Biological Rhythms in People from North Macedonia with Bipolar Disorder: Application of the Macedonian Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN)

Goce Kalcev1, *, Ivan Barbov2, Pavlina Ilieska Kotevska3, Antonio Preti4, Mauro G. Carta5
1 International Ph.D. in Innovation Sciences and Technologies, University of Cagliari, Cagliari, Italy
2 University Clinic of Neurology, Skopje, North Macedonia
3 Public Health Institution, Psychiatric Hospital Demir Hisar, North Macedonia
4Department of Neuroscience, University of Turin, Italy5Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy

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© 2022 Kalcev et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the International Ph.D. in Innovation Sciences and Technologies, University of Cagliari, Cagliari, Italy; E-mail:



The Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN) is a tool aimed at clinically evaluating disturbances in biological rhythm. In this study, we examined the reliability and validity of the Macedonian version of the BRIAN.


A total of 100 participants, including 50 subjects with bipolar disorder (BD) and 50 control healthy subjects, were recruited. Construct validity was tested by comparing the mean BRIAN scores of the BD patients and control subjects.


No difference by gender or age was noticed, but patients differed from controls in education and occupation. Reliability, as measured with Cronbach’s alpha, was good in BD individuals, except for the Rhythms subscale. Reliability in controls was less good, especially for the Sleep and Rhythms subscales. The tool was able to discriminate patients with controls, with large differences on all subscales. However, since the reliability was suboptimal for some of these subscales, these differences cannot be entirely trusted.


The study suggests that the Macedonian version of this instrument has good psychometric characteristics and also encourages the chance of developing mixed screening tools by incorporating elements of biological rhythm dysregulation into the routine evaluation of mood.

Keywords: Bipolar disorder, BRIAN, Macedonian BRIAN, Disturbances, Biological rhythms, Mood.