الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Bipolar disorder (BD) is one of the most common psychiatric illnesses. Classically, periods of prolonged and profound depression alternate with periods of excessively elevated and/or irritable mood, known as mania. Between these highs and lows, patients usually experience periods of full remission. Psychopharmacological and psychsocial treatment exist, but delayed diagnosis and misdiagnosis are common. Treatment rates are low especially in those with middle - and low - income setting. Current evidence suggests a debilitating outcome of co-occurring of BD and substance abuse. People with BD are more vulnerable to substance use disorders (SUDs: abuse or dependence of drugs and/or alcohol). At least 50% of adults with BD go through uncontrolled impulsivity and SUDs in some point in their lives. Furthermore, it has been reported by that people diagnosed with BD are more susceptible to greater use of cocaine, amphetamines, opiates, cannabinoids and hallucinogens in comparison with other psychiatric disorders such as schizophrenia. When SUDs occur in BD there is increased illness severity across a broad spectrum of parameters, including delayed recovery, hastened relapse, increased number and inter-episode persistence of symptoms, increased functional disability, and mortality. Patients with a dual diagnosis of BD and substance dependence experience lower quality of life compared to patients having either diagnosis or healthy controls. Comorbid SUD worsens bipolar patients social functioning to the level reported in schizophrenia.