الفهرس 
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Abstract
Summary
The aim of this work is to further investigate the association of serum CRP levels with the severity of the depressive symptoms in MDD and BD (depressive type), a significant increase in the severity of depressive symptoms depending on higher CRP levels and non-diagnostic value between MDD and BD disorder regarding CRP level.
I. Theoretical Part
Chapter 1:
Chapter mainly dealt with the neurobiology of mood disorders. Neurobiological correlates included the following; genetic factors in terms of hereitability of mood disorders and the results of different linkage and association studies, epigenetics with special inference to the implication of the Brain derived neurotrphic factor (BDNF) in mood disorder, neuroimaging findings using structural and functional MRI and PET scan studies.
Neurobiological changes were further explored with regards to the involvement of the dopaminergic, serotonergic, GABAergic, glutamtergic . Finally, the pathogenesis of mood disorders through the metabolic syndrome and its bidirectional relationship was explored.
Chapter 2:
Immune System and Inflammation in Psychiatric Disorders, which discussed mainly the effects of the immune system and inflammation on the brain have been implicated in a number of psychiatric diseases ranging from mood and anxiety disorders to schizophrenia as well as neurodegenerative diseases. Involved , immunological mechanisms
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affects the brain and behavior , inflammation effects on neurotransmitter metabolism and inflammation effects on neurocircuitry.
Chapter 3:
Final chapter mainly dealt with the C Reactive Protein and its role in mood disorders involving , CRP stracture and function, proinflammatory molecules of CRP ,location and regulation of CRP production and immune markers as clinical outcome and diagnostic predictors.
II. Practical Part
Subjects: The study was done with a total of 90 subjects, consisting of 2 case. groups (BD & MDD) and a control group
group 1
Thirty patients diagnosed with Bipolar Disorder I I with a current depressive episode were chosen from the outpatient clinic of Beni-Suef University Hospital fulfilling the criteria for inclusion in the study. Diagnoses were made according to DSM -5 criteria
group 2
Thirty patients diagnosed with MDD with a current depressive episode were chosen from the outpatient clinic of Beni-Suef University Hospital fulfilling the criteria for inclusion in the study. Diagnoses were made according to DSM -5 criteria.
group 3
A convenient sample of 30 healthy volunteers from nurses and
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hospital employee of Beni-Suef University Hospital .Subjects had no familial relations to each other or to patients to avoid genetic influence on the sample. This group was matched for age, sex and socio-economic status; with no history of substance use, psychiatric disorders or chronic systemic disorders.
Methodology
All 3 groups were subjected to the following assessment procedures:
1.Full psychiatric examination based on Beni-Suef psychiatric interview with special emphasis on mood disorders, according to DSM-5
2.Psychometric assessment was done by: Structured Clinical Interview for DSM-5 (SCID): to apply the diagnostic criteria for MDD and bipolar disorder (depressive type).
3.Beck Depression Inventory (BDI) (Beck, Ward et al. 1961)
Beck Depression Inventory scale was originally developed to measure the severity of depressive symptoms among patients with depressive illness .
3. Blood samples to measure serum CRP levels, using ELISA
Results of the study
On viewing the socio-demographic data of the sample. It can be noted that there was no statistically significant differences between the two groups concerning all of the socio-demographic data including age, sex, marital status, education and occupation indicating that groups were well-matched.
As regards clinical data Positive family history of psychiatric diseases was significantly more prevalent among studied patients with bipolar
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disorders as compared with MDD (11 vs. 3 patients) in bipolar and MDD groups respectively (with a statistically significant (p-value= 0.015).
As regards duration of current episode was significantly longer among studied patients with MDD as compared with bipolar group, patients with duration more than 4 weeks was more among MDD group (23 vs. 15 patients) in MDD and bipolar groups respectively (with a statistically significant p-value= 0.030).
As regards comparison study Beck Depression inventory scale showed a statistically significant difference between control and bipolar groups (8.00 ±2.3 vs. 32.97 ±2.4 in both groups respectively), (p-value <0.001), a statistically significant difference between control and MDD groups (8.00 ±2.3 vs. 31.93 ±2.3 in both groups respectively), (p-value <0.001), however; non-statistically significant difference was detected between bipolar and MDD groups (32.97 ±2.4 vs. 31.93 ±2.3 in both groups respectively), (p-value= 0.090).
CRP level among studied participants showed a statistically significant difference between control and bipolar groups (56.04 ±26.71 vs. 134.96 ±16.45 in both groups respectively), (p-value <0.001), a statistically significant difference between control and MDD groups (56.04 ±26.71 vs. 133.86 ±17.59 in both groups respectively), (p-value <0.001), however; non-statistically significant difference was detected between bipolar and MDD groups (134.96 ±16.45 vs. 133.86 ±17.59 in both groups respectively), (p-value= 0.838).
The median (IQR) CRP level was 120.4/(48.7-135.6) among all males individuals, while The median (IQR) CRP level was 137.7/(84.4-148.9) among all females individuals with statistically significant difference between males and females with p-value= 0.006
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As regard correlative study demonstrate that the elevated plasma levels of CRP have significant positive linear correlation with depression severity as assessed by Beck Depression Inventory (BDI) in all studied population totally (r= 0.887, p-value <0.001). In each group separately, there was a significant positive linear correlation between CRP and depression severity in bipolar group (r= 0.834, p-value <0.001),
The results of ROC curve analysis of Sensitivity and specificity of C-Reactive Protein (CRP) serum level in diagnosis of MDD from BD showed non-statistically significant p-value >0.05, with an area under the curve (AUC) of 0.480 (95% confidence interval: 0.331–0.629)
Linear regression analysis showing the association between increase in CRP level with depression score demonstrate, simple linear regression analysis revealed the CRP level was the mean predictor of the score of Beck Depression Inventory (BDI) scale (R square=0.788 and P=<0.001).