الفهرس 
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Abstract
Introduction
Depressive episodes of major depressive disorder and bipolar disorder seems to be similar and they considered as mood disorders. Although they are different in diagnostic criteria and treatment plan, it’s hard to distinguish between them. Bipolar Disorder is one of the top 20 leading causes of disability worldwide. (Ferrari et al., 2016)
Bipolar disorder is presented by depressive episodes firstly, so it may be diagnosed as major depressive disorder because they are similar in depressive symptoms. The delay between the onset of bipolar disorder and its diagnosis is often very long, with an interval of almost 6 years. The lifetime prevalence of major depressive disorder is approximately 4 times that of BD spectrum disorders, and the clinical presentation of a bipolar depression episode does not differ significantly from unipolar depression. (Samalin et al., 2016)
Thus the treatment may be ineffective for the bipolar patient and as we use antidepressant drugs, we may evoke a manic episode. (Frey et al., 2013) Common clinical features of major depressive disorder are late age of onset, long duration of episodes, initial insomnia, appetite loss/weight loss, and somatic complaints.
Clinicians expect that this depressive patient will experience manic episode and converts to bipolar one with early onset of the disease, short duration and recurrent episodes. Also, bipolar disorder is presented by worthlessness, low self‐esteem, social withdrawal, hypersomnia, hyperphagia, and weight gain, lability of mood, psychotic features, and positive family history for bipolar disorder. (Mitchell et al., 2008)(Ratheesh et al., 2017)
So consideration of clinical characteristics associated with bipolar depression (family history of BD, earlier onset of illness, seasonality, mood reactivity, switching on antidepressants, history of suicide attempt) needed to be implemented in routine clinical practice. (Samalin et al., 2016) Failure to identify major depression from bipolar disorder leads to improper treatment and poor outcomes for both patients. (Frey et al., 2013)
Manic symptoms include extreme irritability, racing thoughts, short attention span, decreased need for sleep, increased energy, and impaired judgment. When a patient experiences manic symptoms alternating with their depressive episodes, they are usually diagnosed bipolar I, while those experiencing less severe, hypomanic episodes usually are diagnosed bipolar II. Bipolar patients tended to exhibit significantly higher prevalence of atypical depression and mixed state than those who have unipolar depression. Additional factors regarding a patient’s current psychiatric state that were found to be significant predictors of bipolarity included: psychomotor agitation, irritability, mood reactivity, and the total number of depressive symptoms exhibited. (Okasha et al., 2013)
Until now, no laboratory or imaging marker has been clearly identified to help for a diagnosis of bipolar depression or predicts the conversion from major depression to bipolar disorder. (dos Santos Oliveira et al., 2019) According to previous studies, impulsivity is related to several psychiatric disorders such as bipolar disorder, attention deficit hyperactivity disorder, personality disorders, and substance abuse and dependence and its treatment should be enrolled in the treatment plan for these disorders. Impulsivity is commonly related to bipolar disorder episodes, prodroma of episodes, and suicidality, but in-between episodes it’s not clear. Maintenance of elevated impulsivity may increase the risk to initiate manic episode. Attentional impulsivity in healthy cases with a family history of bipolar disorder suggests the possibility to have bipolar disorder in the future. (Moeller et al., 2001a)(Henna et al., 2013)
Impulsivity defined as quick action or behavior without forethought or conscious judgment to internal or external stimuli without regard to the negative consequences to the individual or to others. (Henna et al., 2013) According to Patton et al, they separated impulsivity into three components: motor impulsiveness, attention impulsiveness, and non-planning impulsiveness. (Patton JH, 1995) Previous studies reported that manic and euthymic bipolar patients have similar levels of trait impulsivity, also depressed and euthymic bipolar patients also exhibit similar levels of this trait. (Peluso et al., 2007)
Methodology
• Cross sectional, observational, comparative study
• At Okasha Institute of psychiatry, Ain Shams University, Cairo, Egypt on 2020
• Two groups of subjects have been recruited for our study and they are: patients aged 18y-55y (Euthymic unipolar and bipolar patients) and healthy controls.
• Study tools
For the patient group:
1. Structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders-IV diagnoses (DSM IV) using SCID I Arabic version
2. Hamilton Rating Scale for Depression (HAM-D), Arabic version, 21 items
3. Young mania rating scale (YMRS), 11 items
4. Barratt Impulsiveness Scale Arabic version (BIS-11)
For the control group:
1. The Egyptian version of General Health Questionnaire-28 (GHQ-28).
2. Barratt Impulsiveness Scale Arabic version (BIS-11)
The main findings in this study were:
• There were no significant differences between groups regarding their sociodemographic data.
• Regarding unipolar depression
There were no significant differences between sociodemographic characteristics and impulsivity.
The most affected group with non-planning impulsivity was unipolar depression group
• Regarding bipolar depression
There was significant difference between male and female regarding impulsivity score which was higher in males more than females with Mean ± SD (76.94±4.17).
Otherwise, there were no significant differences between occupation, education and marital status and impulsivity.
Regarding motor impulsivity, the most affected group was bipolar depression group
• Analysis of Barratt impulsiveness scale in our study revealed that the unipolar and bipolar groups scored almost the same on total impulsivity measures
• Regarding attentions impulsivity, unipolar and bipolar depression groups were similarly affected.