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Oxidative stress is one of the primary etiological mechanisms of bipolar disorder (BD). The present study was conducted over a period of 24 months on Tunisian on 34 drug‑free male patients with BD (mean age: 34.5 years) and 101 age and gender matched controls (mean age: 34.20 years) were enrolled in the study. Plasma reduced glutathione (GSH) and total thiols levels were significantly decreased in patients compared to controls (respectively  p  &lt;   .001;  p  =   .009). In addition, malondialdehyde (MDA), advanced oxidation protein products (AOPP), protein carbonyls (PC) and homocysteine (Hcys) concentrations and glutathione peroxidase (GSH-Px) activity were significantly increased in patients compared to controls ( p  =   .002;  p  &lt; .001;  p  = .001;  p  &lt; .001 and  p  = .016, respectively). The binary logistic regression analysis revealed that MDA, AOPP and Hcys could be considered as independent risk factors for BD. When using CombiROC analysis, a remarkable increase in the area under the curve (AUC) with higher sensitivity (Se) and specificity (Sp) for MDA, AOPP, PC, GSH-Px and Hcys combined markers was observed. Overall, the identification of the predictive value of these five selected biomarkers related to oxidative stress in drug free patients should lead to a better identification of the etiological mechanism of BD.

Predictive value of oxidative stress biomarkers in drug-free patients with bipolar disorder