1. Introduction
Bipolar disorder is a kind of chronic illness with recurrent mood episodes that can lead to severe impairments in the one’s social and occupational performance [1]. In the present study, using the cases studied by Alaei et al. [5] and the symptoms remembered by patients in the euthymic phase after discharge from hospital, it is aimed to identify the most common symptoms remained in the memory of patients as far as possible in order to help psychiatrists to diagnose a previous episode of this illness and, therefore, provide better and faster patient care. Therefore, a comprehensive knowledge of bipolar disorder pattern over time, extracting the past maniac episodes from the patients’ records for the preparation of life charts, selection of appropriate treatment (pharmacological/non-pharmacological), determining prognosis, planning for follow-up and maintaining treatment are important [3]. The purpose of this study is to investigate the most common symptoms that remembered by patients with bipolar disorder after the maniac phase, by examining the extent of remembering the different symptoms of mania (psychotic symptoms including hallucination and delusion)
2. Method
The study samples includes 59 patients with type I bipolar disorder who were admitted to Hazrat-e-Rasool-e-Akhram Hospital and Iran Psychiatry Hospital in 2012. Their inclusion criteria were participation in the study conducted by Alaei et al. [5]. Structured Clinical Interview for DSM-IV axis I Disorders (SCID-I) and Young Mania Rating Scale (YMRS) were completed for these patients, and their mania symptoms were recorded. Demographic information of these patients was also extracted from their medical records. In the first step, 60±2 months after discharge from hospital, the patients were invited by telephone. After excluding 37 cases (38.5%), 59 samples (61.5%) were interviewed by face-to-face method. After receiving written informed consent from them, the symptoms remembered by them were extracted and recorded using the SCID-I. The researchers also completed the Hamilton Depression Rating Scale (HRSD), YMRS, and Mini–Mental State Examination (MMSE) for the patients.
3. Results
The most common symptom of mania in patients that is remembered 60±2 months after discharge was “decreased need for sleep”. Also, there was a significant difference in the extent that they were able to remember the three symptoms of “decreased need for sleep”, “excessive involvement in pleasurable activity” and “psychotic symptoms” between 1 and 60±2 months after discharge. According to Table 1, the most common symptom of mania remembered 60±2 months after discharge by the patients was “decreased need for sleep”.



The higher positive predictive values were observed in irritability (100%), talkativeness (100%), and decreased need for sleep (96.29%) symptoms, while the higher negative predictive values were related to elevated mood (72.97%), excessive involvement in pleasurable activities (76%), and distractibility (73.80%) symptoms. Moreover, the higher sensitivity values were related to decreased need for sleep (91.22%), irritability (83.92%), and excessive involvement in pleasurable activities (81.25%), and the higher specificity values were related to irritability (100%), talkativeness (100%), and psychotic symptoms (96.42%).
4. Discussion
Most of the symptoms remembered 60 months after discharge by the patients were “decreased need for sleep” and “irritability”, which were also reported by Alaei et al. [5]as the most commonly observed symptoms in one month after discharge. The higher value of irritability can be due to ts unpleasant effects on the patient and the people around him/her, which needs to be treated in admission form [5]. The significant difference in remembering the mania symptoms of decreased need for sleep, excessive involvement in pleasurable activities, and psychotic symptoms can be attributed to increased disease knowledge, being in the euthymic phase, and the withdrawal of patients with cognitive problems as well as the difference in the type of interview and interviewer. It seems that as more time passes since the onset of bipolar disorder, and due to frequent referral and communication of patients with the treatment system as well as possible education on the illness, patients get more information about their illness and its symptoms, and thus increase their insight and recall of past mania symptoms [4]. The frequency of hospitalization [2] can be another reason which was not studied in this study.
The three mania symptoms of “irritability”, “decreased need for sleep”, and “talkativeness” had the highest positive predictive values; this finding is consistent with the findings of the study conducted by Alaei et al. “Elevated mood” had the highest negative predictive value in our study and in Alaei et al.’s study. These results can make the therapist more confident that the patient has a history of manic episode and thus help identify the past maniac episode. Dejection of the presence of elevated mood by the patient also can indicate the therapist that there is no need to seek further to find the symptom in the patient’s records.
5. Conclusion
It can be concluded that the mania symptoms of irritability, talkativeness, and decreased need for sleep are the most important symptoms with positive predictive values. The recall of mania symptoms is reliable even long after hospital discharge. In this regard, clinicians can be assured of their diagnosis of past maniac episodes and the course of bipolar disorder. In case of longitudinal research, therapists are recommended to keep in touch with their patients, and include outpatients in their study population.
Ethical Considerations
Compliance with ethical guidelines
This study was extracted from the thesis of Fatemeh Zarein approved by the Research Ethics Committee of Iran University of Medical Sciences (Code: IR.IUMS.FMD.REC.1396.9411286009). All ethical principles were considered in this study. All participants were informed of the study process, and then a written informed consent was obtained from them. They were free to leave the study at any time, and were assured of the confidentiality of their information.
Funding
This study received no fanatical support from any organization.