LIMITATIONS
manic, psychiatric, bipolar disorder
PATHOPHYSIOLOGY
The existence of clinical heterogeneity of bipolar disorder has led to the formation of various studies in the genetic, epigenetic, molecular, and cellular fields related to its pathophysiology and the provision of various diagnostic, preventive, and therapeutic suggestions related to it, which have also brought variable results (Wartchow et al., On the other hand, the average age of the participants in both spironolactone and placebo groups was between 30 and 35 years old. However, the baseline scores of MMSE were 21.6 for the spironolactone group and 20.8 for the placebo group which was too low considering their age. This point may be considered partly related to the effect of distraction and flight of ideas on manic symptoms and maybe only a temporary low score. We observed that as YMRS scores improved during weeks 4 and 8, MMSE scores also improved. The YMRS scores of the spironolactone group were 16.8 and those of the placebo group were 18.3 in week 8, and the slightly higher scores of the placebo group might be related to the lower improvement in MMSE scores. In this way, despite the statistical significance of the results obtained in the improvement of cognitive symptoms in the eighth week of this trial, it is possible to achieve a more accurate evaluation of these results by continuing to compare the results in subsequent studies after further improvement in YMRS scores in the two groups.In this study, we used the standard therapeutic dose of sodium valproate (200 mg, 3 times a day at an interval of 8 h), the therapeutic usefulness of which we have experienced in our clinical experiences in this center. The use of sodium valproate plasma levels to control the treatment status of patients could be associated with benefits that were not possible in this study due to financial limitations.Due to the severity of the mood and cognitive symptoms of the patients at the beginning of the evaluation of the participants in the study, there were limitations in data collection, which were managed by establishing proper communication with the patients and the cooperation of their caregivers and psychiatric nurses.