All the patients who are admitted to the beds supervised by the authors (SN, AS, and SVS) and some other attends of psychiatry in the hospital are assessed concerning the inclusion and exclusion criteria. Therefore, the sampling will be sequential.

The inclusion criteria are: being aged 18 years or higher, being able to speak Persian, living in Tehran, Karaj or suburbs, being diagnosed as BD type I by a board certified psychiatrist based on the Diagnostic and Statistical Manual of Mental Disorders, 4^th edition, Text Revision (DSM-IV-TR)¹⁰ and taking the same diagnosis with the Structured Clinical Interview for DSM-IV axis I disorders (SCID-I) performed by a trained resident of psychiatry, having at least one telephone line as well as one cell phone to facilitate the contact and giving informed written consent. The exclusion criterion is being mentally retarded or having any other permanent cognitive decline.

At first, the residents of psychiatry were trained to perform the SCID-I and other measurements. After the training, they did the SCID-I on several patients and finally the interrater reliability was calculated.

The eligibility of the patients to enter the study is assessed by the residents of psychiatry based on a fixed schedule. A coordinator introduces every eligible patient to the residents according to their turn. Every resident carries out all measurements on her/his probands and follows them up. The residents invite the probands to continue their treatment with coming to the outpatient clinic of the hospital in a regular basis and refer to the follower physician. The treatment is not based on any fixed program or a common algorithm; instead, it is performed routinely and according to the everyday practice of the physicians. However, if the patients do not agree to be referred to the same resident for continuing the treatment, the patient is referred to another physician for treatment but the follow up measurements are performed according to the predetermined schedule by the referring resident. The research coordinator arranges the follow up sessions for the patients. Whenever the patients’ attendance at the outpatient clinic of the hospital would not be possible on the scheduled date, a home visit is planned. If the patient or her/his family does not allow for a home visit, a telephone follow up will be the final way.

The sampling started in May 2008 and is still going on. The probands are evaluated at the beginning of the study and 2 and 6 months later and every 6 months thereafter. The following instruments are utilized for the evaluations in the visits.

1. Demographic and Clinical Variables Questionnaire: Demographic characteristics and certain clinical features like the information regarding previous hospitalizations and major mood episodes, history of treatments, and adherence to medications, were included in this questionnaire.
2. The Structured Clinical Interview for DSM-IV axis I disorders (SCID-I)^{11, 12, 13}: The SCID-I is a semistructured interview to diagnose the axis I disorders of DSM-IV.¹¹ The Persian clinical version of the SCID-I has been standardized for the Iranian popula-tion.¹³
3. Hamilton Depressive Rating Scale-7 (HDRS-7)¹⁴: HDRS is widely used in psychiatric research with favorable reliability and validity¹⁵ even in telephone interview.¹⁶ McIntyre et al¹⁴ reported that the 7-item HDRS had as much effectiveness as the 17-item one. The total score of HDRS-7 ranges from 0 to 26.
4. Young-Mania Rating Scale (Y-MRS)¹⁷: The Y-MRS is a clinician (or trained rater) administered scale to measure the severity of manic symptoms and includes 11 items with the total score that ranges from 0 to 60. A psychometric evaluation of its Persian version demonstrated a favorable reliability and validity of the scale.¹⁸
5. Scale for the Assessment of Positive Symptoms (SAPS)^{19, 20}: The SAPS is a clinician (or trained rater) administered scale to measure the severity of psychotic symptoms and includes 35 items in 5 sections. Favorable psychometric values for SAPS administered on an Iranian population were reported.²¹
6. Clinical Global Impression (CGI)²²: It rates the patient’s function quickly by clinician and simply shows a general picture of the current state.²² It includes three items: severity of illness, global improvement and efficacy index.
7. Global Assessment of Functioning (GAF) scale¹⁰: The GAF scale is to measure the psychosocial function of patients with psychiatric disorders. It is used during a clinical interview and its score ranges from 0 to 100.¹⁰ The intra-class correlation coefficient of 0.58 was reported on a sample of bipolar patients in Iran.²
8. The World Health Organization Quality of Life (WHOQOL)-BREF²³: This is a self-report questionnaire with 26 items including four domains that are used to assess the patients’ quality of life. Each item is scored from 0 to 5. Its Persian version has been provided on behalf of the World Health Organization.²³ A favorable reliability for the Persian version has been reported on an Iranian clinical sample.³
9. Drug Attitude Inventory-10 (DAI-10) (Shortened Version)²⁴: It is a self-report inventory to rate the attitude of patients toward the prescribed medications and the effects of this attitude on adherence to the medications.²⁴ It has already used on Iranian bipolar patients.²⁵
10. Family Interview for Genetic Studies (FIGS)²⁶: The FIGS is an interview to determine psychiatric disorders in the family. The interview includes general screening questions and a few checklists to consider each diagnosis specifically.²⁶ The present study just utilizes the General Screening questions, the Depression Checklist and the Mania Checklist.

The inter-rater reliability of the HDRS-7, YMRS and SAPS were evaluated in this study. There were five residents of psychiatry who performed the interviews with the patients. To calculate the inter-rater reliability, 35 individuals with BD type I were interviewed. All of the five residents attended these interview sessions, where one resident interviewed with the patient and everyone rated the probands independently.

The rate of reliability for the HDRS-7, YMRS, and SAPS scores are shown in the tables 1, 2 and 3.