Misplaced Pages

Epidemiology

• Depression is a major cause of morbidity the world over: Is not over the world?

changed it to "worldwide" (the world over is a quaint english idiom anyway) Cheers, Casliber (talk · contribs) 10:39, 21 October 2008 (UTC)

• In the year 2030, it is predicted to be the second leading cause of disease burden worldwide (after HIV), according to the World Health Organization: Are the brackets really needed? (I would eliminate them)

parentheses duly removed Cheers, Casliber (talk · contribs) 10:39, 21 October 2008 (UTC)

Comments by delldot ∇.

Wow, very much improved since the peer review I gave it, it's a really great read now, very well organized and informative. Most of these are very minor points about wording.
Lead *However, the relief of symptoms usually occurs several weeks or more after changes in neurotransmitter levels, which suggests that the precise role of neurotransmitter levels in depressive illness is still not fully understood. - Sounds a little repetitive with two uses of 'neurotransmitter levels'. Also use of 'suggests' seems a little weird there; wouldn't we know for sure whether it's fully understood?

Has been changed in the course of this FAC, and you are right BTW Cheers, Casliber (talk · contribs) 10:56, 21 October 2008 (UTC)

*Is there a reason why 'percent' is used in the lead and % is used elsewhere? ::No idea...will check MOS, if nothing there then a symbol it shall be... Cheers, Casliber (talk · Misplaced Pages:MOS#Percentages - erm, not sure. Having read this, ee could go either way I guess. Cheers, Casliber (talk · contribs) 10:59, 21 October 2008 (UTC)

I would make it consistent one way or the other. I think more scientific articles tend to use %. delldot ∇. 03:11, 22 October 2008 (UTC)

agree on thinking about it; done Cheers, Casliber (talk · contribs) 15:01, 22 October 2008 (UTC)

Signs and symptoms

• Could you shorten this without losing meaning? in the typical pattern, a person reports waking very early and being unable to get back to sleep → in the typical pattern, a person wakes very early and is unable to get back to sleep (done) Cheers, Casliber (talk · contribs) 08:41, 21 October 2008 (UTC)
• Those older than 12 years may also begin abusing drugs or alcohol, or exhibit disruptive behavior. -- This kind of makes it sound like kids under 12 never do this, I imagine it's supposed to mean something more like kids over 12 are more likely to, but it's not impossible in younger kids either. Also, just mentioning drugs and alcohol in the peds para makes it sound like that's not a symptom in adults; I thought it was.

(forgot this one) - ok, although substance use does occur in adults with depression, these people are usually (a) more able to articulate their feelings and (b) more likely to have a low mood - teenagers are less likely and also often have an irritable mood, hence it is more in what else is seen around it so to be more mindful of it in this age group (as it is less obvious), or something like it :) Cheers, Casliber (talk · contribs) 03:48, 25 October 2008 (UTC)

I think I see what you're saying, it's not as much of a symptom in adults, more of a comorbidity? delldot ∇. 05:02, 27 October 2008 (UTC)

Causes

• ...the idea that some components of depression are adaptations. This is a surprising assertion, could we have an example? What could possibly be adaptive about depression?

• The elaboration currently comes toward the end of the article, in Sociocultural aspects--i.e., depression can elicit social support, or it can work in a way analogous to physical pain by preventing hasty actions. Maybe something about this should be said earlier? Cosmic Latte (talk) 07:07, 21 October 2008 (UTC)

• Maybe allude to that then (e.g. "see below", although I don't know if that per se is accepted practice). delldot ∇. 06:36, 24 October 2008 (UTC)

• Most antidepressants increase synaptic levels of the monoamine neurotransmitter serotonin. - this is the first use of 'monoamine', maybe give a bit of an explanation of what it means?

This bit is tricky, but I have tried to make an introduction of sorts by changing to "Most antidepressants increase synaptic levels of the hormone serotonin, one of a group of neurotransmitters classified as monoamines. Some also enhance the levels of two other monoamine neurotransmitters, norepinephrine and dopamine." - could replace first "neurotransmitter" with "compound" or "hormone" (?) Cheers, Casliber (talk · contribs) 00:26, 4 November 2008 (UTC)

• tianeptine and opipramol, have been known about for a long time. -- 'been known about' sounds weird.
• A depressive episode may also be triggered by a loss of religious faith. - non-sequitur there, maybe would fit in with a list of events that can precipitate it (e.g. Vulnerability factors—namely early maternal loss...).
• an external locus of control, a tendency to attribute outcomes to external events perceived to be uncontrollable. - it's better to avoid reusing a word from the term you're trying to define in the definition (e.g. 'external is external').

You are right, the term "events" implies outside/not of the body, hence the 2nd 'external' is redundant. Cheers, Casliber (talk · contribs) 10:49, 3 November 2008 (UTC)

Not quite, actually – "private events" is common terminology in Skinnerian tradition. How about "a tendency to attribute outcomes to events outside of personal control" or something similar – since we're talking about attributions, isn't "perceived to be" redundant? /skagedal 11:08, 3 November 2008 (UTC)

Much better and incorporated; I wasn't entirely happy with that, but you have come up with a succinct and better alternative. Cheers, Casliber (talk · contribs) 12:47, 3 November 2008 (UTC)

• What's going on with the two different sets of quotation marks here: "In mourning 'it is the world that has become poor and empty; in it is the ego itself.'" Who's saying what?

• The article authors are quoting Freud, but the initial "In mourning" comes from the article authors themselves. Cosmic Latte (talk) 07:09, 21 October 2008 (UTC)

• Maybe reword to avoid having to quote the article writers then--two sets of quotes is confusing. delldot ∇. 06:36, 24 October 2008 (UTC)

• parents have problems with alcoholism -- this strikes me as redundant, maybe because it seems like alcoholism would always be problematic. Maybe parents are alcoholic or have problems with alcohol.

yep, good tautological pickup, changed to "..a parent with alcoholism" Cheers, Casliber (talk · contribs) 09:48, 21 October 2008 (UTC)

Diagnosis

• If you're looking for material to cut down for length, you could remove the para starting Specialist mental health services are rare in rural areas... this is not remarkable for depression probably, it would be the case for everything. (Or cut it down).

I have mixed feelings about this. Tony noted a first-world bias about the article and wondered if/how it could be addressed. I actually feel it is important to briefly touch on the contrast between urban first-world services and developing countries (and even rural Australia for that matter!). It is important WRT MDD as it is often thought a disorder of developed countries only, yet data shows it worldwide. Cheers, Casliber (talk · contribs) 09:43, 21 October 2008 (UTC)

Ah, no problem then. delldot ∇. 06:36, 24 October 2008 (UTC)

Prognosis

• I think it should be 40–70% rather than 40% to 70% per WP:MOSNUM# Percentages. (done)Cheers, Casliber (talk · contribs) 08:38, 21 October 2008 (UTC)

Refs

• Some journal titles are abbreviated, some aren't. Some abbreviations have periods, some don't. I don't mind helping to go through and make these consistent if you let me know which style you prefer for all of them.

• Aargh, thought I got 'em all. Go for it! Cheers, Casliber (talk · contribs) 08:37, 21 October 2008 (UTC)

Which style? delldot ∇. 03:11, 22 October 2008 (UTC)

Executive decision: I'll go with Last FM (short, clean, and it's the default for Diberri's tool!). delldot ∇. 04:29, 2 November 2008 (UTC)

• Isn't the first letter after a colon in an article title supposed to be capitalized? Again I don't mind doing it myself as long as I know I'm supposed to. Either way it should be made consistent.

Ditto. Cheers, Casliber (talk · contribs) 08:37, 21 October 2008 (UTC)

Caps after the colon, right? delldot ∇. 03:11, 22 October 2008 (UTC)

Great work overall! More comments to follow. delldot ∇. 06:43, 21 October 2008 (UTC)

• Support—although I must disclose that I copy-edited the lead and first one or two sections last month. I hope that this is the first of a run of articles in a woefully undertreated part of WP (psychiatry and psychology) in which Casliber puts his considerable expertise to great public benefit. I'd like to return and make a few detailed comments. Here's one: " A depressive episode may also be triggered by a loss of religious faith." I think this is oddly prominent in the rather short lead para to the section "Psychological", and the Journal of Religion and Health, although published by Springer, is hardly a mainstream source in the field. The article is from 36 years ago; is it relevant nowadays? BTW, can you insert "causes" after the solely adjectival subtitles in the "Causes" section? They look strange, and I think MoS says titles should usually be nominal groups. Tony (talk) 08:28, 22 October 2008 (UTC)

Thanks, I was trying to keep subheadings as succinct as possible, but agree above improvement sounds good. An opinion on whether a bracketed explanation of delusions and hallucinations (i.e. whether we should have them or not) would be appreciated, as I am torn/on the fence with this one. Cheers, Casliber (talk · contribs) 08:55, 22 October 2008 (UTC)

• Support as contributor. Cosmic Latte (talk) 09:31, 22 October 2008 (UTC)

• Support as a minor contributor. I think it was well-written, and this process is great. I must have read the article 5 times, and I didn't see half the points that have been pointed out. I'm embarrassed that I missed the Alzheimer's EEG issue, since I helped write the Alzheimer's with Garrondo. I'm kicking myself. Anyways, excellent article. OrangeMarlin 14:26, 22 October 2008 (UTC)

• Comment on prose - The prose is rather dull and repetitious. For example, the overuse of "may", which is a weak, vague word, in the Biological causes section:

They may also enhance the levels of two other neurotransmitters, norepinephrine and dopamine.

Norepinephrine may be related to alertness and energy as well as anxiety, attention, and interest in life;

Serotonin may help regulate other neurotransmitter systems,

and decreased serotonin activity may allow these systems to act in unusual and erratic ways

Facets of depression may be emergent properties of this dysregulation

There may be a link between depression and neurogenesis of the hippocampus

Drugs may increase serotonin levels in the brain

This increase may help to restore mood and memor

Depression may also be caused in part by an overactive hypothalamic-pituitary-adrenal axis

Depression may be affected by variations in the circadian rhythm.

Can this be worded better? There is one paragraph in this section that does not contain the word "may", starting with "In the past two decades, research has uncovered multiple limitations of the monoamine theory, and its inadequacy has been criticized within the psychiatric community..." and this paragraph is by far the clearest, most straightforward one in the section. And it does not use the passive voice which improves it. In general, so much use of the passive voice in this section makes for less interesting reading. —Mattisse (Talk) 00:56, 23 October 2008 (UTC)

delldot noted lots of "may"s a while ago and I did a big sweep through; I ddid notice some more but you have pointed out a fair few. The issue is alot of the ideas in the paragraph are not definite but conjectural. Nevertheless, I will do a sweep-through and see if we can "mix up" the prose a little. Cheers, Casliber (talk · contribs) 05:15, 23 October 2008 (UTC)

You can do better that "conjectural", can't you? "The evidence of .... indicates..."; The majority of recent literature supports the theory that..."; "There is evidence to support..."; Studies, including those of so-and-so, support the hypothesis that..." etc. Too tired now but I hope I am conveying the idea. —Mattisse (Talk) 05:57, 23 October 2008 (UTC)

Erm, I should have clarified - I wasn't going to use the word as such in the paragraph. Paul Gene added alot of those sources and he seems to be having a (hopefully temporary) wikibreak. Have to be wary of general "There is evidence.." type statements too, still mixing it up ain't a bad idea. Cheers, Casliber (talk · contribs) 11:51, 23 October 2008 (UTC)

More from delldot ∇.

Some more minor points about the writing:
Diagnosis

• "Postpartum depression, which has incidence rate of 10–15%," among who? Probably among new mothers, but it should be specified. (done)

Treatment

• Too many 'patients' in this sentence: Patients are usually assessed and managed as outpatients, and only admitted to an inpatient mental health unit if they are considered to pose a risk to themselves or others. (dammit, this is a hard one. I have been musing about it for a bit now)

• Maybe "care is usually given on an outpatient basis, but... when there is significant risk..."? Two 'patients' is OK IMO, I just thought three was too much. It's really not a big deal anyway. delldot ∇. 05:02, 27 October 2008 (UTC)

• their overall effect is low-to-moderate. I think this would be low to moderate when you're not using it as an adjective before the noun. (yeah, done)
• If you're looking for material to cut to shorten the article, you could move the discussion on the meta-analyses to another article, e.g. depression research or something. This is probably more detail than the average reader is looking for, is quite technical, and as has been mentioned the article's long. Besides, were these two studies so much more important than the tons of others that have been done that they deserve this prominent mention? I would get rid of the first para under 'Efficacy of medication and psychotherapy' (or leave one sentence of summary) and merge the second into the medication section. (no-one has actually jumped up and down about length this FAC, so right now I am not so fussed, however let's see if I mention it what happens)
• Awkward sentence: Short-term memory loss, disorientation, headache and other adverse effects are common, as are long-term memory and other cognitive deficits, which may persist. changed to "Common initial adverse effects include short-term memory loss, disorientation, headache; long-term memory and other cognitive deficits may persist."

Prognosis

• Do the refs at the end of the para cover the sentence beginning Recurrence occurs in 40–70% ? (they can do, but I didn't enter much of this and I am wondering if a reference was lost or mixed up here. There is no review article for some reason. I will see what I can do) (Actually, that statement duplicated material elsewhere, so I removed it and buffed the sentence two before it.)

Epidemiology

• Researchers who compared epidemiological factors in Canada and the US found the rate of major depression to be twice as high for Americans... Could you just say The rate of major depression is twice as high for Americans... or is the 'researchers' part necessary info? (Upon reading it, yeah, I think it needs a bit of context as it is an interesting stat and maybe kept as qualified - I changed it to " A 2007 study...")
• The epidemiology section could use better organization, it kind of skips around. e.g. Depressive episodes following a heart attack might even correspond with an increased risk of further cardiac complications, including death. and Depressed people also have a higher rate of dying from other causes. could be grouped together as similar concepts. First and third paras both mention gender, and the first and last paras discuss morbidity and disease burden respectively. (reorganised so first para is more prevalence and incidence/age etc, second is more social, 3rd is suicide related. Much of this section was moved from elsewhere late in the peace)

Refs

• There are (were) several links to articles you have to pay to get--I think the consensus is to remove these and link only the abstracts (if there's no PMID, you can link to the abstract like this: "Melancholia: A Historical Review" (abstract). I took out the ones I saw, but can you check the links to make sure the rest are accessible? I didn't take this one out because a lot of people might be able to access it. (NYtimes is free to register I think) (I have checked up to ref 131 but I need to sleep now, more later all good now, removed a couple more. There are some duplicate abstracts still)

Keep up the good work. delldot ∇. 05:03, 25 October 2008 (UTC)

Support. A tough subject, thoroughly handled. It is not an easy read, partly due to the subject matter, but also the prose is quite demanding of the general reader. I couldn't get past the Causes section the first time I tried to read this. A few points:

• "In such cases, clients may be especially unaffected by therapeutic intervention" The word "clients" is inappropriate here. (yep; changed to "patients")
• The quotation beginning "a profoundly painful dejection" isn't verbatim. The quotation beginning "In mourning 'it is the world..." contains single quotes that aren't in the source.
• Lithium isn't wikilinked. (wikilinked now to Lithium#Medical_use)
• The Efficacy subsection has a number of problems.

• The "Two recent meta-analyses" suffers from WP:DATED and should state it looked at SSRIs. It can then be noted that this compares against the older tricyclic imipramine.
• The "Despite obtaining similar results, the authors argued about their interpretation. One author concluded that.. The other author agreed that..He pointed out that" has problems because both meta analyses are multi-author papers and the comments attributed to the second "author" came from a later editorial by two of the five authors of the second meta-analysis. The reader wouldn't be interested in the opinion of (apparently) just two people here. It looks like the statement (which you quote) about "seems little evidence to support" has provoked discussion and is worth citing and attributing to the authors of the first study. My guess is the editorial was just one example of the debate that followed and so that debate should probably be described differently to how it is here. In particular, the glass half empty quote is pretty meaningless and remains so even when you know why glasses are mentioned.
• What isn't clear to the reader (until they get to Prognosis) is what is meant by "improvement" wrt treating depression. With most diseases, folk want to be cured, and might regard treatment as making someone no longer depressed. But it looks like improvment can be regarded as being just a little bit less depressed, and the editorial focussed on how much less depressed is needed in order to judge clinical significance.
• The terms "clinically significant" and "effect size" aren't defined wrt these treatments.
• I'm not sure "their overall effect is low to moderate" is justified by the sources. I may be wrong but it looks more like "non-existent to low".
• It is quite disconcernting to read the Psychotherapy and Medication sections and the discussion of X is "effective" and Y is "effective" and then discover the effect is minimal when you get to the "Efficacy" section. The spat between the two "authors" seems like "A: Drugs are a bit rubbish. B: Depends what you mean by rubbish. Oh and psychotherapy isn't any better."

Colin° 23:51, 27 October 2008 (UTC)

The more I look at the section - Major_depressive_disorder#Efficacy_of_medication_and_psychotherapy - the more I am unsure if its presence actually benefits the article. There are a whole heap of issues regarding antidepressants used in studies - higher effects due to nonpublication of negative results, and lower effects due to differing populations used (eg nonsuicidal patients in trials, whereas a large number do in clinical practice do (which suggests the population we treat are more severe anyway, and many have been depressed alot longer than those entering trials. Looking at it, it needs more material on studies of depressed people etc. to help the reader understand the results, and as it is, it may be too much depth for this general article, and better placed in Treatment for depression, where it can be done justice, with the section reduced to a couple of lines and added to Treatment section (at bottom). What do you reckon, or do you reckon the studies were too important not to be at least discussed here. Cheers, Casliber (talk · contribs) 09:22, 29 October 2008 (UTC)

Whoa! Thanks for the support vote, I will see what I can do. You are welcome to substitute any plainer english word for more technical one without loss of meaning. I do sometimes forget which words are more jargony than others, being 'in the field' and all... :) Cheers, Casliber (talk · contribs) 01:42, 28 October 2008 (UTC)

Image review - There are serious problems with the images in this article:

• Image concerns have now been resolved. Awadewit (talk) 20:27, 29 October 2008 (UTC)

• Image:Synapse Illustration2 tweaked.svg - The image description needs to list the source for the information contained in the image itself.

• I don't know where the image's creator got the info, although it's fairly common knowledge--anyway I added a source that contains the information. Cosmic Latte (talk) 15:46, 29 October 2008 (UTC)

• Image:Sigmund Freud-loc.jpg - "No known restrictions" is not the same as the public domain. You must establish that this image is in the public domain in some way. I am thinking that "copyright not renewed" might be the only way, but that is difficult.

• image is not absolutely central, we only got it as we thought it was PD, so removed

• Image:Albert Ellis 2003 emocionalmente sentado.jpg - We need proof that the copyright owner released this image - I am thinking an OTRS ticket might be required.

• I have commented out ellis image for the moment until OTRS can be done. Cheers, Casliber (talk · contribs) 08:33, 29 October 2008 (UTC)

• Image:Lavater1.jpg - We need the full publication information for the book from which this image came - who published it and where? Were there multiple editions? Also, was the image scanned directly from the book or is this from a website? The commons bot has erased the source information, sadly.

Now I have looked at Public Domain - it is an old drawing from a book published 1775-1778 (Physiognomische Fragmente zur Beförderung der Menschenkenntnis und Menschenliebe), and I can pretty well guarantee the orginal uploader must have had a newer reproduction of the image, but even if newer, isn't it clear that it was first published 330 years ago? I guess I should brush up on these, as I am not so crash hot as we always get free images for bird articles. Cheers, Casliber (talk · contribs) 12:43, 29 October 2008 (UTC)

Image:LavaterHollowayFaces.png - I have uploaded a copy from the English translation with all of the appropriate information. Clearly this is not as good as the original version, but until we can obtain all of the information for the German version, etc., will this suffice? Awadewit (talk) 15:27, 29 October 2008 (UTC)

Fantastic, thankyou very much. I was/am quite fond of the illustration (audible sigh of relief) Cheers, Casliber (talk · contribs) 20:14, 29 October 2008 (UTC)

• Image:Emil Kraepelin.png - There is no source, date, or photographer for this image. The license cannot be verified.

• removed, we'll find some free images, wasn't absolutely central anyway. Cheers, Casliber (talk · contribs) 09:06, 29 October 2008 (UTC)

• Image:Wm james.jpg - There is no source, date, or photographer for this image. The license cannot be verified.

• removed, we'll find some free images, wasn't absolutely central anyway. Cheers, Casliber (talk · contribs) 09:06, 29 October 2008 (UTC)

Sorry to be the bearer of bad tidings! Awadewit (talk) 13:39, 28 October 2008 (UTC)

Fair enough, you gotta do what you gotta do. The synapse one I can find a source for the information (and is probably the most important of those listed). Others are not so, but will see what I can do. I am a little bit tied up till November 1 but will have a look around. Cheers, Casliber (talk · contribs) 03:41, 29 October 2008 (UTC)

As much as I hated to do it, I've removed the unsourced James and Kreapelin images. The caption for the James image contained information that wasn't in the text, so I rephrased it slightly and added it to the text. I suppose that, in the future, one or more of us could add properly sourced images of these folks to the Commons. Cosmic Latte (talk) 09:03, 29 October 2008 (UTC)

Please let me strike my own comments per WP:TALK - thanks! It helps me keep things organized! Awadewit (talk) 12:07, 29 October 2008 (UTC)

OK, sorry about that. I will look for some images I can guarantee are in the public domain or otherwise get permission from copyright holder. I am not too fussed though. Cheers, Casliber (talk · contribs) 12:33, 29 October 2008 (UTC)

• Comment - I have been making multiple changes in parts I found a little inaccurate. I hope you don't mind. One suggestion I have is changing the paragraph order in Diagnosis > Clinical assessment. In the U.S., the first point of patient contact could be a general practitioner, psychologist, or other mental health professional who would conduct an assessment. A general pracitioner might prescribe antidepressants without referral to a psychiatrist. A psychiatrist would typically prescribe medication without a medical assessment as described a doctor would do. A psychologist, in those states where psychologists do not have prescribing privileges, would refer to a psychiatrist if a need for a medication assessment were deemed necessary. Without getting into all of this, I would suggest switching the first two paragraphs in the Clinical assessment section, as the complete assessment by a doctor is usually not the first step, in the U.S. at least. —Mattisse (Talk) 19:33, 29 October 2008 (UTC)

I have kept an eye on the changes and have been happy thus far - the two paragraphs currently underneath Clinical assessment to me are interchangeable - there is a valid case for either of them coming first. The more I think about it, Oz and the UK are not too different, as we can be alerted by social workers, etc. as well as GPs. Cheers, Casliber (talk · contribs) 20:14, 29 October 2008 (UTC)

• Question - I am wondering about the accuracy of this statement: "The Beck Depression Inventory, is one of the most widely used tools in the diagnosis of depression,". Are you saying in the U.S. or where? —Mattisse (Talk) 01:43, 30 October 2008 (UTC)

• WP:ITALICS check, why are any of those tools in italics?

• The Beck Depression Inventory is one of the most widely used tools in the diagnosis of depression, although its main purpose is not diagnosis, but determining the presence and severity of symptoms. ... Other scales commonly used include the Geriatric Depression Scale in older populations, which is also valid in patients with mild to moderate dementia; the Hamilton Depression Rating Scale (HRSD-21) designed by psychiatrist Max Hamilton in 1960; and the Montgomery-Åsberg Depression Rating Scale (MADRS).

• SandyGeorgia (Talk) 01:48, 30 October 2008 (UTC)

I don't think naming all these rating scales, many of which I have never heard of, adds to the article, especially since the Rating scales section starts out by saying that evidence indicates rating scales are ineffective as diagnostic instruments for depression anyway. —Mattisse (Talk) 01:57, 30 October 2008 (UTC)

OK, the Beck and Hamilton (and to a lesser extent the other two) are highly notable and often-quoted. I even saw the Beck (BDI) parodied as 'beady-eye' in a comic skit by English comedian Jo Brand. The Hamilton has been the most widely used for about 30 years but I don't have a ref for it (got a ref saying it was the most widley used in the 80s and not been able to find a more recent one). I wasn't sure about italics or not, I guess I saw them as a "work" of some sort, and used the italics for emphasis mor than anything else as well. I think rewording Beck to "widely used" is better. Cheers, Casliber (talk · contribs) 02:04, 30 October 2008 (UTC)

PS: They are the four most notable (by far) out of a large number of raiting scales, so my feeling was/is providing a note on them is good. Cheers, Casliber (talk · contribs) 02:06, 30 October 2008 (UTC)

O.K. The Beck of course for historical reasons and because it is frequently used in research and because Beck is an important figure in depression research. And perhaps one or two others. But I question the statement for the rating scale "which is also valid in patients with mild to moderate dementia"; it has only a 1988 journal reference. I would like to see more than that one journal article. And two of the references in that section have invalid pmid numbers. Not to be hard on you. Sorry to freak out over rating scales! —Mattisse (Talk) 02:26, 30 October 2008 (UTC)

The PMIDs are good, there is something wrong with PubMed right now (or our template, I'm not sure yet). SandyGeorgia (Talk) 02:30, 30 October 2008 (UTC)

This ref is probably very interesting: review article by Katz on the diagnosis of depression in dementia: it specifically talks about the GDS and the Hamilton scales and their good realiability. I have only read the abstract, but it may be enouth to address Mattisse doubts. Diagnosis and treatment of depression in patients with Alzheimer's disease and other dementias. PMID: 9720486.--Garrondo (talk) 08:59, 30 October 2008 (UTC)

Back to my original Question: I am wondering about the accuracy of this statement: "The Beck Depression Inventory, is one of the most widely used tools in the diagnosis of depression". The reference at the end of the sentence does not address the use of how widely it is used. Are you saying in the U.S. or where? There are so many general statements in this article that do not specify what country you are talking about. Regarding the rating scales, are you saying worldwide "The Beck Depression Inventory, is one of the most widely used tools in the diagnosis of depression"? What about the other scales? I think you should specify where these instruments are being used. One reference you gave stated the U.K. decided not to use them as they were not cost effective. What are the dates of these sources on rating scales? Many of the references to rating scales go back to the 1960s. The latest for the Hamilton Depression Rating Scale seems to be 1980. —Mattisse (Talk) 14:51, 30 October 2008 (UTC)

The reason why they are so old is becouse the ref provided is for the original publication of the questionnaire, as it is common to cite in medical journals; which does not mean that an additional review article on them could be of use.--Garrondo (talk) 15:21, 30 October 2008 (UTC)

Per WP:V, primary sources should be used sparingly. When you want to refer to seminal primary sources or original publications, they can be worked into the text by referring both to the original source and a secondary review of that source, as in this sample sentence from Tourette syndrome: A 1998 study published by Leckman et al of the Yale Child Study Center showed that the ages of highest tic severity are eight to twelve (average ten), with tics steadily declining for most patients as they pass through adolescence. The statement is sourced to a secondary source review, but refers back to the primary source. In this case, the primary source is included only because it was seminal research that altered the landscape of TS research and understanding. See WP:MEDRS and Misplaced Pages:Misplaced Pages Signpost/2008-06-30/Dispatches. SandyGeorgia (Talk) 19:01, 30 October 2008 (UTC)

I have finally added the Katz review to the article; I have also found this article, which says that 3 of the most common questionnaries are those of Hamilton, Beck and Montgomery: Measuring depression: comparison and integration of three scales in the GENDEP study. PMID: 17922940 .--Garrondo (talk) 15:48, 30 October 2008 (UTC)

• Montgomery-Åsberg Depression Rating Scale (MADRS) needs a better reference than a 1979 study on a sample of British and Swedish subjects. —Mattisse (Talk) 16:15, 30 October 2008 (UTC)

That is the original article, the very first primary source, where the questionnaire is explained. What else do you need? (My question is not ironic, I really want to know what other kind of ref are you looking for; since for any scientific journal that ref would be enough)--Garrondo (talk) 16:27, 30 October 2008 (UTC)

See WP:MEDRS per SandyGeorgia's comment above. —Mattisse (Talk) 19:10, 30 October 2008 (UTC)

Would these one be enough?:A review of studies of the Montgomery-Asberg Depression Rating Scale in controls: implications for the definition of remission in treatment studies of depression PMID: 15101563. I quote The Montgomery-Asberg Depression Rating Scale (MADRS) is one of the most commonly used symptom severity scales to evaluate the efficacy of antidepressant treatment. Similarly for the Hamilton scale: Rating scales in depression: limitations and pitfalls PMID: 16889106. Quote: Since the introduction of antidepressants to psychopharmacology in the 1960s, the Hamilton Depression Rating Scale (HAM-D) has been the most frequently used rating scale for depression. I could post both of them, and even look for similar articles for the others questionnaires, but I really think they are not really needed. What do you think Mattisse? --Garrondo (talk) 16:36, 30 October 2008 (UTC)

Yes. A huge improvement over the 1979 study currently referenced. However, the statement in the article should clarify its use in research and not only as a "screening tool", as it is under the section "Diagnosis" and so may be misleading to the general reader. The reference you propose is to a research study where it is used as an outcome measure.

This Major depression article does not explain that in the typical research methodology for drug efficacy studies, these rating scales are used as a primary outcome measure. Also, the article abstract cautions, "A limitation of the review is that none of the studies was based on a randomly selected sample from the general population. In addition, the rigor of the screening used to exclude individuals with psychopathology in most studies is unknown; thus, some of the controls may have had diagnosable depression, thereby elevating the mean scores in the presumptively healthy control group." So is this appropriate in the "Diagnosis" section? —Mattisse (Talk) 17:14, 30 October 2008 (UTC)

Their aim is to look for cut-off points for the questionnaire: defining the healthy controls answers to the questionnaire a cut-off point to diagnose an abnormal response can be found, so of course it should be in diagnosis.As I said I believe that wikipedia is asking here more than any peer-revied journal, and the ref provided should be more than enough to point out that the quesionnaire is widely used.--Garrondo (talk) 17:32, 30 October 2008 (UTC)

If you are referring to 15101563, their "aim" was not to look for cut-off points for the questionnaire by defining a cut-off point in the healthy controls' answers to the questionnaire to diagnose an abnormal response. That was one of their methods in the study: to determine the normal range of values on the scale so they could evaluate the efficacy of antidepressant treatment. The purpose was never to "diagnosis". The only time diagnose is mentioned in the abstract is in referring to the methodological problems in the study: "In addition, the rigor of the screening used to exclude individuals with psychopathology in most studies is unknown; thus, some of the controls may have had diagnosable depression, thereby elevating the mean scores in the presumptively healthy control group."

In addition, see the MoS guideline in Manual of Style (medicine-related article) - Citing medical sources and the content guideline in Reliable sources (medicine-related article) Definitions. In the latter it states: "In general, Misplaced Pages's medical articles should be based upon published, reliable secondary sources whenever possible. Reliable primary sources can add greatly to a medical article, but must be used with care because of the potential for misuse. For that reason, edits that rely on primary sources should only make descriptive claims that can be checked by anyone without specialist knowledge. Where primary sources are cited, they should be presented in a manner which hews closely to the interpretation given by the authors or by published, reliable secondary sources. Primary sources should not be cited in support of a conclusion which is not clearly adduced by the authors or by reliable secondary sources..." —Mattisse (Talk) 18:50, 30 October 2008 (UTC)

Thaks for the non-asked for little speech...I have been writting medicine articles for two years, and I almost know MEDMOS word by word...Nevertheless Casliber has added a few refs that should fullfill your requirements regarding the questionnaires.--Garrondo (talk) 18:46, 31 October 2008 (UTC)

• Comment Tony noted above his concerns about this statement: "A depressive episode may also be triggered by a loss of religious faith." Tony specifies his concerns: "I think this is oddly prominent in the rather short lead para to the section 'Psychological', and the Journal of Religion and Health, although published by Springer, is hardly a mainstream source in the field. The article is from 36 years ago; is it relevant nowadays?"

This statement noted by Tony as being from a questionable source is still in the article. I am concerned also that many of the sources in this article similarly are very old and/or reference a single study. I am trying to correct some of them, where the sources are accessible, to clarify the meaning in the article in the context of the reference. —Mattisse (Talk) 14:51, 30 October 2008 (UTC)

I don't see why a loss of religious faith would be any less depressing now than it was 36 years ago, at least in individuals for whom faith had been their primary source of meaning. I do wonder which is more often the cause and which more often the effect (e.g., I can picture something like, X --> MDD --> blame/doubt God --> lose religious faith), but if "lose religious faith --> MDD" is sourced, then it at least jives with what I'd call common sense or intuition. Cosmic Latte (talk) 15:07, 30 October 2008 (UTC)

The point is not what you or I think now, but rather that the reference to a statement given prominence in the section is from one questionable source, the Journal of Religion and Health, and is 36 years old. —Mattisse (Talk) 15:18, 30 October 2008 (UTC)

It looks like the journal is still taken reasonably seriously, e.g., , , . In any event, my point was that there is no reason to assume that the veracity of the referenced finding has changed in the past 36 years. Questioning the finding on account of its age raises the question, "why?"--and I, for one, don't see a reason why the finding would be dated. And as it's worded now, "A depressive episode may also be related to a loss of religious faith," without implying cause or effect, and placed after other components of MDD and directly before a statement that cause and effect are unclear, I certainly don't think it's being given any undue prominence. Cosmic Latte (talk) 15:34, 30 October 2008 (UTC)

I refer you to Tony's comment that the source is not mainstream in the field. The links you give are not reliable sources as to the mainstream importance of the journal. Further, the text in one of your links says: "The Journal of Religion and Health explores the most contemporary modes of religious thought with particular emphasis on their relevance to current medical and psychological research." Current medical and psychological research is not 36 years ago. In medically-related field, recency counts. References to such statements should be to recent review articles (within the last few years). Further discussion of this should move to the talk page. —Mattisse (Talk) 15:56, 30 October 2008 (UTC)

'Tis where I've moved it (Talk:Major_depressive_disorder#Religious_faith). Cosmic Latte (talk) 16:41, 30 October 2008 (UTC)

• Comment on sources - Primary sources should be used only with caution. See: the MoS guideline in Manual of Style (medicine-related article) - Citing medical sources and the content guideline in Reliable sources (medicine-related article) Definitions. —Mattisse (Talk) 18:50, 30 October 2008 (UTC)

Yeah, I generally try to use reviews etc., if ones are used, I do so with caution. I am not fussed if we remove the religion bit. Cheers, Casliber (talk · contribs) 23:27, 30 October 2008 (UTC)

O.K. Just in the Rating scales section:

"The Beck Depression Inventory is a widely used tool in the diagnosis of depression" - there is no source for this except Beck's original description of the 2nd edition: http://www.cps.nova.edu/~cpphelp/BDI2.html

This reference to the Hamilton Scale is probably a primary source, since its date is 1960: http://www.ncbi.nlm.nih.gov/pubmed/14399272

This reference for the Montgomery-Åsberg Depression Rating Scale (MADRS) is a primary source (http://www.ncbi.nlm.nih.gov/pubmed/444788).

This reference to the PHQ-2 is a primary source ( and its for an alternative self-administration of it: http://www.ncbi.nlm.nih.gov/pubmed/10568646

I believe I have these straight, as the references are confusing. —Mattisse (Talk) 00:42, 31 October 2008 (UTC)

OK, got extra refs for Beck, Hamilton and MADRS, working on others. There is quite a bit online. I just have to hop off the keyboard for a bit as things are busy where I am.Cheers, Casliber (talk · contribs) 02:33, 31 October 2008 (UTC)

I did a whole lot of WP:ITALICS corrections; unclear why italics were used throughout in ways that aren't set out at MoS. Also, the pp parameter on Harvnb's gives a pp. on page ranges (vs p on single pages). And, Diberri doesn't use a p. on journal citations, which are formatted as Volume(number):pages. I standardized it to the Diberri format on journals, and a p. or pp. on books. SandyGeorgia (Talk) 23:46, 30 October 2008 (UTC)

Many were in hte context of Misplaced Pages:ITALICS#Words_as_words, where a word or combination of words was introduced and defined for the first time, so I thought it fell under the auspices of that eg when introducing cognitive beaviour therapy for first time. Again, I have not done this sort of article before here so am not too experienced and if you reckon it doesn't go under this then that is fine with me. Cheers, Casliber (talk · contribs) 00:20, 31 October 2008 (UTC)

I left the "words as words" that conform with Misplaced Pages:ITALICS#Words_as_words; see the examples there. Introducing a term for the first time isn't the same as describing a term, as in: * Deuce means "two". The term panning is derived from panorama, which was coined in 1787. The most common letter in English is e. SandyGeorgia (Talk) 00:25, 31 October 2008 (UTC)

Comment - The religion statement, which you said was O.K. to remove, has been added back with a primary source reference. On the talk page, a review article on the subject was suggested: This review article abstract states its findings: "The majority of well-conducted studies found that higher levels of religious involvement are positively associated with indicators of psychological well-being ... Usually the positive impact of religious involvement on mental health is more robust among people under stressful circumstances (the elderly, and those with disability and medical illness)."

I suggest using this review article as a source, and changing the wording of the statement to be in accord with what the source actually says. The abstract does not mention depression nor the effects of a loss of religious faith. —Mattisse (Talk) 15:54, 31 October 2008 (UTC)

All right, I'll go along with that (although I think that primary material is used cautiously in the article--e.g., I don't see it being synthesized to advance any non-NPOV position--and don't see what harm the religious-alienation bit can do). Cosmic Latte (talk) 21:03, 31 October 2008 (UTC)

• Questions:

• Is this image sourced properly enough to add to the Sociocultural aspects section? "Someone during 19th century" isn't much of an attribution, but "Scanned by Infrogmation from copyright expired US book, 1890s volume 'The World's Great Classics'" looks promising. Cosmic Latte (talk) 18:41, 1 November 2008 (UTC)
• So what's the verdict on the religion issue? If there's consensus among, say, Cas, Mattisse, and Sandy to use the review article instead of the primary material, I'll be fine with that--but my "closing argument," again, is that the current use of primary material doesn't seem even close to being in violation of WP:SYN. Cosmic Latte (talk) 19:09, 1 November 2008 (UTC)

Oppose for now - per too many inaccurate or misleading statements that are not congruent with a professional level article on this subject such as the use of "From a psychoanalytic perspective" - psychoanalysis is not a perspective; it is a theory or body of ideas that is more formal than a "perspective". Also, the quote within a quote in the line: "and a lowering of self-regarding feelings" that is more severe than mourning. "In mourning 'it is the world that has become poor and empty; in it is the ego itself.'". Here, apparently Freud is being quoted in a quotation by someone else in another work.

When used in practice, many theories get mixed and used together, hence "perspective" captures how it is used, however my preference is not strong, as yours appears to be on this one. (therefore changed) I am also not too fussed about the Freud quote, as it seems to be more trouble than its worth Cheers, Casliber (talk · contribs) 20:26, 1 November 2008 (UTC)

(For the following, I am using the "Rating scale" section as an example as I have grown too discouraged to continue beyond it and I am tired of arguing about the misuse of primary sources.)

• Per too many primary sources used in a misleading way. For example, "Milder depression has been associated with what has been called depressive realism, or the "sadder-but-wiser" effect, a view of the world that is relatively undistorted by positive biases, or a more accurate assessment of their own abilities.. The second source is to a primary source study comparing "depressed students" with "nondepressed students" and does not say these students had "Milder depression".

Your edit was wordy and went into possibly more detail than what was warranted. We could probably just lose the second sentence source and all. Cheers, Casliber (talk · contribs) 20:26, 1 November 2008 (UTC)

• Per the inclusion of "rating scales" under "Diagnosis" when even the citations state that Beck's scale, for example, rates the severity of depression and was not designed to "diagnosis".

The primary use of rating scales as an outcome measure for drug studies is not explained. From reference source (http://www.ncbi.nlm.nih.gov/pubmed/12601223) in the rating scale section: "A large number of rating scales has been developed to assess depression severity and change during antidepressant therapy." This source goes on to say: "The most frequently used observer rating scales, the Hamilton Depression Rating Scale (HDRS) and the Montgomery-Asberg Depression Rating Scale (MADRS), and the most frequently used self-rating scale (the Beck Depression Inventory, or BDI) were developed more than 20 years ago. Their historical background is too often forgotten and they are reflections of their origin: the HDRS and the MADRS reflect antidepressant activity while the BDI reflects psychotherapy." Therefore, not only does the section misrepresent the use of rating scales and present them out of context, it misrepresents its sources. It has nothing to do with diagnosis but with antidepressant outcome studies. There is not a reference to backup the statement: "The Beck Depression Inventory is a widely used tool in the diagnosis of depression..." - and does this imply worldwide, in particular countries, or what?

diagnosis of depression changed to assessment of depressive symptoms - didn't see that. That is what they do period. Cheers, Casliber (talk · contribs) 20:26, 1 November 2008 (UTC)

This is why I changed from "most widely to widely" as different sources say Hamilton or Beck. As I am familiar with the subject, in practice they are used as screening or in research, clinicians may use them as an adjunct to a clinicial exam (rarely), but are not used for diagnosis as such in clinical day-to-day practice. Also, the specificity with drugs vs therapy is not that evident when you read. I am trying to keep it simple. Cheers, Casliber (talk · contribs) 20:26, 1 November 2008 (UTC)

• Per Colin's objections to the "Causes" section (even though he registered his support) as the kind of confusion he describes seems to pervade the article. I have cleared up portions of the article, I don't know if Colin has done the same.

Yes, it is a verbally challenging section, and the key is to see what technical words can be replaced by plainer ones without losing meaning. I am too tired to do it further tonight but will have a look at this tomorrow.

• Per the use of generalized, unqualified statements, without specifying to which countries the statements apply. The authors seem to assume that their statements apply to all, when practices in different countries vary. The same generalized, unqualified statements are sourced by references that often greatly qualify the statement by using specific subject sample, methodologies that are faulty, etc.

Erm..what? Can you give an example? Practice in the developed world doesn't vary too much, and practice in the third world is scant, which I hope I made clear. I will do my best to address this but please point out what/where you mean. Cheers, Casliber (talk · contribs) 14:01, 2 November 2008 (UTC)

• The article is slanted toward the Western world, more so than necessary. Perhaps the article should not pretend to be anything other than a British and American perspective.

I have tried to incorporate as much on global issues but it is tricky as much treatment outside first would population centres is meagre at best, a problem across all mental health, so tricky elaborating on issues not specific to major depression. I have tried to highlight differences in both diagnosis and treatment sections (and one mention in signs and symptoms). Cheers, Casliber (talk · contribs) 06:38, 2 November 2008 (UTC)

• Someone needs to go through the article and check the accuracy and relevance to the article of the cited sources, as I have tried to do in a few sections. Judging from my experience, I have little faith of proper referencing all sections of the article. A random check shows that some sections are more accurately referenced than others.

Erm, a look through the history will see alot of detailed reviewing. Specifics are helpful here. The alternate therapies and drugs were gone through especially thoroughly but it is difficult at times trying to explain results within a paradigm of clincial significance, placebo effect etc Cheers, Casliber (talk · contribs) 06:38, 2 November 2008 (UTC)

I hope someone who knows the subject matter can go through the article and check for accuracy and relevancy of the cited sources. I hope that matter of the proper use of primary sources has been clarified, although as the example I gave ubove, even when the improper use is pointed out and attempts made to correct, there seems to be a general reluctance to respect this issue and insure that sources are reflected accurately by the article wording.

Further, I am shocked (naive as I am) that anyone would register a "Support" for this article on an important topic without carefully reading it through.

This article needs to be accurate. There is no reason the problems cannot be fixed. Other than worrying about the format of citations etc., this article has elicited surprisingly few "eyes" to vet it. I would like to see this rectified. —Mattisse (Talk) 19:48, 1 November 2008 (UTC)

• Comment: Although my support !vote remains, I agree with Mattisse that the article has a Western slant to it. It could do well with some more Eastern facts and figures. Cosmic Latte (talk) 20:08, 1 November 2008 (UTC)

• Comment: With this diff, I added information about religiosity from the secondary source that Sandy found. I've left the primary reference in there, but, as per my above statements, I won't protest if one of you would like to remove it. I do, however, wonder if it might be a bit of a challenge to fit in the secoundary source without the context that the primary-referenced material provides. Cosmic Latte (talk) 21:38, 1 November 2008 (UTC)

• Comment

From the introduction: reasons to fail FA, if the rest of the article is written like this.

• "electroconvulsive therapy is used in severe cases" is misleading. I think that this fails to indicate that ECT may be treatment of last resort, after drug medication has failed.

Nope, two exceptions would be (1) a person with clear-cut psychotic depression refusing oral medication and actively suicidal and (2) a person in whom ECT has shown a good response and is (or their family) is requesting it knowing that it has worked more quickly than other methods. Both are severe, neither are last resort, hence the adjective severe

That is obvious. In some people (especially elderly people, I think) ECT may be used, if it has worked well before. But for those who will take medication and most accept medication, ECT is not the first choice in severe depression, and so the introduction is missleading, I think. Snowman (talk) 22:49, 1 November 2008 (UTC)

Ok, what about "electroconvulsive therapy is an option in severe cases."?unsigned by Casliber (talk) 1 November 2008

In would be helpful if you remembered to sign. I do not know why you tried to defend this point. There are simply too many misleading phrases (even for basic points) in the small portions of the article that I have looked at. So to me, it fails FA. Snowman (talk) 23:07, 1 November 2008 (UTC)

Oops on the signing, I am getting a few edit conflicts on this page. I am defending this point because it is right, and your proposal does not capture how it is used. bland statements on failing are likely to be ignored, so focussing on specifics is prudent. Cheers, Casliber (talk · contribs) 23:17, 1 November 2008 (UTC)

I am thinking of an typical reader becoming distressed discovering that ECT is the treatment for severe depression. It should say words to the effect that whenever possible medication is given as the first choice, but sometimes ECT is given when medications fails (or has failed previously). I have found a point that needs correcting, and this is not a bland statement. Snowman (talk) 23:39, 1 November 2008 (UTC)

The text of the article says "ECT is most often used as a last resort treatment by hospital psychiatrists for severe major depression which has not responded to trials of antidepressant or, less often, psychotherapy or supportive interventions". The introduction should say the same. Currently the introduction is missleading and it fails to indicate the correct use of ECT. Snowman (talk) 00:27, 2 November 2008 (UTC)

I have removed "last resort" from body of text; I am not actually sure how it got there in the first place as this section seems to have changed since I looked at it last. The words are not used in the source. Cheers, Casliber (talk · contribs) 03:14, 3 November 2008 (UTC)

• "Hospitalization may be necessary in cases associated with self-neglect or a significant risk of suicide" is too narrow. I think that there are other reasons for admission: social reasons, the effects of delusions, bizarre dangerous behaviour, and many other factors. Snowman (talk) 21:43, 1 November 2008 (UTC)

Ok, I will change to self or others - an admission to hopsital for homelessness as such is for a social not medical reason, and beyond the scope of teh article. Bizarre delusions for the most part are not part of depression. Cheers, Casliber (talk · contribs) 22:11, 1 November 2008 (UTC)

I did not mean purely social reasons. Where there is no one competent at home to do caring, shopping, and so on, the threshold for admission is lower. The presence of the delusions that occur in depression may cause the person to behave dangerously. I think sectioning should be briefly included in the introduction. Snowman (talk) 22:28, 1 November 2008 (UTC)

The idea of a lead is a simple succicnt sumary, hence keeping it simple to harm to self or others which also includes delusions which may cause same (they are uncommon remember). I actually thought joining "hospitalisation" and "necessary" assumed the connotation of involuntary treatment, however if you missed it then I can assume others will to, so will think about how to add. Watch this space.

I think it is very difficult to write a good introduction for a medical article. "keeping it simple" is difficult too. After modifications, this sentence fragment reads a bit better now. Snowman (talk) 23:43, 1 November 2008 (UTC)

From the main text:

• "Those older than 12 years may begin abusing drugs or alcohol, or exhibit disruptive behavior." This sounds like a different diagnosis rather than a simple diagnosis of depression. This is more likely to be found in mixed emotional disorder or a conduct disorder, which is not mentioned or explained. Snowman (talk) 21:56, 1 November 2008 (UTC)

Agree this one is tricky - combined with an atypical presentation of irritability, it is something to keep in mind with children. I was in a mind to remove it but can see its use in remaining. Yes adults use drugs sometimes with dperssion but the diagnosis is more clear-cut there generally. I will read it again and am not fussed whether it stays or goes. Cheers, Casliber (talk · contribs) 22:19, 1 November 2008 (UTC)

Drugs and alcohol in children is usually a conduct disorder, or a mixed disorder. I think that you are talking about a different diagnosis here. When added to disruptive behaviour it would be difficlut not to diagnose a conduct element to it. Behavoural problems are found in depression, but the axis of the symptomolgy in the article appears to be arround conduct disorder. Snowman (talk) 22:49, 1 November 2008 (UTC)

OK, I removed it as it is more general and not specific to this. Cheers, Casliber (talk · contribs) 23:00, 1 November 2008 (UTC)

OK, misleading section has been removed. Snowman (talk) 23:50, 1 November 2008 (UTC)

• "A mental state examination includes an assessment of the person's current mood and an exploration of thought content, in particular thoughts of hopelessness, self-harm or suicide." is too narrow. I think that the diagnostic process would be to look for the general absence of optimistic thoughts or plans, with negative thoughts.

Hang on, covered in "exploration of thought content" and "assessment of the person's current mood"- pessimism nihilism is more succinct than absence of optimism. I will add that word

Nevertheless, it is inadequate here. Snowman (talk) 22:33, 1 November 2008 (UTC)

I thought about it, given that it is a central part of initial assessemnt, I now think elaborating a bit more is a good idea, so changed to broadened to "in particular the presence of themes of hopelessness or pessimism, self-harm or suicide, and an absence of future plans or optimistic thoughts'" Cheers, Casliber (talk · contribs) 23:56, 1 November 2008 (UTC)

You can change "future plans" to "positive plans", as all plans are future. Snowman (talk) 00:10, 2 November 2008 (UTC)

• "Testosterone levels may be used to diagnose hypogonadism, a cause of depression in men." Hormone levels are also important in women, with low hormone levels in menopausal or menopausal women being implicated in depression. Snowman (talk) 22:16, 1 November 2008 (UTC)

I haven't seen that - if I can find it in a review article on depression I will add it. Have you a reference? Cheers, Casliber (talk · contribs) 22:27, 1 November 2008 (UTC)

It may be under endocrinology or gynaecology. Snowman (talk) 22:33, 1 November 2008 (UTC)

I have seen some bits and pieces online, and alot of vagueness, and studies here and there. Personally I do believe the field is underresearched and gender may have something to do with it, also a very difficult area to study as childbearing and menopause are such big events with huge psychological implications it is very hard to tease out what is biological. I will ask a few colleagues, very tricky as I'd rather a review article here. It certainly hasn't been on the radar in summaries I have read thus far (but they were written by men :p) Cheers, Casliber (talk · contribs) 23:51, 1 November 2008 (UTC)

I recall, when HRT was in fashion, the presence of depression is an indication for giving oestrogens in a higher dose, as the depression does not respond with lower doses. Snowman (talk) 23:55, 1 November 2008 (UTC)

OK, upon thinking about it, while I emotionally agree - depression relateed to female hormones does not crop up on consensus statements in the field, though experts admit more reseach is needed. Misplaced Pages is here to report a subject, not reseach or change importance, I have looked at alotta depression material and not seen it, so the onus is on you to provide a resonably review-type article snowman. Cheers, Casliber (talk · contribs) 01:57, 2 November 2008 (UTC) Actually, there may be some material to incorporate after all, see Talk:Major_depressive_disorder#Biopsychosocial_developmental_perspective Cheers, Casliber (talk · contribs) 12:53, 3 November 2008 (UTC)

• Re:Hang on, covered in "exploration of thought content" and "assessment of the person's current mood"- pessimism nihilism is more succinct than absence of optimism. I will add that word

When have you ever seen "nihilism" in a diagnostic manual? Looks up those two words in an dictionary. Nihilism is not a more succinct form of "absence of optimism" or "pessimism". —Mattisse (Talk) 22:38, 1 November 2008 (UTC)

OK, was hasty in editing above - ok pessimism as nihilism too esoteric and latter word is more synonymous with hopelssness which is already mentioned. Cheers, Casliber (talk · contribs) 22:50, 1 November 2008 (UTC)

• "This includes a complete history of the person's current circumstances." Does this mean a complete account of the patient's current circumstances. How can it be history if it is current? Snowman (talk) 00:16, 2 November 2008 (UTC)

In medicine, taking a history is slightly different to the lay defnition, it means taking a person's history up to and including the present. Cheers, Casliber (talk · contribs) 00:29, 2 November 2008 (UTC)

In the English language one finds out about the patient's current circumstances and discover if they live in a flat or a house, and who they live with, and so on. It is possible to take a history of how the circumstances arose, but not a history of the circumstances. Snowman (talk) 00:41, 2 November 2008 (UTC)

Not in a medical (or psychiatric) history, that is why it is bluelinked Snowman - are you a doctor or do you work in health? Cheers, Casliber (talk · contribs) 01:41, 2 November 2008 (UTC)

Er...yeah, strange objection, Snowman. Please see medical history. Cosmic Latte (talk) 02:49, 2 November 2008 (UTC)

The "medical history" page says the clinician then documents the social circumstances of the patient, which sounds correct. Gelder, Gath, Mayou, and Cowen's book "Oxford textbook of Psychiatry. 3rd edition. p. 31. ISBN: 0192625012 says: Present circumstances: questions about housing finances, and the composition of the household help the interviewer to understand the patients circumstances. There is no awkward grammar here. Snowman (talk) 03:00, 2 November 2008 (UTC)Snowman

Yes, a medical history takes into account "present circumstances." So I take it that you've answered your own question, "How can it be history if it is current?" to your satisfaction? Cosmic Latte (talk) 03:14, 2 November 2008 (UTC)

But the article just says "complete history" and not "medical history", and I do not think it would be easier to read if is said "medical history". The article should make it as easy to read as possible and this is awkward wording, which my book and the "medial history" page avoids. Snowman (talk) 03:21, 2 November 2008 (UTC)

The article doesn't say "complete history"; it says "complete history." There is a difference: As Casliber pointed out, the latter contains a wikilink, and wikilinks exist to help us avoid the very sort of confusion that you're talking about. If the word "history" seems unclear in that context, then click on it, and it'll suddenly become clear. Anywho, how do you propose that it be worded? Cosmic Latte (talk) 03:28, 2 November 2008 (UTC)

Erm, a doctor takes a history, and tehn documents circumstances etc. I suppose one could call it an 'interview' but we don't, we call it a 'history', plain and simple. I will ask at the medical page. Cheers, Casliber (talk · contribs) 06:28, 2 November 2008 (UTC)

Well, Gelder, Gath, Mayou, and Cowen's book "Oxford textbook of Psychiatry. 3rd edition. p. 25. ISBN: 0192625012 has a section headed "The diagnostic interview", in a chapter called "Interviewing, clinical examination, and record keeping." In the UK the term "clerking the patient" is often used which includes taking the history and collecting information, as well as the examination. I also think that taking a collateral history from someone who knows the patient is significant enough to be mentioned in the article. I do not know why you and another editor of the article are deffending awkward grammar in the line "taking a complete history of the circumstances". It reads the same with or without wikilinks. Also, the word "complete" may not be appropriate, as I would have thought that any history taking process needs to be somewhat selective owing to time constraints. Snowman (talk) 10:20, 2 November 2008 (UTC)

I agree with Snowman, it looks strange. The link does not make a difference, it should be just as understandable to someone who is reading a print-out. This is similar to what is described as "easter egg" links at WP:MOSLINK. How about something like "This includes a record of the person's circumstances..."? /skagedal 09:38, 3 November 2008 (UTC)

(outdent) - ok, I see a possibility, "record" is a good choice and one I hadn't thought of, and I have used it as a verb, ".. will record the person's current circumstances, biographical history and current symptoms, and a family medical history to see if other family members have suffered from a mood disorder, and discuss the person's alcohol and drug use." This also reduces one "history", as I see we had three in a row. Cheers, Casliber (talk · contribs) 10:25, 3 November 2008 (UTC)

• Oppose: there seems to be inaccuracies and misleading wording almost everywhere I look. This is a terrible flaw for a medical article for which it must fail FA, in my opinion. Snowman (talk) 00:41, 2 November 2008 (UTC)

I will try to do what I can point by point, but what I meant about "bland statement" above was meant to refer to this, making hyperbolic statements and generalisations, especially after you were unhappy with the name change could be seen as pointy and hence ignored in an effort to gain consensus. Cheers, Casliber (talk · contribs) 01:41, 2 November 2008 (UTC)

I would have liked to have found a first class article, and if it was a first class article, I would say so. I do not know why you dismiss my comments as bland, expecially, as I seem to share the same sort of concerns as those of User:Mattisse, and I have pointed out multiple problems being as objective as I can. Quite frankly, I think the section about disruptive children with depression going on drugs and alcohol was out of context at best and nonsense and misleading at worst, without mentioning a conduct disorder or mixed disorder element, and I am glad that you have removed it. I would have liked to help with the page more over the months, but when I was editing this page several months ago, I found it difficult to get anything done as my all my edits were reverted, and it subsequently took me many edits on the talk page before I could get any agreement from the maim editors to get a few steps forward. I guess that other new editors to the page would have also found it difficult to get anything done on the page. It is a difficult complex article, and being a medical article it should not be missleading. Perhaps it should have gone to GA, where more people could have objectively made comments on it. I do not think I will watch this page, and I do not plan to edit this page for a while. Nevertheless, my oppose decision is made for good reasons based on the current state of the article. Snowman (talk) 02:33, 2 November 2008 (UTC)

Snowman, I am sorry that you were reverted by someone, and it is very hard to please everyone on such a big, complciated article. You pointed out some other material which is good to work on above but you were wrong about ECT as a last resort, you have an interpretation about medical history that no-one else hasa problem with, so sorry, but I don't have faith that what you see as misleading is what other people see. So, you need to list items you see as misleading for them to be improved. Cheers, Casliber (talk · contribs) 06:44, 2 November 2008 (UTC)

1. Well, the article says "ECT is most often used as a last resort treatment by hospital psychiatrists for severe major depression which has not responded to trials of antidepressant or, less often, psychotherapy or supportive interventions", which seems to me to support what I am saying about the introduction giving the wrong impression. Snowman (talk) 10:20, 2 November 2008 (UTC)

2. I may not be right every time I raise a concern about the article for discussion, and I welcome learning points; nevertheless, I have found many points that needed amending in a short space of time in the sections of the article that I have quickly looked at, and I think that the article needs more reviewers and copyeditors, and it is not ready for FA at this juncture. Snowman (talk) 10:20, 2 November 2008 (UTC)

Comment - Snowman's comment directly above ("the article needs more reviewers and copyeditors, and it is not ready for FA at this juncture") is my view also. I found so many inaccurate points in just the small parts of the article I addressed that I am not confident of the accuracy of the remainder. I also agree with him that simple wording is often misleading and sometimes a few more words are needed for accuracy, rather than dismissing such as "wordiness".

I made 85 edits (according to the edit counter) in the last few days trying to correct inaccuracies in a small portion of the article. But now I am not confident in my edits, as when they were made I was working under the assumption that the article was basically factually accurate. Now I see the article as permeated with inaccurate wording.

Making constructive suggestions here takes a great deal of effort. Many of the responses to suggestions made for changes in the article further my feeling that some editors and supporters of this article are not well informed about the subject. I have grown tired of the arguments on this page, where the essence of my comments have often not been addressed.

For example, my repeated question has been ignored or followed by complaints about italics: where is reference that the Beck is the most widely used rating scale. I add, is it used for "diagnosis" or a measure in drug outcome studies? And if it is primarily used as an outcome measure, as it is in my experience, why is it under "Diagnosis"? If the editor can use as his evidence "I am familiar with the subject" for the claim that the Beck is widely used, then why can I not use my "experience" to say, maybe, but not for diagnosis.

Another example is my repeated concerns urging discretion in the use of primary sources, which at that point were ignored by the article editors, and was responded to with the comment, "Thaks for the non-asked for little speech" by an editor supporting the use of primary sources as the first resort.

It is also discouraging that the "Supports" come from co-editors of the article, or are accompanied by comments like "VERY IMPRESSIVE ARTICLE", or "although I must disclose that I copy-edited the lead and first one or two sections last month". (I will note also, the complaint made by this editor in his "Support" were not addressed until I repeatedly made a big deal out of it.) This article is not being taken seriously. I am glad that the images and citations and italics are correct. In my view it is more important that the article content is accurate.

Sorry, but the resistance to attempts to improve this article makes continued involvement no longer worth my effort. —Mattisse (Talk) 15:43, 2 November 2008 (UTC)

I changed the issues concerning Beck Depression scale in the article already WRT "most widely" to "widely" and the mention of diagnosis; they were good pickups. I will try to work on the prose. The "Now I see the article as permeated with inaccurate wording" is a big call without supplying examples - different sections have had different inputs. Agree the article content needs to be correct. Many of those who have commented have been involved in fairly lengthy and through discussion and criticism on the article's talk page as it has evolved. I have left notes at other places now on WP where people with some knowledge of the material may get involved. Cheers, Casliber (talk · contribs) 00:58, 3 November 2008 (UTC)

• I support making Major depressive disorder a featured article. Great work! Best, --A Nobody 16:41, 3 November 2008 (UTC)

• Additional comment: The introduction has benefited from more than a dozen modifying edits today by a number of editors, with revealed a number of misleading sections, badly written sections, and omissions: there were two inconsistent different definitions of "depression" - one in the first paragraph and a different one in the third paragraph; that patients were given antidepressant medication was not included; there were significant changes in emphasis - such as from "often" to "generally"; difficult to read sections were made easier to read; extra wikilinks were added; information was prioritised and reorganised; an seemingly unnecessary mention to an Australian physician was taken out. Every one of the former four paragraphs in the introduction were modified. I do not know what "change in diagnostic standards" was meant to mean or imply. I guess that the examination that the introduction has had today gives yet more examples of the inaccurate wording that seems to me to be nearly everywhere I look in the article, and I think that the "support" given much earlier by the editors of this article in this review above can be disregarded. I think the introduction is worthy now, although not perfect. I hope the rest of the article can be carefully copy edited, and I am sure a collective wish to get to FA is out there. It is not one of my priorities to copy edit the entire article. I am not watching this page. Snowman (talk) 16:55, 3 November 2008 (UTC)

• Actually, there have been 48 edits to the article today as of now. —Mattisse (Talk) 19:54, 3 November 2008 (UTC)

I do agree the intro flows much nicer now with the paragraphs, though I am unsure we need to specify that ECT is done under GA particularly. I only removed the "overdiagnosis" segment temporarily as it didn't fit in with the flow and it is a hard statement to phrase exactly - previous discussion on the topic had left it as best attributed to a specific authority, as it is definitely not a universal opinion, though widely discussed. A vast proportion of material is still the same Cheers, Casliber (talk · contribs) 22:34, 3 November 2008 (UTC)

• Followup comment - Note that the issues I complained about above have not been addressed. As stated above, I have only examined a small part of the article for accuracy in wording and sources. There is no point in doing more, given the lack of responses that actually address issues I raised. Given this, I remain skeptical about the accuracy of the rest of the article.

To Mattise - We're getting there, there is no need to repeat yourself. Keeping comments brief, constructive and to the point is appreciated. I come here in my own free time to edit as I enjoy it - I do not enjoy being subjected to reams of self-righteous invective and feeling like I am being held to ransom. I am trying; it is a big article and there is alot to cover. I am sorry you were reverted which set you off like this, and I am sorry your comments were interspersed above. I think that casting aspersions on other established editors as lazy at best and dishonest at worst is bordering on a personal attack. I advise you to keep comments short, constructive and to the point and avoid making assumptions about others. Lengthy rants have the appearance of filibustering to disrupt this to make a point, I hope that is not the case. I welcome your constructive feedback and will try to work to address concerns. Cheers, Casliber (talk · contribs) 22:34, 3 November 2008 (UTC)

• Apology - I am sorry. I only repeated myself because I have asked many times and these issues were never addressed and I felt like they were being skipped over and the topic changed. I am sorry that you interpret my comments as " reams of self-righteous invective". I regret that you interpret my comments as "casting aspersions on other established editors as lazy at best and dishonest at worst is bordering on a personal attack". I get your hint and will not comment any more on the article. This has been an unpleasant experience for me also, and I am sorry if I let my frustration show. I wish you the best tn this endeavor. I guess I got too caught up in the subject matter. Again, I apologize. Regards, —Mattisse (Talk) 23:23, 3 November 2008 (UTC)

• thanks for that - (sigh of relief) I know this is an important topic to get right and I have generally kept awya from articles liek this as it becomes not-fun very quickly, but I do think I have something to offer in hauling this one to featured status. I don't want you to leave completely, the points you hav raised have been very valid, but as you can see with an article of this size and breadth, it is a huge task, and my time is limited, furthermore where I am at the moment ther computer is loading WP pages very slowly, which makes rapid editing of large articles problematic. As long as people strike objections when done and keep it brief the page is quite manageable. It is tricky when there are a plethora of sources out there. Snowman's contributions are important as I realise just about everyone till now who has commented is pretty familiar with biological and medical material, hence limiting our ability to make it accessible to broader population. We are getting there. Cheers, Casliber (talk · contribs) 23:56, 3 November 2008 (UTC)

To both Mattisse and Snowman - I will attempt to go through specific issues raised on this list for as long as the FAC remains open. If it closes then so be it. If you choose not to participate, that is your business and I am sure the closer will look at the situation/consensus once time is reached. Your call Cheers, Casliber (talk · contribs) 22:34, 3 November 2008 (UTC)

• "The Beck Depression Inventory is a widely used tool in the diagnosis of depression" - where is the reference to this other than your experience? Are you talking about worldwide or your country or what? You only say, "As I am familiar with the subject..."
• My complaint has not been remedied regarding the placement of the statement on religion, which echoes the objection of User:Tony1 (" A depressive episode may also be triggered by a loss of religious faith." I think this is oddly prominent in the rather short lead para to the section "Psychological",) and User:Delldot's statement (I think it is his - hard to tell with all the interruptions and diversions) objecting to the inclusion of the religious statement in the first paragraph of "Psychological causes". To quote User:Delldot (or whomever) "A depressive episode may also be triggered by a loss of religious faith. - non-sequitur there, maybe would fit in with a list of events that can precipitate it (e.g. Vulnerability factors—namely early maternal loss...)."
• The religious statement has now been changed to "Depression may also be connected to feelings of religious alienation..." The first part of the religious statement is referenced by a primary source: http://www3.interscience.wiley.com/journal/75503053/abstract. The religious alienation statement reflects the source inaccurately. The source uses the words "religious strain". Feelings of "alienation" as such do not necessarily reflect alienation from God, but can be non religious in nature, e.g. existential, Social alienation, etc.

• The source states, "Depression was associated with feelings of alienation from God." While I certainly agree that alienation needn't be religious in nature, I'm not sure how "religious alienation" is an inaccurate reflection of the source. Even so, I'm completely open to suggestions as to how it could be better phrased. As for the use of the primary material at all, see User_talk:Casliber#Religion_ref_in_MDD_article. Cosmic Latte (talk) 18:46, 3 November 2008 (UTC)

• You still have not addressed the location of the religious statement per my objection, as well as that of User:Tony1 and User:Delldot (or whomever). Nor the use of a primary source there when review articles are available. Is your use of a primary source justified here per WP:MEDRS? Your link to User talk:Casliber#Religion_ref_in_MDD_article is just Casliber's opinion, nothing more. —Mattisse (Talk) 19:25, 3 November 2008 (UTC)

• Among other things, WP:MEDRS states that a citation of a primary source "should follow closely to the interpretation of the data given by the authors." Because I'm citing the abstract--i.e., the authors' summary/interpretation of their own work--I don't see any problems there. It also says, "Individual primary sources should not be cited or juxtaposed so as to 'debunk' or contradict the conclusions of reliable secondary sources." As it's worded now, a primary source and a secondary source are complementing one another--i.e., depression up, religious alienation up (primary); depression down, religious involvement up (secondary): no debunking or contradicting there. WP:MEDRS is saying to be careful with primary sources, and I haven't seen any demonstration of a lack of care. As for the location, I thought your objection was based on the use of a 36-year-old source and therefore a potential WP:WEIGHT concern. That source has not been cited ever since you removed it from the article. Cosmic Latte (talk) 20:07, 3 November 2008 (UTC)

Sorry. It is confusing. But to be clear, I have also objected per the objections of User:Tony1 (" A depressive episode may also be triggered by a loss of religious faith." I think this is oddly prominent in the rather short lead para to the section "Psychological",) and User:Delldot's statement (I think it is his - hard to tell with all the interruptions and diversions) objecting to the inclusion of the religious statement in the first paragraph of "Psychological causes". To quote User:Delldot (or whomever) " A depressive episode may also be triggered by a loss of religious faith. - non-sequitur there, maybe would fit in with a list of events that can precipitate it (e.g. Vulnerability factors—namely early maternal loss...)."

Also, I do not think "religious alienation" statement can be generalized to the entire population by citing one study using "a nonclinical sample of 200 college students and a clinical sample of 54 persons seeking outpatient psychotherapy". That is the problem with using primary sources. If you had a review article saying the same thing, then your primary source could be used as an example to amplify the point. —Mattisse (Talk) 21:20, 3 November 2008 (UTC)

Point taken, although subtle aspects of the wording already seem to assign greater weight to the secondary source: "Depression may also be connected to feelings of religious alienation ; conversely, depression is less likely to occur among those with high levels of religious involvement " (emphasis added). Those subtleties are accidental, but they nonetheless seem to imply that we should accept the primary source somewhat more tentatively (and this is the point that seems to underlie WP:MEDRS). I think the major issue regarding generalizability, though, is one you brought up earlier: It's unclear how well the entire article applies to non-Western cultures. The discussion in Major_depressive_disorder#Sociocultural_aspects leads me to think that much of it might not apply very well (although the presence of that discussion is reason enough for me, at least, not to oppose FA status on account of the Western slant). Cosmic Latte (talk) 21:36, 3 November 2008 (UTC)

• Further, objections raised above by all parties are almost impossible to follow because of the constant interruption by other editors, either responsive or off topic, so it is impossible to determine who said what. Objections about content are replied to with objections about italics or references and such so there is no continuity. Therefore, it is very hard to identify what objections have or have not been addressed, especially with the constant rewording of the article by many editors. The article appears to be influx.
• I echo Snowman's comment above for the reasons he gives: "I think that the "support" given much earlier by the editors of this article in this review above can be disregarded." —Mattisse (Talk) 17:46, 3 November 2008 (UTC)

Regarding the Beck questionnaire: In the following reference (Meta-analysis of the factor structures of four depression questionnaires: Beck, CES-D, Hamilton, and Zung. PMID: 16287149): The Beck Depression Inventory or BDI (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) is probably the best known and most widely used depression scale. Reviews of the Beck Depression Inventory are available elsewhere (Beck, Steer, & Garbin, 1988; Richter, Werner, Heerlein, Kraus, & Sauer, 1998). Is it enough? I'll try to access also those reviews.-Garrondo (talk) 18:30, 3 November 2008 (UTC)

This one is the definitive one, althought a bit old: Over the years the BDI has become one of the most widely used instruments not only for assessing the intensity of depression in psychiatrically diagnosed patients (Piotrowski, Sherry,& Keller, 1985), but also for detecting depression in normal populations (Steer,Beck, & Garrison, 1986). (PSYCHOMETRIC PROPERTIES OF THE BECK DEPRESSION INVENTORY:TWENTY-FIVE YEARS OF EVALUATION; Clinical Psychology review;8; 77-100; 1988). I'll add it to the article tomorrow if nobody objects.--Garrondo (talk) 19:00, 3 November 2008 (UTC)

That is 20 years ago, a long way from today's practices which have changed radically since then. How about a more recent review? —Mattisse (Talk) 19:25, 3 November 2008 (UTC)

• Comment Snowmanradio and Mattisse have made some comments that the article has radically changed (especially the lead), the article is in flux and that early supportive reviews should be disregarded. A few observations:

• The article has changed from when I reviewed it to now. See this diff. Looking at that diff, you'd think the lead had been totally rewritten along with a number of other paragraphs.
• However, analysing the 400 or so sentences of body text show that only 25% have been altered at all. Most of those changes appear to be copyedits though some do affect meaning and a small amount of new material has been added (but not much). You can see a sentence-level diff here (I've moved some sentences around to match the original, but otherwise the text is unchanged). Even the lead looks to have had just a copyedit.
• In my experience (not as extensive as some here) the lead is always a fertile ground for review comments. Everyone has their own idea about what to emphasise in those few paragraphs. Writing a good lead is hard but worth expending much effort on because that's all many readers will consume. It is also the playground of the uninformed -- well-meaning copyedits and additions that end up distancing the text from its sources.
• Similary, the Causes section is the most difficult in this article, and has also seen a higher number of edits.
• An awful lot of FAC discussion concerns the religious sentence and the Beck questionnaire. Improvements to both of these are probably better handled on the article talk page than FAC IMO.
• Not all reviewers are subject experts or have access to the sources used, but they may be experienced in other areas that are also important for FAC.
• I don't feel the article has changed substantially enough for me to revise my earlier opinion (made after spending several hours reading the text closely).
• I respect the expert opinions being made by all parties. I really hope that any tension can be dissipated and you guys can improve this important topic.

Colin° 23:16, 3 November 2008 (UTC)

The comments were directed at only the editors of the article who were very early supporter of the article, and not to yourself actually. These people has declared an interest in the article with their support opinion. No one, has suggested that your "support" should be disregarded. Being a medical article, I think that errors in it are a fatal flaw. I think that some copy edits can change the emphasis significantly, and the initial problem may only be apparent to people who know a bit about the subject matter. I think an assessment of the overall change will need to include an examination of each individual correction to make an informed opinion of the recent changes that perhaps you were not anticipating. I would have thought that most of this changes are concentrated in the sections that have been under the microscope, and I expect that more errors will be repaired. How important is the factual content of a medical article? Are you saying that it is fine for a FA to have an problem in 1 in 4 sentences? Snowman (talk) 00:21, 4 November 2008 (UTC)

Please see WP:WIAFA: "1(e) stable: it is not subject to ongoing edit wars and its content does not change significantly from day to day, except in response to the featured article process." SandyGeorgia (Talk) 01:02, 4 November 2008 (UTC)

1. Leckman JF, Zhang H, Vitale A, et al. "Course of tic severity in Tourette syndrome: the first two decades" (PDF). Pediatrics. 1998;102 (1 Pt 1):14–19. PMID 9651407. Retrieved on October 28, 2006.
2. Cite error: The named reference Swain was invoked but never defined (see the help page).