Background: Despite the effectiveness of pharmacotherapy in acute phase of bipolar mood disorder, patients often experience relapses or recurrent episodes. Hospitalization of patients need a great deal of financial and humanistic resources which can be saved through understanding more about the rate of relapse and factors affecting this rate.Methods: In a descriptive analytical study, 380 patients with bipolar disorder who were hospitalized in psychiatric emergency ward of Noor hospital, Isfahan, Iran, were followed. Each patient was considered for; the frequency of relapse and recurrence, kind of pharmacotherapy, presence of psychotherapeutic treatments, frequency of visits by psychiatrist and the rank of present episode.Results: The overall prevalence of recurrence was 42.2%. Recurrence was lower in patients using lithium carbonate or sodium valproate or combined therapy (about 40%), compared to those using carbamazepine (80%). Recurrence was higher in patients treated with only pharmacotherapy (44.5%) compared to-those treated with both pharmacotherapy and psychotherapy (22.2%). Patients who were visited monthy by psychiatrist had lower rate of recurrence compared to those who had irregular visits.Conclusion: The higher rate of recurrence observed in carbamazepine therapy may be due to its adverse reactions and consequently poor compliance to this drug. Lower rates of recurrence with psychotherapy and regular visits may be related to the preventive effects of these procedures and especially to the effective management of stress.

Objectives: In the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), children with severe nonepisodic irritability are diagnosed as disruptive mood dysregulation disorder (DMDD) and this diagnosis is included in the mood disorder section. The current study aimed to know whether the DMDD is a subgroup of bipolar disorder (BD) or an independent disorder. Method: For gathering valid English and Persian data, Medline, PsycINFO, Scopus, and DSM databases for English and SID for Persian resources were searched and reviewed until Summer of 2013.Results: Up until now research comparing severe and permanent (nonepisodic) irritabilities (equivalent to DMDD) with BD indicate that BD and DMDD are similar in severity and functional impairment, and different in gender distribution, familial clustering, course and prognosis, comorbidities and neuropsychophysiologic functions. In following years, children with DMDD are more likely to suffer from unipolar depressive and anxiety disorders, but BD has not been seen among them.Conclusion: The DMDD seems not to be a subgroup of BD and rather it should be included as an independent diagnosis in the mood disorder section. The DSM editors need to be flexible enough to make necessary revisions encountering further new findings.

Fahr’s disease is a progressive and idiopathic basal ganglia calcification with normal metabolism of calcium and phosphor with motor and psychiatric signs and symptoms. Dementia, chorea athetosis, psychosis and depression due to Fahr’s disease are frequently reported, but Fahr’s disease with bipolar mood disorder manifestation is very rare and we found only 3 case in review of literature from 1955 to 2005. In this case report , a 21-year old girl is presented who was admitted to Sari-Zare psychiatric hospital for aggression, restlessness and insomnia. After mental status examination and Para clinical investigation, bipolar disorder due to Fahr’s disease was detected. To date no specific treatment was found for this disease. This point is important that the patients with Fahr,s disease are sensitive to neuroleptic malignant syndrome.

Fahr’s disease is a progressive and idiopathic basal ganglia calcification with normal metabolism of calcium and phosphore with motor and psychiatric sings and symptoms. Dementi, chorea attetosise, psychosis and depression due to Fahr’s disease are frequently reported, but Fahr’s disease with bipolar mood disorder manifestation is very rare and we found only 3 cases in review of literature from 1995 to 2005. In this case report, a 21-years old girl is presented who was admitted to Sari-Zare psychiatric hospital for aggression, restlessness and insomnia. After mental status examination and paraclinical investigation, bipolar mood disorder due to Fahr’s disease was detected. To date no specific treatment was found for this disease. This point is important that the patients with Fahr’s disease are sensitive to neuroleptic malignant syndrome.    

Objective: The Mood disorder questionnaire (MDQ) has been designed as a screening self-report inventory for diagnosing bipolar mood disorders. This study investigated the validity and the optimal cut-off threshold of the Persian version of MDQ in a group of Iranian depressive patients.Methods: One hundred and twenty patients with probable diagnosis of mood disorders attending psychiatric clinics were recruited to this cross-sectional study. The structured clinical interview for DSM-IV (SCID) was employed as the gold standard of diagnosis to discriminate between unipolar and bipolar depressions. Translated version of MDQ in Persian was completed by the patients and the final scores were summed up by a physician. The sensitivity and specificity of MDQ were calculated and compared with the diagnosis made by SCID. The ROC curve was used to determine the optimal cut-off point for diagnostic accuracy.Results: Ninety patients with bipolar depression and 30 patients with unipolar depressive disorder completed the MDQ. Internal reliability of MDQ was good with a Cronbach's alpha coefficient of 0.773. Regarding the original scoring criteria (symptoms and supplementary questions), the sensitivity and specificity of MDQ for bipolar disorder were 70% and 100% respectively. In current study, the optimal cut-off score without applying the supplementary questions was calculated to be 6 or more, with a sensitivity of 80% and a specificity of 93.3%.Conclusion: MDQ appears to be a useful screening tool for bipolar depression in Iranian psychiatric practice. Conflict of Interest: This paper is not related to financial profits of the authors and was supported by Tabriz University of Medical Sciences.

Background: Considering the difficulties in diagnosing bipolar disorder in clinical practice and lack of needed screening instruments in Persian language, the present study aimed at assessing sensitivity, specificity, and predictive values for the Persian Bipolar Spectrum Diagnostic Scale.Methods: The study was conducted in a university-affiliated hospital in Tehran, Iran, in a sample of 181 consecutive outpatients aged 18 – 65 years. The used instruments were the Structured Clinical Interview for DSM-IV axis I disorders, the Persian Bipolar Spectrum Diagnostic Scale, the Persian Mood Disorder Questionnaire, and the Scale to Assess Unawareness of Mental Disorder.Results: Most patients were males (58%) and had bipolar I disorder (57%). Other bipolar disorders and major depressive disorder were diagnosed as 5.5% and 21%, respectively. Testretest of the Persian Bipolar Spectrum Diagnostic Scale and Mood Disorder Questionnaire demonstrated a good reliability for both. The sensitivity, specificity, and positive and negative predictive values of the Persian Bipolar Spectrum Diagnostic Scale at the score of 14, were 0.52, 0.79, 0.81, and 0.49, respectively. The sensitivity and specificity of the parallel application of the Persian Bipolar Spectrum Diagnostic Scale and Mood Disorder Questionnaire were 0.76 and 0.67, respectively.Conclusion: The Persian Bipolar Spectrum Diagnostic Scale and Mood Disorder Questionnaire are useful in screening patients with bipolar disorder in clinical psychiatric settings. Parallel use of both tests seems more effective than either alone.

Background: Bipolar disorder and borderline personality disorder have some similar symptoms that might confuse the diagnosis. Many experts defend the borderline pathology within the spectrum of bipolar illness. Objectives: This study aimed to compare patients with borderline personality disorder and bipolar disorder from a novel perspective, i. e., personality traits defined by the five-factor model of personality. Methods: This descriptive-analytical study was conducted in Psychiatry Clinics of Tabriz University of Medical Sciences. Consecutive patients diagnosed with borderline personality disorder and bipolar I disorder by a semi-structured clinical interview were enrolled excluding those with comorbidity. The NEO inventory was used to score on five major domains of personality. Results: A total of 60 patients (40 males) completed the study with a mean age of 28. 3 8. 1 years (range: 19-59). Regardless of the diagnosis, patients scored the highest on openness to experience and the least on conscientiousness. There was no significant difference between patients with bipolar mood disorder and patients with borderline personality disorder in terms of five personality dimensions. Males, in general, scored higher than females on conscientious, but male patients with bipolar disorder scored higher on agreeableness and extroversion. Conclusions: This study showed a comparable personality profile between patients with bipolar disorder and borderline personality disorder.

Bipolar disorder is a chronic psychological condition that disturbs many patients’,lives around the world. The exact pathophysiology of bipolar disorder is yet unknown, but there are several hypotheses to explain this condition. One of the most challenging theories is the role of oxidative stress in the progression of bipolar disorder. Here, we conducted a narrative review to gather the studies that investigated the relationship between bipolar disorder and oxidative stress. We searched PubMed, Scopus, Web of science, and google scholar databases using the following keywords: “, bipolar disorder, ”,“, oxidative stress, ”,“, oxidative markers, ”,and “, bipolar patients. ”,A majority of studies showed that oxidative markers such as Thiobarbituric acid reactive substances are significantly higher in bipolar patients compared to healthy subjects. Based on the included articles, bipolar disorder is associated with oxidative stress. Nevertheless, further well-established Cohorts are required to support these results.

Multiple sclerosis is a chronic disease from which mostly the young adults may suffer. Pathologically, it might be distinguished by the inflammation, demyelination and sclerosis in several regions of white matter in central nervous system. In present report, I have introduced a patient who suffered from a period of Acute Mania with Psychosis after a experience of psychological stress .In the diagnostic examinations, it was known that she suffered from Multiple Sclerosis. Although a very small part of hospital admission is related to this disease, and the occurrence of Acute Mania Syndrome with Psychosis as the initial presentation of disease might be a rare phenomenon , the higher prevalence of bipolar disorder in this disease increases the probability of the fact that such few patients might also have been seen with the bipolar syndrome presentation in the psychiatric hospitals and notices the necessity of recognition and attention to this disease in the differential diagnosis ,especially when there are inexplicable neurological signs.