Sorry for the incredibly long wait in the GAN queue. I hope we can move through it quickly and move on to more recent things. Looking forward to the read! Ajpolino (talk) 16:17, 2 February 2020 (UTC)
 * Great, thank you, ! I will watch closely as you make suggestions and I will implement them as I can. I'll let you know if there are any assessments that seem questionable, but I think I'm pretty reasonable on these GANs. My only ask is to refrain from failing the article as I'm working on it and to allow me a reasonable amount of time to revise the article as appropriate while we're working together. As you said, it took quite a while before someone took on the herculean task of reviewing this massive but crucial article. I would hate to go through that again if we can avoid it, so I'll try and get it passed on the first go-around here. Thanks and I'll start looking through your suggestion! TylerDurden8823 (talk) 19:26, 4 February 2020 (UTC)
 * Sounds good. If you think something I'm suggesting is off-base just tell me so. If we're truly at loggerheads, we'll call WT:GAN or WT:MED for a second opinion rather than send you back to the multi-month GAN queue. So far the article looks great. If you get busy and don't have time for this, there's no big rush, just let me know and we can put it on hold for as long as needed. Cheers. Ajpolino (talk) 22:12, 4 February 2020 (UTC)
 * Ok, made it through the article. It generally looks good. I've marked some small things that should be addressed before this article can pass the GA criteria. There's no rush, so if you need more than a few weeks, let me know and we can mark the GA review as "on hold" (which doesn't mean anything; it just indicates to editors watching the GAN queue that I haven't forgotten about you). Happy editing! Ajpolino (talk) 22:18, 9 February 2020 (UTC)
 * I'll be able to work on this more in the next few days. Thanks for being patient! TylerDurden8823 (talk) 03:49, 25 February 2020 (UTC)
 * I think I have addressed all of the points you have raised on this review. If there are any I missed that need further work, please let me know. Thanks! TylerDurden8823 (talk) 08:14, 28 February 2020 (UTC)

Pardon the delay. Ok looks great! I have very few comments left, so I'll post them here so it's easier to keep track:
 * -I think all subsequent points have been addressed! TylerDurden8823 (talk) 01:44, 10 March 2020 (UTC)
 * Great! I'll have a look in the next few days (sorry again; busy times in real life). In the meantime, thoughts on 's concern about File:Bipolar mood shifts.png below? I've tried to clarify the image source. But is it still an image that we want at this article? Ajpolino (talk) 17:41, 10 March 2020 (UTC)


 * 1) Mechanism - Manic and depressive episodes tend to be characterized by ventral versus dorsal dysfunction in the vPFC. - being neither a physician nor an anatomist, it's not clear what meaning I should be gleaning from this sentence. Is it the right vs. left activation you describe in the next sentence? Or does ventral versus dorsal dysfunction have some precise meaning? Any way you could clarify that? Even if you lose some precision by saying "manic vs. depressive episodes are characterized by dysfunction in different regions of the vPFC", that may be more meaningful to readers than it is now.
 * ✅ Agreed-this was a bit too technical as it was previously written. I have adjusted it. TylerDurden8823 (talk) 05:42, 3 March 2020 (UTC)
 * 1) Mechanism - while no differences were found in people with bipolar depression does this contradict the paragraph above where it notes that people with BPD always have more amygdala activity than non-BPD people?
 * ✅ No, this is not a contradiction. The listed areas of the brain in this sentence (the lingual gyrus, frontal lobe, etc) are distinct from the amygdala. This is simply highlighting that people who are manic, depressed, or euthymic with bipolar disorder have differing activities in certain brain regions, but this does not contradict the note about the amygdala. TylerDurden8823 (talk) 05:42, 3 March 2020 (UTC)
 * perhaps you could clarify the sentence then. I understood the way it is currently written to mean that people with BP have (relative to non-BP people) decreased lingual gyrus activitiy in euthymia, decreased inferior frontal cortex activity in mania, and no difference in activity of any brain region during depression (which seemed at odds with the above that they have increased amygdala activity all the time and decreased activation of the left vPFC during depressive episodes). But from what you said above, it sounds like you're intending to mean that people with BP have the first two things from the list, but no change in the lingual gyrus or inferior frontal cortex during depression. Is that correct? Ajpolino (talk) 16:42, 3 March 2020 (UTC)
 * Okay, so I looked through the cited 2011 review. People with bipolar disorder (relative to healthy control/people without bipolar disorder) have increased activity in medial temporal lobe structures (e.g., parahippocampus, amygdala, hippocampus), putamen, caudate, and pallidum. Note-this is consistent with the sentence you alluded to that discusses amygdala hyperactivity-this does indeed appear to be present in people with bipolar disorder relative to people without bipolar. Now, the same meta-analysis done by the authors also showed decreased activity of the inferior frontal gyrus and putamen (yes, I know I mentioned putamen in both lists-it probably depends on whether the person with bipolar is in a manic, depressed, mixed, or euthymic state).


 * The review goes on to say this-euthymic bipolar vs people without bipolar: decreased activation in the lingual gyrus. People with bipolar mania had decreased activation of the inferior frontal gyrus relative to people without bipolar disorder. The meta-analysis did not find any consistent results for a specific brain area that uniquely had increased or decreased activity relative to healthy controls. Hopefully, that clears that up a bit. I'll see if I can make the sentence clearer to convey these points. I added another paragraph at the beginning based on that review that hopefully lays a little more of the foundation/context to make things a bit clearer as well. TylerDurden8823 (talk) 04:22, 4 March 2020 (UTC)


 * 1) Mechanism>Neurochemical (2nd paragraph) - The increase in GABA... makes it sound like we should already be aware that GABA increases by this point in the article (which I don't think we are?). Could you clarify why that is, or just clarify in the text that we also know that GABA increases?
 * ✅ I agree this seemed to come out of nowhere. I looked through the cited 2001 review and couldn't find verify the material. I also can't seem to find a ton of contemporary reviews (I found just a few) discussing brain GABA levels and bipolar disorder. I trimmed the sentence since it's confusing and doesn't seem to add much. TylerDurden8823 (talk) 04:26, 6 March 2020 (UTC)


 * 1) Mechanism>Neurochemical - There's a tag with a comment. Can you look into it?
 * ✅-this verification tag has been addressed and fixed. TylerDurden8823 (talk) 01:17, 10 March 2020 (UTC)


 * 1) Diagnosis>Bipolar spectrum - There is speculation as to whether this condition may occur with great frequency in the general, untreated population... substantial emotional dysregulation could use a reference.
 * ✅-I am unable to find a specific reference that speculates about unipolar hypomania in this way (if someone can find one that says something like this and adds it later, that's fine). TylerDurden8823 (talk) 01:43, 10 March 2020 (UTC)


 * 1) History - There is a tag with a comment. Can you look into it?
 * ✅- I am unable to find anything corroborating the specific piece about the Paris Psychiatric Society. Therefore, I removed it. If someone else finds a source that clearly supports that particular aspect of it, I would have no objection. TylerDurden8823 (talk) 01:02, 10 March 2020 (UTC)

Otherise, this looks great and meets the GA criteria. I'm glad to see such a large article cleaned up. Thanks again for the read. Happy editing. Ajpolino (talk) 23:00, 2 March 2020 (UTC)

GA review – see WP:WIAGA for criteria


 * 1) Is it well written?
 * A. The prose is clear and concise, and the spelling and grammar are correct:
 * •Lead - "The elevated mood is signficant..." I'm not sure if "significant" has a specific meaning in the clinical world, but to a normal reader, I don't think "the elevated mood is significant" will have any meaning. Could you rephrase to get your intended meaning across? Alternatively, it looks like if you cut "is signficant, and" from that sentence it would still make sense. Your call.
 * ✅ The term significant definitely has meaning in the clinical world (though what that meaning is might differ depending on whom you ask). I tried rewording it to "greater than expected". Does that seem clearer? TylerDurden8823 (talk) 19:42, 4 February 2020 (UTC)
 * "Greater than expected" is still confusing since I'm not sure what I would be expecting... I assume the purpose of the sentence is to introduce the two diagnostic levels of mania. So how about replacing the sentence with something like "If the elevated mood is severe or associated with psychosis, it is called mania; if less severe, it is called hypomania." Does that communicate what you're trying to say? I'm not at all wedded to that wording, so let me know what you think.
 * ✅ Sure, that sounds fine. TylerDurden8823 (talk) 01:42, 5 February 2020 (UTC)
 * •Lead - "These difficulties occur a quarter to a third of the time, on average." - It's unclear if you mean 1/4 to 1/3 of people experience difficulties, or people with BD have difficulties during 1/4 to 1/3 of their lives. Could you clarify that sentence somehow?
 * ✅ After looking at the sourced review article, it appears this means ~1/4-1/3 of people with bipolar disorder experience these functional problems, not 1/4-1/3 of the time in their lives. I adjusted the wording for clarity. TylerDurden8823 (talk) 19:42, 4 February 2020 (UTC)
 * •Signs & symptoms - Is there another word or wikilink for "psychomotor activity"? I assume to a layreader it sounds like something only X-Men could do...
 * ✅ That's a tougher one to simplify into lay language (at least concisely). Psychomotor agitation is wikilinked for further explanation for the reader. It's basically the amount of physical movement a person has as influenced by their mood (agitated/manic --> constant fidgeting vs depressed --> abnormally slowed movements despite being physically capable of moving faster). I revised this (I can work on it more if needed) but hopefully this is clearer. TylerDurden8823 (talk) 19:48, 4 February 2020 (UTC)
 * •Signs & symptoms - "Mania is distinguished from hypomania by..." by whom? Presumably some diagnostic reference manual?
 * ✅-this is from the DSM-5 criteria. I have clarified that point and cited a 2016 Lancet review article that verifies this fact. TylerDurden8823 (talk) 20:08, 4 February 2020 (UTC)
 * •Causes - You mention bipolar "type I" and "type II" are the same as the "Bipolar I disorder" and "Bipolar II disorder" mentioned later in the diagnosis section? If so, could you wikilink them (and maybe even use the same terminology) in the causes section? If not, could you clarify what they are (the words "type I" don't appear outside that section).
 * ✅-I revised this for internal consistency to avoid confusing readers. TylerDurden8823 (talk) 20:29, 4 February 2020 (UTC)
 * •Causes - You redefine the abbreviation BPD (which you'd already defined in the lead) and then use it just once. For the rest of the article you spell out "bipolar disorder". I'd suggest you either don't bother re-defining the abbreviation, or just change that one instance of "BPD" to "bipolar disorder" and the whole article will be consistent...
 * ✅-fixed.
 * •Causes - Does "Major unipolar depression" = Major depressive disorder? If so, could you wikilink it here? To an uneducated reader it might sound like it's some distinct and new disorder. If it's not the same, maybe you could put an appropriate wikilink or something?
 * ✅ Yes, major unipolar depression is the same as major depressive disorder. I have adjusted this section for consistency and just switched it to major depressive disorder to avoid confusion and increase consistency throughout the article. TylerDurden8823 (talk) 20:48, 4 February 2020 (UTC)
 * •Causes - "Estrogen in women has been linked to bipolar disorder" seems to give almost no information. Since you say above that men and women experience bipolar disorder at similar rates, I assume estrogen isn't causatively linked in any way. So could you clarify what the linkage is (or if there's not enough clear on the topic to justify more words, you could cut it as undue...)?
 * I'll look into this. Standby. TylerDurden8823 (talk) 20:49, 4 February 2020 (UTC)
 * ✅ I have cut it for now. I looked at the articles cited and it's a very interesting topic but seems too preliminary for inclusion in the article at this time. TylerDurden8823 (talk) 06:23, 9 February 2020 (UTC)
 * •Causes - "were initially successful in a meta-analysis..." The word "successful" doesn't seem to make sense here. Can you rephrase it somehow?
 * ✅ Yes, I have rephrased this. I agree the meaning was unclear here. TylerDurden8823 (talk) 20:48, 4 February 2020 (UTC)
 * •Causes>Genetic - Maybe "Findings point strongly to heterogeneity, with different genes being implicated in different families.[57] Robust and replicable genome-wide significant associations showed several common SNPs, including variants within the genes CACNA1C, ODZ4, and NCAN.[42][51]" should be moved up earlier in the section? It's mostly discussed two paragraphs earlier, so it's confusing when the topic of GWAS associations reappears here.
 * ✅ I have moved this up where it seems to make more sense for the article's flow. TylerDurden8823 (talk) 06:27, 9 February 2020 (UTC)
 * •Mechanism>Physiological - Ok, I found this section pretty fragmented and challenging to read. I made a few wording tweaks to the beginning and end of the first paragraph to clarify what I think the intended meaning was. Please take a look, make sure I didn't mess up anything, and edit as you see fit.
 * ✅-reviewed, adjustments look reasonable to me. TylerDurden8823 (talk) 20:55, 13 February 2020 (UTC)
 * •Mechanism>Physiological - In the first paragraph you indicate that vPFC activity could be a mood marker, while amygdala hyperactivity could be a trait marker. In the second paragraph you indicate that both could be trait markers. Can you clarify this somehow?
 * ✅ I trimmed some of the material that I agree was pretty confusing to read and difficult to tell if it was internally consistent. Hopefully, this update is clearer for readers and easier to follow. TylerDurden8823 (talk) 08:14, 28 February 2020 (UTC)
 * •Mechanism - In general, the mechanism section reads like a laundry list of disconnected hypotheses and facts. Is there anything you can do to clarify this section? In its current state I'm not sure who it would be of use to. If you don't have time to do this right now, I can try to help (though I'm no neuroscientist), and/or we can try to recruit a neuro/med/molecular biology person to help out.
 * •Diagnosis - "to rule-out medical causes" - Reads weird to a non-physician. Maybe just "other" causes? Or "non-psychiatric" causes?
 * ✅ Rephrased. TylerDurden8823 (talk) 06:31, 9 February 2020 (UTC)
 * B. It complies with the manual of style guidelines for lead sections, layout, words to watch, fiction, and list incorporation:
 * •Lead - "the risk of death from natural causes such as coronary heart disease in people with bipolar is twice that of the general population" I don't think this appears in the body of the article (though maybe I've missed it?). A very brief discussion of this in the article proper would be nice.
 * ✅-I elaborated on this a bit more (there was a reference to it though it was a bit vague) in the prognosis section. TylerDurden8823 (talk) 20:53, 13 February 2020 (UTC)
 * 1) Is it verifiable with no original research?
 * A. It contains a list of all references (sources of information), presented in accordance with the layout style guideline:
 * •Management>Psychosocial - "...recognizing prodromal symptoms before full-blown recurrence, and, practising the factors that lead to maintenance of remission" has an unclear citation, a full citation needed tag, and then cites two books without page numbers to clarify. The sentence is pretty general, so hopefully you can easily find a better reference?
 * ✅ I have replaced the citation needed template and incomplete/vague references with an updated reference and reworded the sentence a bit but basically with the same meaning. TylerDurden8823 (talk) 06:41, 27 February 2020 (UTC)
 * B. All in-line citations are from reliable sources, including those for direct quotations, statistics, published opinion, counter-intuitive or controversial statements that are challenged or likely to be challenged, and contentious material relating to living persons&mdash;science-based articles should follow the scientific citation guidelines:
 * C. It contains no original research:
 * •Signs and symptoms>Hypomanic episodes - There should be a reference at the end of the first paragraph to verify that some with hyomanic episodes "are irritable or demonstrate poor judgment."
 * ✅ I have added a secondary source verifying that hypomanic episodes may include irritability and poor judgment as features. TylerDurden8823 (talk) 06:04, 27 February 2020 (UTC)
 * •The lead says 85% of the cause is attributed to genetics while the Causes section says 60-80% is attributed to genetics. Could you clarify?
 * ✅ This has been updated and is now consistent in the body and lead. TylerDurden8823 (talk) 06:15, 27 February 2020 (UTC)
 * •Diagnosis - "Semi structured interviews such as the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS) and the Structured Clinical Interview for DSM-IV (SCID) are used for diagnostic confirmation of bipolar disorder" could use a reference.
 * ✅ I removed this since I am unable to find clear verification of this statement. TylerDurden8823 (talk) 07:59, 27 February 2020 (UTC)
 * D. It contains no copyright violations nor plagiarism:
 * Looks good to me. Passed Earwigs (only hit was a Facebook page that I'm fairly certain grabbed the text from this page).
 * 1) Is it broad in its coverage?
 * A. It addresses the main aspects of the topic:
 * B. It stays focused on the topic without going into unnecessary detail (see summary style):
 * 1) Is it neutral?
 * It represents viewpoints fairly and without editorial bias, giving due weight to each:
 * 1) Is it stable?
 * It does not change significantly from day to day because of an ongoing edit war or content dispute:
 * 1) Is it illustrated, if possible, by images?
 * A. Images are tagged with their copyright status, and valid fair use rationales are provided for non-free content:
 * Sorry for butting in but there is a problem - File:Bipolar mood shifts.png - (a) this image has no source, and (b) it potentially misrepresents the condition. They key feature is that it has discrete episodes characterised but interepisode absence of symptoms - the graph does not show that. Cas Liber (talk · contribs) 00:33, 4 March 2020 (UTC)
 * That's okay, Cas., I want the article to improve so all feedback is welcome to achieve that. Can you clarify for me what you mean that the linked picture has no source? I do appreciate your second point (do you have an alternative picture you would propose for use in its place?). Something more like this or  what you had in mind? TylerDurden8823 (talk) 22:40, 10 March 2020 (UTC)
 * Also, while we're on the subject of images for the article, what do you think of this one for the neurochemical section? It might make things a little bit easier since describing various parts of the brain can feel abstract to people not well-versed in neuroscience. TylerDurden8823 (talk) 22:48, 10 March 2020 (UTC)
 * Okay - the problem with the File:Bipolar mood shifts.png is that I can't see the well (euthymic) interepisode functioning. What I mean about sources is that there needs to be a source for where the information came from on the page. For instance, the neuroscience one (need to read that article and digest) is sourced from the paper. Many graphs are sourced from textbooks/review articles/etc. so they need to me mentioned. So a textbook would be great. I am sorting now as I can 100% guarantee someone will quiz us on this at FAC (which is where I want to take this). I will try to think of a source... Cas Liber (talk · contribs) 07:13, 11 March 2020 (UTC)
 * Well, it looks like the image you're referring to came from Osmosis, didn't it? I understand (and agree with) your point about the noteworthy absence of clear episodes of interepisode remission as an important shortcoming of that particular image. What are your thoughts on some of the other images I linked to above? I realize they're not in English (I realize that's not ideal for an English Wikipedia page), but they do demonstrate interepisode remissions more clearly. I understand this may come up in FAC and I agree that is where we should take this eventually. This is the last single thing I see on the GA review so I'm hoping we can solve this last point so we can free up the GAN page a bit since they're getting backed up. Admittedly, this part about images is a bit outside my wheelhouse. Thanks! TylerDurden8823 (talk) 20:41, 11 March 2020 (UTC)
 * B. Images are relevant to the topic, and have suitable captions:
 * 1) Overall:
 * Pass or Fail:
 * It represents viewpoints fairly and without editorial bias, giving due weight to each:
 * 1) Is it stable?
 * It does not change significantly from day to day because of an ongoing edit war or content dispute:
 * 1) Is it illustrated, if possible, by images?
 * A. Images are tagged with their copyright status, and valid fair use rationales are provided for non-free content:
 * Sorry for butting in but there is a problem - File:Bipolar mood shifts.png - (a) this image has no source, and (b) it potentially misrepresents the condition. They key feature is that it has discrete episodes characterised but interepisode absence of symptoms - the graph does not show that. Cas Liber (talk · contribs) 00:33, 4 March 2020 (UTC)
 * That's okay, Cas., I want the article to improve so all feedback is welcome to achieve that. Can you clarify for me what you mean that the linked picture has no source? I do appreciate your second point (do you have an alternative picture you would propose for use in its place?). Something more like this or  what you had in mind? TylerDurden8823 (talk) 22:40, 10 March 2020 (UTC)
 * Also, while we're on the subject of images for the article, what do you think of this one for the neurochemical section? It might make things a little bit easier since describing various parts of the brain can feel abstract to people not well-versed in neuroscience. TylerDurden8823 (talk) 22:48, 10 March 2020 (UTC)
 * Okay - the problem with the File:Bipolar mood shifts.png is that I can't see the well (euthymic) interepisode functioning. What I mean about sources is that there needs to be a source for where the information came from on the page. For instance, the neuroscience one (need to read that article and digest) is sourced from the paper. Many graphs are sourced from textbooks/review articles/etc. so they need to me mentioned. So a textbook would be great. I am sorting now as I can 100% guarantee someone will quiz us on this at FAC (which is where I want to take this). I will try to think of a source... Cas Liber (talk · contribs) 07:13, 11 March 2020 (UTC)
 * Well, it looks like the image you're referring to came from Osmosis, didn't it? I understand (and agree with) your point about the noteworthy absence of clear episodes of interepisode remission as an important shortcoming of that particular image. What are your thoughts on some of the other images I linked to above? I realize they're not in English (I realize that's not ideal for an English Wikipedia page), but they do demonstrate interepisode remissions more clearly. I understand this may come up in FAC and I agree that is where we should take this eventually. This is the last single thing I see on the GA review so I'm hoping we can solve this last point so we can free up the GAN page a bit since they're getting backed up. Admittedly, this part about images is a bit outside my wheelhouse. Thanks! TylerDurden8823 (talk) 20:41, 11 March 2020 (UTC)
 * B. Images are relevant to the topic, and have suitable captions:
 * 1) Overall:
 * Pass or Fail:
 * B. Images are relevant to the topic, and have suitable captions:
 * 1) Overall:
 * Pass or Fail:
 * Pass or Fail:

Hi all, I'm glad to see the attention this article has received over the last week or so. I think this now clearly meets the GA criteria so I'm going to mark it as a pass. Thanks all for the interesting read. Since several of you have expressed an interest in improving this article further, I've included some minor comments from a non-physician reader's perspective. Take em or leave em:
 * Signs & symptoms - their content and nature is consistent with the person's prevailing mood is so vague as to be unhelpful.
 * , is there any way you can perhaps make this piece a bit clearer for a general audience? Since you added this part, I don't want to assume what you were trying to say. TylerDurden8823 (talk) 06:28, 13 March 2020 (UTC)
 * I'll take a look Cas Liber (talk · contribs) 11:28, 13 March 2020 (UTC)
 * Still thiking on this - wht it means in essence is - manic mood often have delusions that are euphoric/grandiose/religiose, while depressed poeple have delusions about parts of their body being dead, having cancer or owing alot of money to the tax department. Tired now, need to sleep but will sort tomorow. Cas Liber (talk · contribs)


 * Signs & symptoms - According to the DSM-5 criteria... more than a week the verb "requires" is a little confusing to read. Perhaps it's be clearer to say something like "According to the DSM-5 criteria, manic symtoms lasting at least four days are termed "hypomania" while symptoms lasting a week or more are called "mania"."
 * Fixed. I hope this is clearer now. TylerDurden8823 (talk) 18:31, 12 March 2020 (UTC)


 * Totally unimportant, but is it "DSM-5" or "DSM 5"? There's one of each in the Symptoms section (also there's a "DSM-V" later).
 * It's DSM-5. I fixed the one outlier. TylerDurden8823 (talk) 18:31, 12 March 2020 (UTC)


 * Causes - The overall heritability of the bipolar spectrum has been estimated at 0.71 Is there a different way to express this number that's more intuitive? I think this sentence will be essentially meaningless to non-biologists. After skimming our article on heritability perhaps the answer is no...
 * I think we do this in the lead when we sum this up more concisely by stating the percentage of risk attributable to genetics. TylerDurden8823 (talk) 18:32, 12 March 2020 (UTC)


 * The first paragraph of the mechanism section is much-improved. A gold sticker to whoever wrote it (apologies for not checking the very active history more thoroughly). The rest of the section could use more structure and context to be clear to a non-expert. It still, at times, reads like a list of facts and citations.
 * There was some discussion above concerning whether File:Bipolar mood shifts.png misrepresents the disease by omitting euthymic periods. The same could be said of File:Bipolar disorder subtypes comparison between Bipolar I, II disorder and Cyclothymia.svg further down the page. While squiggles on a cartesian plane obviously won't perfectly encapsulate a disorder, we should decide how much mis-representation we'd like to tolerate in clarity's name. I (or someone else) could generate a more precise File:Bipolar disorder subtypes comparison between Bipolar I, II disorder and Cyclothymia.svg if you'd like. Fixing File:Bipolar mood shifts.png would be more challenging for me, but perhaps someone could do it (or we could ask Osmosis to change it and just see if they respond).
 * "Medical cause" is used throughout to mean "non-psychiatric" cause (I think). I don't think this division is clear to non-clinicians, most of whom would probably consider psychiatric disorders to be "medical".
 * Adjusted. I agree that this distinction could be unclear to someone outside of medicine. TylerDurden8823 (talk) 19:03, 12 March 2020 (UTC)


 * Rapid cycling - and is found in a significant proportion of individuals with bipolar disorder this is basically meaningless as written. Does significant mean it's statistically associated with bipolar disorder? Or that a substantial portion of people with bipolar disorder have it? If so, how substantial?
 * Fixed-I have clarified what is meant by "significant proportion" by adding more specific statistics with a supporting (and recent) secondary source for reference. TylerDurden8823 (talk) 02:25, 13 March 2020 (UTC)


 * Medication - ...or those with more psychotic symptoms or a more schizoaffective clinical picture not clear what this means.
 * I reworded a bit. Hopefully this is clearer. I'm not sure what is unclear about more psychotic symptoms but the schizoaffective clinical picture is referring to schizoaffective disorder, which has a bipolar subtype that can have some overlap with bipolar disorder. TylerDurden8823 (talk) 06:16, 13 March 2020 (UTC)


 * Prognosis - The standardized mortality ratio from suicide in bipolar disorder is between 18 and 25. Standardized mortality ratios won't be quickly understood by non-specialists, but Standardized mortality ratio makes it sound like this means someone with bipolar disorder is 18 to 25 times more likely to die by suicide than a member of the general population? If that's correct, perhaps phrasing it that way would be more meaningful to most readers.
 * I have reworded this a bit to (hopefully) make it more accessible to a more general audience. Hopefully this helps. TylerDurden8823 (talk) 06:25, 13 March 2020 (UTC)


 * The first paragraph of the Society & culture section feels like arbitrary examples of people describing their bipolar disorder in some medium. If these are really notable cases, perhaps that could be clarified somehow?
 * -I have added a transition sentence to try to make this feel a bit smoother diving into this discussion, but I'm not sure I understand the problem. Can you elaborate a bit on what you feel is missing and why these examples feel arbitrary? TylerDurden8823 (talk) 06:35, 13 March 2020 (UTC)
 * Yep, sorry I should have been more clear. The section begins by noting that people with bipolar disorder face social stigma and prejudice. So it felt a bit random when the rest of the paragraph was four disconnected examples of individuals' descriptions of their bipolar disorder. Were these four examples important in changing society's understanding of the disorder? Were they key cases that brought the disease into the public eye? Are they just in this article because the editors who wrote An Unquiet Mind, Chris Joseph (autobiographer), Stephen Fry: The Secret Life of the Manic Depressive, and Ronald Braunstein popped over to this article to add a link? It's unclear to an uneducated reader (such as myself). If these are significant examples, maybe that could be somehow clarified? If not, maybe they could be replaced with other material. For example, at Parkinson's_disease, it looks like three notable cases are mentioned in the section with some context and independent sources, while other cases in notable people were collected at List of people diagnosed with Parkinson's disease. Ajpolino (talk) 16:07, 13 March 2020 (UTC)
 * This is a good point - it is often hard to craft sections such as this as it can be hard to find encompassing views etc. Also people add material they feel is notable and I often think twice before removing it. Will see what we can do. Cas Liber (talk · contribs) 20:42, 13 March 2020 (UTC)
 * , okay, I understand what you mean now. Cas & I will look into it further to see if we can find sources that discuss whether these particular examples (or others) changes society's views on bipolar disorder or whether this is actually an example of just a bunch of random (though famous) names added in as noteworthy people who have the disorder. TylerDurden8823 (talk) 05:31, 14 March 2020 (UTC)
 * , I've worked on this some more. Better? TylerDurden8823 (talk) 06:43, 17 March 2020 (UTC)
 * It's somewhat better, though the dividing line between advocacy and notable cases is somewhat unclear (since most of Advocacy is about a notable case). For what it's worth, I think the section would be enriched by more focus on stigma, societal perceptions, et al. and less focus on certain individual cases. A quick search on Google/GScholar suggests there are some papers on stigma and bipolar disorder. That said, I'll defer to the more experienced article-crafters here on what's necessary to see the article through an FA nomination. Great to see all the work post-GA status! Let me know if there's anything I can do to help! Ajpolino (talk) 02:19, 18 March 2020 (UTC)
 * Sure, no problem. I was modeling after the PD but I'm happy to expand on the stigma and societal perceptions piece in the advocacy section. That's easy enough. With that said, I would encourage a re-read of the advocacy section. It is mentioning famous examples of bipolar disorder, but specifically within the context of how they have been taking actions to destigmatize bipolar disorder and change the conversation. That's really where the emphasis is in that subsection. The notable cases subsection basically just mentions other celebrities who have been public about their diagnosis and says nothing about advocacy efforts so that seems like a rather clear distinction to me. TylerDurden8823 (talk) 02:59, 18 March 2020 (UTC)


 * I'm aware of the suggested section order at Manual_of_Style/Medicine-related_articles, but my opinion (for what it's worth) is that the section on "Specific populations" would fit better in the article higher up with the other medical sections, perhaps after Prognosis. Finding it after History and Society & culture is a surprise to read.
 * After looking at it again, I agree. I think it would be better a bit higher up in the article so I'll be bold and move it upward. TylerDurden8823 (talk) 18:44, 12 March 2020 (UTC)
 * How does it fit between "prognosis" or "epidemiology"? We could split these details out to other sections of this article and than remove the sections themselves. Doc James  (talk · contribs · email) 19:09, 12 March 2020 (UTC)
 * That's fine too. I just think it makes even less sense at the very end. TylerDurden8823 (talk) 21:46, 12 March 2020 (UTC)

Otherwise the article reads nicely to me. If you'd like me to read through it again in the future for clarity, let me know. Otherwise, I'll stay out of your hair. Thanks again all for the interesting read. It was a pleasure to see so much work go into this article. Happy editing! Ajpolino (talk) 06:19, 12 March 2020 (UTC)