Low serum total cholesterol has been reported to be assotiated with risk of suicidal, violent and impulsive behaviours. To date there are no laboratory tests for diagnosing bipolar disorder (BD). Case vignette to illustrate the clinical observation of changes of serum total cholesterol (STChol) and mood disturbaces of patient with bipolar disorder (BD) at admission and in remission was used.

A 23- years old, healthy and drug-free female met the ICD-10 criteria for bipolar disorder. She was assesed during two mixed episodes to explore change in serum cholesterol (Chol) levels at admission (A) of first (1e) episode and after remission (R), one month later. The readmission due to second consecutive mixed episode (2e) was 19 months later. MADRS scale for depression and YMRS scale for mania were applied, and body mass index (BMI) was assessed.

Chol-1eA 2,50 mmol/l (normal range 3,63-6,20 mmol/l), Chol-1eR 3,90 mmol/l; Chol- 2eA 3,05 mmol/l. BMI-1e 20,5 BMI-2e 21,0. YMRS-1eA score 27, YMRS-1eR score 4, MADRS-1eA score 23, MADRS-1eR score 3, YMRS-2eA score 23, MADRS-2eA score 21. The patient did not change her diet during the course of illness.

In this case low STChol was assotiated with the oncet of mixed episodes of BD and normalised after remmision of episode. Low STChol could be a state marker or risk factor for mixed episode of BD. Further investigations are need to explore the possible relationship between STChol and course of different episodes of BD.