Bipolar Affective Disorder is one of the ten most disabling diseases.UK Guidelines recommend that specialist opinion is saught for difficult to treat patients and our aim was to characterize the Bipolar Patients referred to a Specialist Tertiary Centre.

A consecutive sample of thirty patients referred, who met ICD 10 criteria for Bipolar Disorder, were studied. Information was collected from the patient files. Recorded variables included socio-demographic, clinical and treatment characteristics.

20% were male, 80% female. The mean age was 46.2 years old (SD 13.5).The modal age of first episode of mental illness was 18.5 years. High rates of unemployment (76.7%) and family history of mental illness (93.3%) were found. 30% were Bipolar I, 63.3% Bipolar II, and 6.7% Bipolar III. 56.7% met criteria for Rapid Cycling. 83.3% had anxiety features, 73.3% a risk of self- harm and 53.3% psychotic symptoms. Low rates of substance misuse were found.73,3% had a concurrent medical illness. The mean number of psychotrophic medications was 3.23(SD 1.54) and ECT was tried in 23.3% of the patients.

This sample had higher rate of rapid cycling than found in routine bipolar populations. The majority of patients were at a high risk of self-harm, showed features of anxiety, had a positive family history and concurrent medical illnesses which worsened their prognosis and turned them into a “very difficult to treat” group. The characteristics of the sample satisfy the referral policy of the Centre and the current and draft UK Guidelines.