User:Med2019/sandbox

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This is place to practice clicking the "edit" button and practice adding references (via the citation button). Please see Help:My_sandbox or contact User_talk:JenOttawa with any questions.

Link: Project Homepage and Resources


 * Note: Please use your sandbox to submit assignment # 3 by pasting it below. When uploading your improvements to the article talk page please share your exact proposed edit (not the full assignment 3).


 * Talk Page Template: CARL Medical Editing Initiative/Fall 2019/Talk Page Template

 Wikipedia Assignment 2 

1) After consulting a few different databases, including PsycINFO and PubMed, I decided to use PubMed as it had the most relevant information pertaining to our topic. I first consulted the MeSH database in Medline to determine the best search terms for bipolar I disorder.

Search term used: (bipolar disorder) OR (bipolar type I disorder)

Applied filters were: “review”, “5 years”, “english”, and “best match”

2) Potential sources that were identified and considered were ones that focused specifically on bipolar I disorder or differentiated between bipolar I and bipolar II disorders, and articles that were systematic reviews, meta-analyses, or practice guidelines.

Examples:

i) The diagnosis and management of Bipolar I and II Disorders: Clinical Practice Update

https://journals-scholarsportal-info.proxy.queensu.ca/pdf/00256196/v92i0010/1532_tdamobaidcpu.xml

ii) Borderline personality disorder and bipolar disorder: what is the difference and why does it matter?

http://dw2zn6fm9z.search.serialssolutions.com/?sid=Entrez:PubMed&id=pmid:25536097

3) Selected source:. Bobo, W.V. (2017). The diagnosis and management of bipolar I and II disorders: Clinical practice update. Mayo Clinic Proc, 92(10); 1523-1551. http://dx.doi.org/10.1016/j.mayocp.2017.06.022

This source was selected because it focused specifically on bipolar disorders only, differentiated between the two, was a clear review, and addressed clinical guidelines specifically.

4) This is a secondary source (i.e. not primary article or research) trial, is a clinical practice guideline published by a major scientific source (Mayo Clinic) therefore comes from the top of the ‘hierarchy of evidence’, and is up-to-date having been published in 2017.

5) This source will be used by myself or another groupmate to help describe bipolar I disorder and differentiate it from bipolar II and borderline personality disorders, as well as help update the treatment section for bipolar I disorder according to DSM-V criteria.

NOTE: For the purposes of assignment 3, I am going to use an additional article that was not originally identified in the above search system. This source was found through PubMed as well by searching for “CANMAT bipolar” and selecting for the most recent CANMAT guidelines for bipolar disorder. This source was selected as an appropriate Wikipedia source as it is a secondary source (i.e. not primary article or research trial), is a clinical practice guidelines published by a recognized Canadian source (Canadian Network for Mood and Anxiety Treatments), therefore comes from the top of the ‘hierarchy of evidence’, and is up to date having been published in 2019 as the most recent guidelines.

Source: Yatham LN, Kennedy SH, Parikh SV, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord. 2018;20(2):97–170. doi:10.1111/bdi.12609

 Wikipedia Assignment 3 

1) Proposed Changes:

Under the Patient education section, below the subtitle, I propose adding the following additional sentences:

“Psychosocial interventions can also be used for managing acute depressive episodes and for maintenance treatment to aid in relapse prevention. This includes psycho education, cognitive behavioural therapy (CBT), family-focused therapy (FFT), interpersonal and social-rhythm therapy (IPSRT), and peer support.”

This appears clear and to the point. I would not change this sentence. -rreidcaf

Changes in response to Dr. Reid’s feedback: none required

Final Feedback:

- Simply written and clear.

- terms properly wiki-linked

- no issues with people-first language.

RREIDCAF

2) Rationale:

The main treatment for people with bipolar disorders is pharmacological treatments, which is highlighted in the page. However, little attention is paid to additional or adjuvant treatments that are proven to be effective for treatment of acute depressive episodes and maintenance of treatment for relapse prevention, both of which are important for quality of life to the individual and family. The positive evidence for the adjuvant treatments in my proposed change is highlighted in the CANMAT guidelines for bipolar disorder. Additionally, the section on the Wikipedia page only includes information on patient education. However, the CANMAT guidelines highlight that patient education is just one of many psychosocial interventions that can be beneficial in treating patients with bipolar disorder. Therefore, by including this information, it is creating a fuller picture for the audience on all possible treatment avenues for bipolar I disorder.

As noted above, the main source used to gather this information is the CANMAT guidelines for bipolar disorder:

Yatham LN, Kennedy SH, Parikh SV, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord. 2018;20(2):97–170. doi:10.1111/bdi.12609

This source was found through PubMed as well by searching for “CANMAT bipolar” and selecting for the most recent CANMAT guidelines for bipolar disorder. This source was selected as an appropriate Wikipedia source as it is a secondary source (i.e. not primary article or research trial), is a clinical practice guideline published by a recognized Canadian source (Canadian Network for Mood and Anxiety Treatments), therefore comes from the top of the ‘hierarchy of evidence’, and is up to date having been published in 2018. It is the most recent, standardized guideline in Canada for treating bipolar disorder, which is why I used its treatment recommendations to inform my changing of the Wikipedia article.

'''Although slightly wordy, I think you feel like you needed to justify the use of the CANMAT guidelines, which you did well. -rreidcaf'''

Changes in response to Dr. Reid’s feedback: none required

Changes well justified, including where they came from, and why.

RREIDCAF

Controversy/Varied Opinion: The CANMAT guidelines state that the above mentioned psychosocial treatments can be useful for treating acute depressive episodes as well as preventing relapse in people with bipolar disorder, however, it mentions there is no evidence or recommendations for the use of psychosocial interventions for acute mania. While mania is one of the major components in bipolar disorder, I am still proceeding with my proposed change to highlight the other therapy options for the other components of bipolar disorder, and highlighting what aspect of bipolar disorder they are useful in treating. Since the Wikipedia article already includes information on patient education, I believe my addition will supplement this portion of the article and better rationalize the inclusion of patient education to the readers of this article.

'''The main issue with Mania, is that patient's lack insight (they don't believe they are sick, often feel that they are the only ones who are well). Often, as people are responding to treatment, we assess their degree of insight and their ability to use and accept psychosocial techniques as interventions as indications of their improvement. You may, after posting your proposed changes to the talk page, add a sentence regarding lack of evidence in psychosocial treatment for mania later, but I think that you have achieved the objective of assignment #3 and would not suggest changes to your current submission. -rreidcaf'''

Changes in response to Dr. Reid’s feedback: none at this time for current submission, but see response from talk page posting.

No additional Feedback

RREIDCAF

3) Critique of Source:

This source is made by the Canadian Network for Mood and Anxiety Treatments (CANMAT), and therefore may not reflect the guidelines in other countries or regions. Since it is from a Western organization, it may also be biased toward the medical model of disease. However, the bipolar I article in Wikipedia largely focuses on the biomedical view of the condition, and this source supplements this view. The section could be further supplemented by verifying these treatment guidelines with recommendations from other secondary sources from other regions or sources.

'''Well done. I believe there is more critique that can be done on CANMAT guidelines (it'd be great to be a fly on the wall when these were being written) but you have achieved the goals of the assignment. -rreidcaf'''

Additionally, the selected source is a practice guideline, which could be subjected to a number of critiques specific to this type of evidence. These guidelines include physicians and members of departments of psychiatry from various university institutions across Canada, the US, as well as in Australia and Spain. However, it did not note consulting with many patient populations to develop these guidelines, and only institutions in developed countries were consulted. The guidelines have clearly identified any conflicts of interest for each contributor which contributes to the credibility of the document. These guidelines outlined a rigorous process of evidence selection and review, which included paying attention to levels of efficacy, clinical support based on experience and expert consensus, and includes first, second, and third line recommendations to include a broad scope of recommendations. The guidelines described following a clear process for finding info and agreeing on the recommendations, and provides a good overview of and hierarchical rankings of recommendations for management for various patient populations. Overall, I think this is a high quality clinical practice guideline that could benefit by including more varied stakeholders and patient populations in the guideline development.

Good assessment of the practice guideline. RREIDCAF

Changes in response to Dr. Reid’s feedback: added to critique of source according to email and Dr. Murray’s post.