“…Indeed, these patients have a high risk for substance abuse, legal problems and suicide attempts. [50][51][52][53] The main factors associated with poor BD prognosis are the following: earlier age of onset, duration of symptoms, rapid cycling, mixed episodes, psychotic symptoms, comorbidities such as ADHD and anxiety disorders, low socioeconomic status, negative life events, presence of psychiatric disorders in the family, absence of psychotherapy, low adherence to pharmacological treatment, use of antidepressants and alcohol. [45][46][47][48][54][55][56] …”