International guidelines regarding the treatment of bipolar disorder differ noticeably from everyday practice, they stress the importance of the use of mood stabilizers as monotherapy. However, in practice polytherapy is widely used, including antipsychotic drugs, and for periods that far exceed the duration of acute episode.

Determine the frequency of long-term use of antipsychotic drugs in the treatment of bipolar disorder and identify situations that may justify this attitude.

Retrospective study of all first-admitted patients with bipolar disorder in two psychiatric wards of Razi Hospital between 2006 and 2008 and over a three-year follow-up.

Our sample consisted of 72 patients. Antipsychotic agents have been used in association with mood stabilizers for a period exceeding 6 months in over 80% of patients with an average duration of 26.56 months ± 12.21 months. Long-term antipsychotic use was significantly correlated with the following factors: male gender, bad family support, poor medication adherence, presence of mixed episodes, psychotic characteristics associated, high frequency of manic recurrences, absence of symptom-free interval, delayed diagnosis as well as a doubtful diagnosis with an acute psychotic disorder or schizophreniform disorder.

This study highlights the fact that international guidelines should be better applied in naturalistic conditions, and that clinicians have to be better informed about these recommendations.