الفهرس 
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Abstract
SUMMARY
The main aim of this study was to evaluate serum level of vitamin D in patients with bipolar disorder and to evaluate vitamin D and in relation to gender difference in patients with bipolar disorder.
1- TheoreticalPart
Chapter 1:
Neuropsychiatric disorders are multifactorial and are likely influenced by complex interactions between genetics, nutrition, and environment. There has been a considerable progress in the identification of gene variations associated with many neuropsychiatric disorders. What is less known is which nutritional deficiencies may interact with genetic pathways and how the gene–environment interactions may prepare the background suitable for neuropsychiatric disorders. In recent years, the possible effects of vitamin D and vitamin D deficiency have been intensely studied in mental health.
Chapter2:
Immunohistochemical studies showed widespread distribution of specific vitamin D receptors in brain. Then, the neuroprotective effects of vitamin D hit the mark in scientific world. Vitamin D was found to strongly induce the synthesis of neuron growth factors and glial cell line-derived neurotropic factors and protect the brain against reactive oxygen species via up regulation of antioxidant molecules, such as glutathione in no neuronal cells.In addition to above-mentioned neurobiological findings, many clinical studies have thoroughly consolidated the importance of serum vitamin D levels in mental health. Several observations have shown that low 25(OH)D serum concentrations are associated with an elevated risk of impaired executive cognitive functions, personality traits, autism spectrum disorders, multiple sclerosis, schizophrenia, seasonal affective disorder and major depression.
Recently, it is provided by evidence that vitamin D is a key regulator of brain serotonin synthesis through tryptophan hydroxylase 2, which contains a vitamin D response element consistent with activation. This finding strengthens the possible linkage between low levels of serum 25(OH) D and mood regulation problems, especially depressive symptoms. However, the fact that interactions between serum vitamin D levels and mood disorders including major depressive disorder, seasonal affective disorder and premenstrual dysphoric disorder
Chapter 3:
Several studies suggest an association between hypovitaminosis D and mood disorders including major depressive disorder, seasonal affective disorder and premenstrual dysphoric disorder. On the other hand, there is not enough study about acute manic episode and hypovitaminosis D. This data insufficient zone led us to study on whether vitamin D deficiency is associated with acute manic episode and has an impact on disease activity.
2- Practical Part
Subjects
Patients (Groups A & B)
group (A):
Fifty patients with Bipolar disorder (25 male and 25 female) from outpatient clinic Beni-Suef university hospital
group (B):
Fifty subjects as control group (25 male and 25 female) from health staff and colleagues matched with the patients group in age, sex, education and socio demographic statuses.
Methodology
Patients were subjected to the following.
• PsychiatricassessmentwasconductedusingtheSocio-demographicinterviewderived fromthe psychiatricsheetof KasrAlAiny
• Relevantdataincluded(socio-demographicdata,onsetoftheillness,familyhistoryof psychiatricillness andadherenceto treatment).
- Behavioral and developmental features that suggest Bipolar disorderaccording to DSM5
- Blood sample to measure serum VD ,ionized calcium, mg and phosphorus levels
• BipolarDisordergroupwassubjectedtotheclinicallyratedYoungManiaRating Scale (Younget al.,1978) And Hamilton DepressionRating Scale (Hamilton,1960).
Resultsofthe study
Regarding Sex, There wasn’t a significant difference between the two studied groups (p= 1).
Age in Bipolar disorder group ranged from 30 to 55 with mean ± SD = 42.10 ± 8.18 while in Control group the Age ranged from 32 – 56 with mean ± SD = 41.66 ± 7.28 with no statistical significant difference (P> .05) between the two groups.
VD in Bipolar disorder group ranged from 3 to 31.7with mean value of 14.93 ± 6.36while in control group ranged from 9.8 to 63.43with mean value 21.4 ± 9.65 with statistical significant lower level of VD in bipolar group (p= <.001).
Ionized calcium in Bipolar disorder group ranged from 1.1 to 1.3 with mean ± SD = 1.19 ± 0.05 while in Control group the Ionized calciumranged from 1.1 to 1.3 with mean ± SD = 1.19 ± 0.05 with no statistical significant difference (p= 0.706) between the two groups.
Phosphorus in Bipolar disorder group ranged from 0.8 to 1.6 with mean ± SD = 1.11 ± 0.17 while in Control group the Phosphorus ranged from 0.8 to 1.4 with mean ± SD = 1.14 ± 0.17 with no statistical significant difference (p= 0.342) between the two groups
Mg level in Bipolar disorder group ranged from 0.5 to 2.2 with mean ± SD = 1.37 ± 0.45 while in Control group the Mg levelranged from 1.5 to 3.3 with mean ± SD = 2.31 ± 0.41 with highly statistical significant difference (p= <.001) between the two groups
the duration of episode ranged between 3-15 weeks with mean value of 7.46 ± 2.39 weeks
Severity was assessed using Young Mania Rating Scale showed that 2% were minimal severity, 24% were mild, 58% were moderate and 16% were severe.
Hamilton depression scale demonstrated that 2% were mild severity, 20% were moderate severity, 24% were severe and 6% were very severe.
Finally according to Sensitivity, specificity of VD for prediction of bipolar disorder our study showed that at cutoff point ≤18.5 VD has sensitivity of 92% and specificity of 76% for predicting SBP
Based on our findings, we recommend for further studies on larger sample size and on large geographical scale to emphasize our conclusion.