{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T17:36:48Z","timestamp":1782927408623,"version":"3.54.5"},"reference-count":69,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T00:00:00Z","timestamp":1739923200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Introduction: Bipolar disorder (BD) affects over 1% of the global population and significantly impacts psychosocial functioning and life expectancy. This manuscript has the objective of investigating gender differences in the clinical and biochemical parameters of patients affected by BD. Methods: This retrospective cross-sectional study examined 672 patients diagnosed with BD in psychiatric wards in Milan and Monza. Clinical data and biochemical parameters were collected on the first day of hospitalization. Independent sample t-tests, chi-square tests and binary logistic regressions were performed to identify gender differences in BD. Results: With regard to univariate analyses, women were found to be more susceptible to psychiatric comorbidities (\u03c72 = 12.75, p &lt; 0.01), medical comorbidities (\u03c72 = 45.38, p &lt; 0.01), obesity (\u03c72 = 6.75, p = 0.01) and hypercholesterolemia (\u03c72 = 23.54, p &lt; 0.01), as well as to having more mood episodes in the year prior to hospitalization (t = 5.69, p &lt; 0.01). Men were found to be more likely to develop psychotic symptoms (\u03c72 = 4.40, p = 0.04), to be tobacco smokers (\u03c72 = 15.13, p &lt; 0.01) and to have substance abuse disorders (\u03c72 = 14.66, p = &lt;0.01). Logistic regression analyses showed that women compared to men showed more psychiatric comorbidity (p &lt; 0.01), higher Global Assessment of Functioning (GAF) scores (p = 0.05) and higher total cholesterol plasma levels (p &lt; 0.01); however, they also had fewer red blood cells (p &lt; 0.01) and lower creatinine plasma levels (p &lt; 0.01). Conclusions: Female patients (compared to males) exhibited higher levels of global functioning despite the higher frequency of psychiatric comorbidity and susceptibility to metabolic complications; consistent with earlier studies, female patients also showed higher cholesterol levels. Further studies will have to confirm the present findings and identify gender-related clinical pathways for the management of BD.<\/jats:p>","DOI":"10.3390\/brainsci15020214","type":"journal-article","created":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T09:36:22Z","timestamp":1739957782000},"page":"214","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Gender Differences in Clinical and Biochemical Variables of Patients Affected by Bipolar Disorder"],"prefix":"10.3390","volume":"15","author":[{"given":"Luigi","family":"Piccirilli","sequence":"first","affiliation":[{"name":"Department of Neurosciences and Mental Health, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8350-499X","authenticated-orcid":false,"given":"Enrico","family":"Capuzzi","sequence":"additional","affiliation":[{"name":"Department of Mental Health, Fondazione IRCCS San Gerardo dei Tintori, via G.B. Pergolesi 33, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Legnani","sequence":"additional","affiliation":[{"name":"Department of Neurosciences and Mental Health, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Di Paolo","sequence":"additional","affiliation":[{"name":"Department of Neurosciences and Mental Health, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4131-0466","authenticated-orcid":false,"given":"Anna","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Neurosciences and Mental Health, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Ceresa","sequence":"additional","affiliation":[{"name":"Department of Neurosciences and Mental Health, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia Maria","family":"Esposito","sequence":"additional","affiliation":[{"name":"Department of Neurosciences and Mental Health, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luisa","family":"Cirella","sequence":"additional","affiliation":[{"name":"Healthcare Professionals Department, Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Surace","sequence":"additional","affiliation":[{"name":"Department of Mental Health, Fondazione IRCCS San Gerardo dei Tintori, via G.B. Pergolesi 33, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Tagliabue","sequence":"additional","affiliation":[{"name":"Department of Mental Health, Fondazione IRCCS San Gerardo dei Tintori, via G.B. Pergolesi 33, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Clerici","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3359-3191","authenticated-orcid":false,"given":"Massimiliano","family":"Buoli","sequence":"additional","affiliation":[{"name":"Department of Neurosciences and Mental Health, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"},{"name":"Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.1016\/S0140-6736(15)00241-X","article-title":"Bipolar disorder","volume":"387","author":"Grande","year":"2016","journal-title":"Lancet"},{"key":"ref_2","first-page":"363","article-title":"Bipolar disorder: Clinical overview","volume":"39","author":"Leweke","year":"2016","journal-title":"Med. Monatsschr. Pharm."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1841","DOI":"10.1016\/S0140-6736(20)31544-0","article-title":"Bipolar disorders","volume":"396","author":"McIntyre","year":"2020","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1111\/bdi.12419","article-title":"Is age of onset associated with severity, prognosis, and clinical features in bipolar disorder? A meta-analytic review","volume":"18","author":"Joslyn","year":"2016","journal-title":"Bipolar Disord."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1192\/bjp.2021.102","article-title":"Characterisation of age and polarity at onset in bipolar disorder","volume":"219","author":"Kalman","year":"2021","journal-title":"Br. J. Psychiatry"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1111\/eip.13051","article-title":"Which factors delay treatment in bipolar disorder? A nationwide study focussed on duration of untreated illness","volume":"15","author":"Buoli","year":"2021","journal-title":"Early Interv. Psychiatry"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s12991-023-00442-5","article-title":"Correlates of long duration of untreated illness (DUI) in patients with bipolar disorder: Results of an observational study","volume":"22","author":"Porceddu","year":"2023","journal-title":"Ann. Gen. Psychiatry"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.eurpsy.2019.09.001","article-title":"Correlates of current rapid-cycling bipolar disorder: Results from the Italian multicentric RENDiBi study","volume":"62","author":"Buoli","year":"2019","journal-title":"Eur. Psychiatry"},{"key":"ref_9","first-page":"86","article-title":"Current Status and Treatment of Rapid Cycling Bipolar Disorder","volume":"44","author":"Miola","year":"2024","journal-title":"J. Clin. Psychopharmacol."},{"key":"ref_10","first-page":"e20233267","article-title":"The association of blood biomarkers with cerebral white matter and myelin content in bipolar disorder: A systematic review","volume":"46","author":"Ali","year":"2024","journal-title":"Braz. J. Psychiatry"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1016\/j.jpsychires.2013.05.018","article-title":"Cytokines in bipolar disorder vs. healthy control subjects: A systematic review and meta-analysis","volume":"47","author":"Munkholm","year":"2013","journal-title":"J. Psychiatr. Res."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Dadouli, K., Janho, M.B., Hatziefthimiou, A., Voulgaridi, I., Piaha, K., Anagnostopoulos, L., Ntellas, P., Mouchtouri, V.A., Bonotis, K., and Christodoulou, N. (2022). Neutrophil-to-Lymphocyte, Monocyte-to-Lymphocyte, Platelet-to-Lymphocyte Ratio and Systemic Immune-Inflammatory Index in Different States of Bipolar Disorder. Brain Sci., 12.","DOI":"10.3390\/brainsci12081034"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Fusar-Poli, L., Natale, A., Amerio, A., Cimpoesu, P., Grimaldi Filioli, P., Aguglia, E., Amore, M., Serafini, G., and Aguglia, A. (2021). Neutrophil-to-Lymphocyte, Platelet-to-Lymphocyte and Monocyte-to-Lymphocyte Ratio in Bipolar Disorder. Brain Sci., 11.","DOI":"10.3390\/brainsci11010058"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s12991-023-00450-5","article-title":"Study on association of serum uric acid levels with bipolar disorder: Systematic review and meta-analysis in Chinese patients","volume":"22","author":"Chen","year":"2023","journal-title":"Ann. Gen. Psychiatry"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1017\/S0924270800032798","article-title":"Differences in cholesterol and metabolic syndrome between bipolar disorder men with and without suicide attempts","volume":"21","author":"Nad","year":"2009","journal-title":"Acta Neuropsychiatr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/j.psychres.2017.08.059","article-title":"Biological aspects and candidate biomarkers for rapid-cycling in bipolar disorder: A systematic review","volume":"258","author":"Buoli","year":"2017","journal-title":"Psychiatry Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"437","DOI":"10.3109\/09540261.2010.514601","article-title":"Is sex important? Gender differences in bipolar disorder","volume":"22","author":"Diflorio","year":"2010","journal-title":"Int. Rev. Psychiatry"},{"key":"ref_18","first-page":"91","article-title":"Women and bipolar disorder across the life span","volume":"59","author":"Sit","year":"2004","journal-title":"J. Am. Med. Womens Assoc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1017\/S1092852918001529","article-title":"Gender-related differences in patients with bipolar disorder: A nationwide study","volume":"24","author":"Buoli","year":"2019","journal-title":"CNS Spectr."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Fusar-Poli, L., Amerio, A., Cimpoesu, P., Grimaldi Filioli, P., Natale, A., Zappa, G., Aguglia, E., Amore, M., Serafini, G., and Aguglia, A. (2021). Gender Differences in Complete Blood Count and Inflammatory Ratios among Patients with Bipolar Disorder. Brain Sci., 11.","DOI":"10.3390\/brainsci11030363"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Capuzzi, E., Ossola, P., Caldiroli, A., Auxilia, A.M., and Buoli, M. (2022). Malondialdehyde as a candidate biomarker for bipolar disorder: A meta-analysis. Prog. Neuropsychopharmacol. Biol. Psychiatry, 113.","DOI":"10.1016\/j.pnpbp.2021.110469"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.jad.2017.12.038","article-title":"Gender differences in C-reactive protein and homocysteine modulation of cognitive performance and real-world functioning in bipolar disorder","volume":"229","author":"Arranz","year":"2018","journal-title":"J. Affect. Disord."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Wang, H., Wang, X., Wang, H., Shao, S., and Zhu, J. (2024). Chronic Corticosterone Administration-Induced Mood Disorders in Laboratory Rodents: Features, Mechanisms, and Research Perspectives. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms252011245"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/S2215-0366(18)30255-4","article-title":"Rheumatoid arthritis and depression: An inflammatory perspective","volume":"6","author":"Nerurkar","year":"2019","journal-title":"Lancet Psychiatry"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1177\/1078390319890400","article-title":"Is There an Association Between Oxytocin Levels in Plasma and Pregnant Women\u2019s Mental Health","volume":"27","author":"Serati","year":"2021","journal-title":"J. Am. Psychiatr. Nurses. Assoc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1192\/bjp.133.5.429","article-title":"A rating scale for mania: Reliability, validity and sensitivity","volume":"133","author":"Young","year":"1978","journal-title":"Br. J. Psychiatry"},{"key":"ref_27","first-page":"21","article-title":"Rating depressive patients","volume":"41","author":"Hamilton","year":"1980","journal-title":"J. Clin. Psychiatry"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1111\/j.1600-0447.1986.tb02723.x","article-title":"The Montgomery-Asberg Depression Scale: Reliability and validity","volume":"73","author":"Davidson","year":"1986","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"783","DOI":"10.2466\/pr0.1973.33.3.783","article-title":"Inter- and intra-rater reliability of the Brief Psychiatric Rating Scale","volume":"32","author":"Flemenbaum","year":"1973","journal-title":"Psychol. Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1002\/j.1552-4604.1977.tb04606.x","article-title":"A method for evaluating anxiolytic sedatives","volume":"17","author":"Wang","year":"1977","journal-title":"J. Clin. Pharmacol."},{"key":"ref_31","first-page":"41","article-title":"Measures in the day hospital. I. The global assessment of functioning scale","volume":"8","author":"Dufton","year":"1992","journal-title":"Int. J. Partial. Hosp."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/j.gtc.2016.07.012","article-title":"Obesity Epidemiology Worldwide","volume":"45","author":"Mincey","year":"2016","journal-title":"Gastroenterol. Clin. N. Am."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Esposito, C.M., Barkin, J.L., Ceresa, A., Nosari, G., Di Paolo, M., Legnani, F., Cirella, L., Surace, T., Tagliabue, I., and Capuzzi, E. (2023). Are There Any Differences in Clinical and Biochemical Variables between Bipolar Patients with or without Lifetime Psychotic Symptoms?. J. Clin. Med., 12.","DOI":"10.3390\/jcm12185902"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1016\/j.psychres.2017.02.067","article-title":"Substance abuse in patients with bipolar disorder: A systematic review and meta-analysis","volume":"253","author":"Messer","year":"2017","journal-title":"Psychiatry Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1034\/j.1399-5618.2001.30503.x","article-title":"Response to lithium maintenance treatment in bipolar disorders: Comparison of women and men","volume":"3","author":"Viguera","year":"2001","journal-title":"Bipolar Disord."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1016\/S0193-953X(03)00036-4","article-title":"Gender differences in bipolar disorder","volume":"26","author":"Arnold","year":"2003","journal-title":"Psychiatr. Clin. N. Am."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1016\/j.jad.2023.07.060","article-title":"Gender differences in suicide among patients with bipolar disorder: A systematic review and meta-analysis","volume":"339","author":"Hu","year":"2023","journal-title":"J. Affect. Disord."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Johnson, J.L., Ratner, P.A., Malchy, L.A., Okoli, C.T., Procyshyn, R.M., Bottorff, J.L., Groening, M., Schultz, A., and Osborne, M. (2010). Gender-specific profiles of tobacco use among non-institutionalized people with serious mental illness. BMC Psychiatry, 10.","DOI":"10.1186\/1471-244X-10-101"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1590\/1516-4446-2015-1789","article-title":"Psychiatric and clinical correlates of rapid cycling bipolar disorder: A cross-sectional study","volume":"38","author":"Gigante","year":"2016","journal-title":"Braz. J. Psychiatry"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/BF00344125","article-title":"The course of affective disorders. II. Typology of bipolar manic-depressive illness","volume":"226","author":"Angst","year":"1978","journal-title":"Arch. Psychiatr. Nervenkr."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/S0165-0327(98)00003-2","article-title":"Gender differences in patients with bipolar disorder influence outcome in the medical outcomes survey (SF-20) subscale scores","volume":"49","author":"Robb","year":"1998","journal-title":"J. Affect. Disord."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1007\/s11126-020-09838-y","article-title":"Gender Differences in Clinical Characteristics and Comorbidities in Bipolar Disorder: A Study from South India","volume":"92","author":"Pillai","year":"2021","journal-title":"Psychiatr. Q."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/j.jad.2018.05.077","article-title":"Help-seeking intention for depression in early adolescents: Associated factors and sex differences","volume":"238","author":"Ando","year":"2018","journal-title":"J. Affect. Disord."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.5498\/wjp.v12.i9.1204","article-title":"Psychotic symptoms in bipolar disorder and their impact on the illness: A systematic review","volume":"12","author":"Chakrabarti","year":"2022","journal-title":"World J. Psychiatry"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.psyneuen.2017.06.017","article-title":"Gender differences in susceptibility to schizophrenia: Potential implication of neurosteroids","volume":"84","author":"Huang","year":"2017","journal-title":"Psychoneuroendocrinology"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Patel, R.S., Virani, S., Saeed, H., Nimmagadda, S., Talukdar, J., and Youssef, N.A. (2018). Gender Differences and Comorbidities in U.S. Adults with Bipolar Disorder. Brain. Sci., 8.","DOI":"10.3390\/brainsci8090168"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1111\/bdi.12141","article-title":"Sex differences in rates of obesity in bipolar disorder: Postulated mechanisms","volume":"16","author":"Baskaran","year":"2014","journal-title":"Bipolar Disord."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.genhosppsych.2024.06.004","article-title":"Physical comorbidities of older age bipolar disorder (OABD) patients: A global replication analysis of prevalence and sex differences","volume":"90","author":"Teixeira","year":"2024","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"81","DOI":"10.3109\/08039488.2013.775341","article-title":"The role of estrogen in bipolar disorder, a review","volume":"68","author":"Meinhard","year":"2014","journal-title":"Nord. J. Psychiatry"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1111\/j.1399-5618.2005.00237.x","article-title":"Gender differences in bipolar disorder: Retrospective data from the first 500 STEP-BD participants","volume":"7","author":"Baldassano","year":"2005","journal-title":"Bipolar Disord."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Menculini, G., Steardo, L., Sciarma, T., D\u2019Angelo, M., Lanza, L., Cinesi, G., Cirimbilli, F., Moretti, P., Verdolini, N., and De Fazio, P. (2022). Sex Differences in Bipolar Disorders: Impact on Psychopathological Features and Treatment Response. Front. Psychiatry, 13.","DOI":"10.3389\/fpsyt.2022.926594"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Hwang, W.J., Lee, T.Y., Kim, N.S., and Kwon, J.S. (2020). The Role of Estrogen Receptors and Their Signaling across Psychiatric Disorders. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22010373"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1016\/j.jad.2021.09.066","article-title":"Sex differences in neurocognitive and psychosocial functioning in bipolar disorder","volume":"296","author":"Varo","year":"2022","journal-title":"J. Affect. Disord."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1111\/ijlh.12843","article-title":"Establishment of new complete blood count reference values for healthy Thai adults","volume":"40","author":"Wongkrajang","year":"2018","journal-title":"Int. J. Lab. Hematol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1177\/0004867416644508","article-title":"White blood cell count correlates with mood symptom severity and specific mood symptoms in bipolar disorder","volume":"51","author":"Sylvia","year":"2017","journal-title":"Aust. N. Z. J. Psychiatry"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1080\/08039488.2020.1807048","article-title":"A comparison of inflammatory markers in manic and euthymic states of bipolar disorder","volume":"75","author":"Usta","year":"2021","journal-title":"Nord. J. Psychiatry"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1373\/clinchem.2015.240531","article-title":"Complex biological profile of hematologic markers across pediatric, adult, and geriatric ages: Establishment of robust pediatric and adult reference intervals on the basis of the Canadian Health Measures Survey","volume":"61","author":"Adeli","year":"2015","journal-title":"Clin. Chem."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Mithaiwala, M.N., Phillips, N.S., Nguyen, D.H., Beehler, M.S., Ballard, H.S., Vincent, A.S., Lovallo, W.R., Kochunov, P., Hong, L.E., and O\u2019Connor, J.C. (2024). Increased white blood cell in young adults with family histories of alcohol and other substance use disorders. Addict. Biol., 29.","DOI":"10.1111\/adb.70000"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Ambayya, A., Su, A.T., Osman, N.H., Nik-Samsudin, N.R., Khalid, K., Chang, K.M., Sathar, J., Rajasuriar, J.S., and Yegappan, S. (2014). Haematological reference intervals in a multiethnic population. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0091968"},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Chen, Y., Ma, C.N., Luo, L., Yin, J., Gao, Z., Yu, Z., and Wan, Z. (2020). The cross-sectional association between mean corpuscular volume level and cognitive function in Chinese over 45 years old: Evidence from the China Health and Retirement Longitudinal Study. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0243227"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1016\/S0272-6386(98)70074-5","article-title":"Serum creatinine levels in the US population: Third National Health and Nutrition Examination Survey","volume":"32","author":"Jones","year":"1998","journal-title":"Am. J. Kidney Dis."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"e35575","DOI":"10.1097\/MD.0000000000035575","article-title":"Reference intervals of biochemical analytes in healthy adults from northern China: A population-based cross-sectional study","volume":"102","author":"Jia","year":"2023","journal-title":"Medicine"},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Wang, Y., and Charchar, F.J. (2021). Establishment of sex difference in circulating uric acid is associated with higher testosterone and lower sex hormone-binding globulin in adolescent boys. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-96959-4"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/s12576-013-0287-2","article-title":"Sex differences in serum CK activity but not in glomerular filtration rate after resistance exercise: Is there a sex dependent renal adaptative response","volume":"64","author":"Amorim","year":"2014","journal-title":"J. Physiol. Sci."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"114476","DOI":"10.1016\/j.psychres.2022.114476","article-title":"Gender differences in clinical and biochemical parameters of patients consecutively hospitalized for unipolar depression","volume":"310","author":"Ceresa","year":"2022","journal-title":"Psychiatry Res."},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Preuss, U.W., Schaefer, M., Born, C., and Grunze, H. (2021). Bipolar Disorder and Comorbid Use of Illicit Substances. Medicina, 57.","DOI":"10.3390\/medicina57111256"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/j.ibneur.2024.04.001","article-title":"Cognitive rehabilitation in bipolar spectrum disorder: A systematic review","volume":"16","author":"Razavi","year":"2024","journal-title":"IBRO Neurosci. Rep."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.jad.2013.08.024","article-title":"Is the combination of a mood stabilizer plus an antipsychotic more effective than mono-therapies in long-term treatment of bipolar disorder? A systematic review","volume":"152\u2013154","author":"Buoli","year":"2014","journal-title":"J. Affect. Disord."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1097\/PRA.0000000000000680","article-title":"Lithium Use for Suicide Prevention, Revisited","volume":"29","author":"Wortzel","year":"2023","journal-title":"J. Psychiatr. Pract."}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/15\/2\/214\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:38:06Z","timestamp":1760027886000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/15\/2\/214"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,19]]},"references-count":69,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["brainsci15020214"],"URL":"https:\/\/doi.org\/10.3390\/brainsci15020214","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,19]]}}}